Short answer: yes, several. This is an honest roundup. Freshpaint is a legitimate, well-built product, and for some organizations it's the right call. But it's tracking software priced for health systems, and if you're a private practice or a multi-location group, "compliant tracking" is only one of about six problems you're actually trying to solve.

Why practices look for a Freshpaint alternative

Three reasons come up over and over:

1. Price model. Freshpaint is enterprise SaaS, sold on annual contracts that typically run five figures. For a hospital replacing a vacated analytics stack, that's fine. For a three-location dermatology group, it's often more than the entire monthly ads budget.
2. It's software-only. Freshpaint gives you a compliant pipe. It does not build the landing pages, run the Google Ads, write the SEO content, answer the phones, or follow up with the leads. Someone on your team still has to do the marketing — and configure the tool correctly.
3. Scope. Practices don't just need analytics events de-identified. They need forms that don't leak PHI, booking that writes into the EHR, call tracking, retargeting, email — the whole patient-acquisition path, each piece HIPAA-safe.

If your problem is genuinely "we have a marketing team and 40 tools; we need a compliant event layer between them," Freshpaint is a strong answer. If your problem is "we need patients, and we can't afford a compliance mistake getting them," keep reading.

The alternatives, honestly compared

1. Freshpaint (the baseline)

Best for: hospitals and health systems with in-house marketing teams.

Quick recap for anyone new to it: Freshpaint intercepts the events your site would normally fire at analytics and ad platforms, de-identifies them, and passes along only what each destination is allowed to see — all under a signed BAA. It's healthcare-native and mature. The trade-offs are the ones this whole article is about: five-figure annual contracts, and a scope that ends at the data layer. (We go deep on the product itself in PilotPractice vs Freshpaint.)

2. Piwik PRO

Best for: organizations that want a GA4-style analytics suite with a BAA, and have an analyst to drive it.

Piwik PRO is a full analytics platform (analytics, tag manager, consent manager) that will sign a BAA on its paid healthcare-eligible plans and offers EU/US data-residency options. It's the closest thing to "Google Analytics, but a vendor who'll sign a BAA." What it doesn't solve: ad-platform conversion feedback. Analytics living in Piwik PRO doesn't get your conversions back into Google Ads or Meta for optimization — you still need a separate, careful pipeline for that. And the free tier is not the tier with the BAA; budget for the paid plan.

3. Matomo (self-hosted)

Best for: technically strong teams that want full data ownership at low software cost.

Self-hosted Matomo puts analytics data on your own server, which sidesteps the third-party-disclosure problem for analytics — there's no vendor to send PHI to, so no BAA is needed for the analytics layer itself. The honest catch: you are now the hosting provider. Server hardening, patching, backups, access controls, and audit logging all become your responsibility, and your hosting provider may need a BAA. It also does nothing for ads conversion tracking, and the interface trails GA4. Cheap software, expensive ownership.

4. Server-side Google Tag Manager (DIY)

Best for: practices with a genuinely capable developer and an appetite for maintenance.

A server-side GTM container on your own cloud project can filter and de-identify events before they reach GA4 or ad platforms. Done right, it's flexible and cheap in licensing terms. Done wrong — and it's easy to do wrong — it forwards IP addresses, client IDs, and URL parameters that identify patients, and you've rebuilt the exact problem the OCR bulletin described, just one hop away. Google won't sign a BAA for GTM or GA4, so the burden of proving nothing identifiable crosses the wire is entirely on your configuration, forever, through every tag change. We wrote up how that architecture works (and where it breaks) in our server-side GTM explainer.

5. PilotPractice (platform + agency)

Best for: private practices and multi-location groups that need the marketing done, not another tool to operate.

Disclosure: this is us, so weigh accordingly — but the category difference is the point. PilotPractice isn't a tracking tool you buy alongside an agency; it's the agency and the platform in one subscription. The compliant plumbing comes with it rather than being the product: one first-party script on the site (allowlisted UTMs and click IDs, no vendor pixels), intake that skips the website database entirely, booking wired into 30+ EHR/EMR systems, call tracking, and an encrypted CRM underneath — all under a single BAA, backed by SOC 2 and a live trust center (trust.pilotpractice.com). On the analytics side, we're building a server-side GA4 forwarder — PII scrubbing before anything reaches Google — as the next layer of that stack; today, attribution and conversion reporting live first-party and conversions flow to ad platforms as de-identified server-side uploads.

And critically: our team runs the ads, SEO, website, booking flow, and follow-up on top of that stack. You're not implementing anything.

Where we're not the right fit: a 500-bed health system with a 12-person marketing department and a martech stack to keep. That's Freshpaint's home turf, and we'd tell you so.

Comparison table

A note on the "just turn off tracking" option

There's a sixth alternative practices sometimes reach for: rip out GA4, the Meta pixel, and everything else, and run blind. It's compliant, and it's a mistake. Without conversion feedback, Google and Meta's bidding algorithms optimize on nothing; cost per booked patient climbs while you can't see which campaigns, keywords, or pages are producing. The vacated OCR tracking guidance didn't make measurement illegal — it made identifiable measurement risky. Every serious option on this page exists to keep the signal and drop the identity. Going dark solves the compliance problem by abandoning the marketing problem, which is the more expensive of the two.

The checklist: 8 questions before you pick

1. Do we have someone in-house who will own this tool weekly — or are we buying software that will sit misconfigured?
2. Will the vendor sign a BAA, and on which plan?
3. How do conversions get back to Google Ads and Meta without patient identifiers riding along?
4. What happens to form submissions — do they touch the website database or a third-party form vendor at all?
5. Is booking covered, and does it write to our EHR, or is that yet another vendor?
6. What's the all-in cost: license + implementation + the person who operates it + the agency that still does the marketing?
7. Can the vendor show audit evidence — SOC 2 report, subprocessor list, a trust center — or just a compliance page?
8. If a leak is found later, can data be retracted from downstream platforms?

Freshpaint answers several of these well. So do we. The tools in the middle answer one or two and leave the rest to you.

The real question: who's doing the marketing?

Every option above, except one, ends the same way: you now have compliant plumbing and zero new patients until someone runs campaigns through it. If you have that someone, pick the tool that fits your team and budget — Freshpaint for enterprise, Piwik PRO for BAA-backed analytics, Matomo or server-side GTM if you're technical and cost-sensitive.

If you don't have that someone, that's the gap PilotPractice exists to close: the compliant stack and the people who run your ads, SEO, site, booking, and follow-up on it. See the full head-to-head in PilotPractice vs Freshpaint, or start with our HIPAA-compliant marketing guide for the whole picture.

Not sure what your current site is leaking? Run our free PHI leak scanner — no email gate — or book a demo and we'll walk your stack with you.