Healthcare Services Growth

Every patient visit represents an opportunity to deliver value and generate revenue. According to MGMA productivity benchmarks, there's wide variation in how much production different practices—and different providers within the same practice—generate per visit.

One provider sees a patient, addresses their chief complaint, and generates $200 in production. Another provider sees a similar patient, provides comprehensive care, properly documents and codes services, and generates $450. The second provider isn't over-treating or gaming the system. They're delivering more complete care and getting appropriately compensated for it.

Production per visit is one of the most important metrics in practice management because it directly impacts your ability to serve patients well while maintaining financial sustainability. The goal isn't maximizing revenue at all costs—it's ensuring you're delivering comprehensive care, coding accurately for services provided, and capturing appropriate value for the expertise and time you invest.

Understanding Production Drivers

Several factors influence how much revenue each patient visit generates.

Service complexity has the biggest impact. A simple follow-up generates less than a comprehensive new patient exam, which generates less than a complex procedure. But within each service type, there's still variation based on how thoroughly you deliver care.

Coding accuracy ensures you're paid appropriately for work performed. Under-coding—selecting lower-level codes than documentation supports—leaves money on the table. Over-coding risks compliance issues. Accurate coding matches your documentation to the correct billing codes.

Ancillary services integrate additional appropriate services into visits. Diagnostics, procedures, product recommendations, or preventive services that benefit patients also increase production when medically necessary and properly delivered.

Product sales in relevant specialties (optometry, dermatology, aesthetic medicine) add non-service revenue to visits when patients benefit from recommended products.

The key is that all these drivers should stem from delivering better, more comprehensive care—not from finding ways to bill more for the same care.

Comprehensive Care Delivery

The foundation of higher production per visit is more thorough care.

Complete examination means looking beyond the chief complaint. When a patient comes in for one issue, excellent providers assess their overall health status related to that visit's scope.

In primary care, this might mean:

Reviewing preventive care status
Screening for age-appropriate conditions
Assessing chronic disease management
Updating medication reviews

In dental practice:

Complete oral examination, not just problem teeth
Periodontal assessment
Oral cancer screening
Bite and jaw evaluation

In specialty practices:

Comprehensive evaluation within specialty scope
Related systems assessment
Risk factor identification
Preventive recommendations

Addressing all conditions found during examination is both good medicine and good business. If you identify three issues during an exam but only treat the one the patient mentioned, you're providing incomplete care.

Don't ignore findings just because the patient didn't complain about them. Document what you find, explain its significance, and recommend appropriate treatment. Let the patient decide whether to proceed, but make sure they're informed.

Preventive services prevent future problems while adding appropriate production today. Age-appropriate screenings, vaccinations, preventive treatments, and risk reduction interventions serve patients well while generating legitimate revenue.

Many patients skip preventive care until problems develop. Offering and encouraging prevention during regular visits improves outcomes and captures revenue that would otherwise be lost.

Follow-up care planning ensures continuity. When you identify issues requiring future attention, schedule appropriate follow-up before the patient leaves. This ensures they get needed care while protecting future production.

The connection to your healthcare practice metrics is direct—production per visit is a key performance indicator that reflects both clinical thoroughness and operational efficiency.

Coding Optimization

Proper coding captures the value of comprehensive care without crossing into inappropriate up-coding.

Documentation requirements are the foundation. You can only code for services you've documented adequately. Your notes must support the codes you bill.

For evaluation and management (E&M) codes following CMS E&M documentation guidelines:

History complexity
Examination extent
Medical decision-making complexity
Time spent (for time-based coding)

For procedures:

What was done
Why it was medically necessary
How it was performed
Results or outcomes

Code selection accuracy requires knowing the criteria for each code level. Many providers default to mid-level codes out of habit or uncertainty, even when documentation supports higher levels.

Under the current E&M guidelines:

Level 2: Straightforward medical decision-making
Level 3: Low complexity
Level 4: Moderate complexity
Level 5: High complexity

If your documentation shows moderate complexity but you code level 3, you're under-coding. If documentation shows low complexity but you code level 4, you're over-coding.

Modifier usage ensures accurate payment when circumstances vary from typical:

Modifier 25: Significant, separately identifiable E&M on same day as procedure
Modifier 59: Distinct procedural service
Modifier 76/77: Repeat procedures

Misusing modifiers leads to claim denials. Not using appropriate modifiers leaves money on the table.

Avoiding under-coding is common and costly. Providers under-code for several reasons:

Lack of confidence in coding knowledge
Fear of audits
Not documenting thoroughly enough to support higher codes
Habit and autopilot behavior

If you consistently code at lower levels than your documentation supports, you're giving away significant revenue. A practice seeing 30 patients per day that under-codes by an average of just $20 per visit loses $150,000+ annually.

Get coding education specific to your specialty. Have experienced coders review your documentation and coding patterns. Invest in ensuring accuracy in both directions—not too high, not too low.

Ancillary Service Integration

Appropriate ancillary services add value for patients and production for your practice.

In-office procedures handle issues immediately rather than referring out. If you have the training, equipment, and time to perform procedures in-house, patients benefit from convenience and you capture the production.

Consider what procedures you currently refer out that you could bring in-house:

Minor surgical procedures
Diagnostic services
Injection therapies
Screening tests

Calculate the volume, required investment, and potential ROI before adding capabilities. But if you're referring significant revenue to others for services you could deliver, you're limiting production unnecessarily.

Diagnostic services identify issues and guide treatment. When clinically appropriate, in-office diagnostics provide immediate information while generating additional production.

Examples include:

Point-of-care lab testing
Diagnostic imaging
Screening assessments
Specialized testing

The key is medical necessity. Ordering tests that don't change clinical decision-making wastes money and time while creating compliance risk.

Product recommendations in appropriate specialties serve patient needs. When specific products genuinely benefit patients, recommending and dispensing them is good care.

This applies particularly in:

Optometry (glasses, contacts, eye care products)
Dermatology (medical-grade skincare)
Aesthetic medicine (skincare, supplements)
Physical therapy (supports, devices)

Don't push products patients don't need. Do educate about products that will genuinely help and make them available for purchase.

Referral alternatives keep care in-house when appropriate. Before referring patients to other providers, consider whether you can address their needs yourself with additional training or capabilities.

Some referrals are necessary and appropriate. Others happen by habit when you could serve the patient directly with proper preparation. Consider integrating same-day treatment strategies to address identified needs immediately when clinically appropriate.

Your approach to service mix optimization should identify high-value services you could add to increase appropriate in-house care.

Ethical Considerations

Higher production per visit must be grounded in ethics and compliance.

Medical necessity is the absolute requirement. Every service you provide and bill for must be medically necessary for that patient's condition. Convenience, revenue goals, or practice financial needs never justify unnecessary care.

Ask yourself: "If this were my family member, would I recommend this service?" If the honest answer is no, don't provide it.

Patient benefit focus keeps priorities straight. The purpose of comprehensive care is better patient outcomes, not higher production. Production is a result of excellent care, not a goal in itself.

When explaining recommended services, emphasize patient benefits:

"This test will help us rule out X condition"
"Treating this now prevents Y from developing"
"This preventive service significantly reduces your risk of Z"

If you can't articulate clear patient benefit, reconsider whether the service is truly necessary.

Avoiding over-treatment requires discipline and self-awareness. The incentive to do more is real when your income depends on production. But over-treatment harms patients, wastes resources, and creates ethical and legal risk.

Warning signs of over-treatment:

Providing services significantly more frequently than evidence suggests
Recommending aggressive treatment for marginal findings
Pressure on staff to increase service utilization
Patient confusion about why so many services are needed

Compliance requirements must be strictly followed:

Accurate coding that matches documentation
Medical necessity for all billed services
Proper documentation standards
Adherence to payer policies
Anti-kickback and Stark law compliance

Production optimization that crosses compliance lines isn't optimization—it's fraud. The short-term revenue gain isn't worth the risk of audits, recoupment, penalties, or worse. Your billing transparency practices should ensure patients clearly understand what services they're receiving and why.

Measurement and Benchmarking

Track production per visit to understand your current state and measure improvement.

Production tracking provides the baseline:

Average production per patient visit overall
Production by visit type (new patient, follow-up, procedure)
Production by provider
Production by payer type
Trends over time

Calculate this monthly and track trends. Declining production per visit may indicate:

Shift toward simpler cases
Under-coding issues
Less comprehensive care delivery
Insurance reimbursement changes

Increasing production per visit suggests:

More complex cases
More thorough care
Better coding accuracy
Addition of ancillary services

Provider comparison within multi-provider practices reveals variation. If one provider averages $350 per visit while another averages $220 for similar patient types, understanding why helps everyone improve.

Differences might reflect:

Coding variations
Care comprehensiveness
Efficiency with ancillary services
Patient mix differences

Use comparison to identify best practices, not to criticize. Share what high performers do well so others can learn.

Improvement goals should be realistic and ethical:

10-20% improvement often achievable through better coding and comprehensiveness
20-30% possible when adding appropriate ancillary services
Beyond 30% requires significant service mix or patient mix changes

Set goals that push toward excellence without creating pressure to over-treat.

Connections to provider productivity become clear—higher production per visit improves productivity even when patient volume stays constant.

Specialty-Specific Strategies

Different specialties have different opportunities for production optimization.

Primary care can increase production through:

Comprehensive preventive care integration
Chronic disease management documentation
Appropriate wellness visits
In-office procedures and diagnostics
Accurate coding for complexity

Dental practices benefit from:

Complete mouth examination and treatment planning
Periodontal assessments and treatment
Preventive services beyond basic cleaning
Same-day treatment when appropriate
Proper documentation supporting higher codes

The dental hygiene recall system creates opportunities for comprehensive care and treatment planning during hygiene visits.

Specialty practices focus on:

Depth of specialty examination
Appropriate specialty procedures
Related diagnostic services
Preventive services within specialty scope
Comprehensive documentation of complexity

Aesthetic practices can optimize through:

Comprehensive aesthetic assessment
Multiple treatment area identification
Product integration
Maintenance program development
Package and combination treatments

For aesthetic practices, aesthetic service upsells done ethically can significantly increase production per visit.

Staff Training and Culture

Your team significantly influences production per visit.

Clinical staff need training on:

Identifying opportunities for comprehensive care
Proper documentation techniques
Assisting with ancillary services
Patient education about recommended services
Workflow efficiency

Administrative staff require knowledge of:

Coding accuracy and compliance
Charge capture processes
Insurance verification for services
Financial policy communication
Scheduling optimization

Effective front desk excellence directly impacts production capture through accurate charge entry and proper service documentation.

Provider development includes:

Coding education and updates
Clinical skill development for new services
Documentation improvement
Time management for comprehensive visits
Communication training for service recommendations

Create a culture where comprehensive care is the standard, not the exception. When thorough care is "just how we do things," higher production follows naturally.

Common Mistakes to Avoid

Don't sacrifice quality for speed. Rushing through visits to see more patients often reduces production per visit while harming care quality.

Don't under-document out of habit. Comprehensive documentation supports accurate coding and protects you in audits.

Don't let patients leave with unaddressed issues. If you identified three problems but only treated one, you provided incomplete care.

Don't ignore coding education. Staying current with coding changes and best practices directly impacts revenue. Consider this a critical component of your team structure delegation strategy to ensure someone owns coding accuracy.

Don't cross ethical lines for production. Over-treatment and fraudulent billing destroy practices and careers.

Building Sustainable Production

Higher production per visit isn't about seeing every patient as a revenue opportunity. It's about delivering comprehensive, high-quality care and being appropriately compensated for it.

Practices that optimize production per visit while maintaining ethical standards typically achieve:

15-25% revenue improvement without seeing more patients
Better patient outcomes through more thorough care
Higher patient satisfaction with comprehensive service
Improved practice sustainability and provider compensation
Lower compliance risk through better documentation

The work requires attention to clinical excellence, coding accuracy, service integration, and ethical practice. But the returns—financial and clinical—make it essential for practices that want to serve patients well while building sustainable businesses.

Stop leaving revenue on the table through under-coding, incomplete care, or missed opportunities for appropriate service delivery. Focus on comprehensive care, accurate documentation, and proper coding, and your production per visit will reflect the true value you provide.

Tara Minh

Operation Enthusiast