Revenue per Patient Visit

[Dermato Fight Club]

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I just calculated my revenue per patient over the past three years. I figured I'd put this info into a thread for other people to get a sense of numbers when they are negotiating contracts. Obviously, things change from region to region and with what insurances you take etc. But I feel like this is probably a good start.

If anyone else wants to put their number here, please go ahead.

I calculated that over the past 3 years I've averaged $143 per visit. I was the lowest in my group from $143-$181. Median $153. Mean $157.

I just wanted those people getting out to have another data point to understand how many patients they need to see in order to make x income.

For instance, if you want to make a salary of 250k, and are being paid 30% of collections, you need to be seeing 22-23 patients a day 5 days a week for 48 weeks.

Keep in mind though, we do not separate DME. So this is with DME being added to the collections. We also do not take medicaid.

 

[pod squad]

Does this include cash pay services/ancillaries as well? Or just insurance payments?

 

[Dermato Fight Club]

Does this include cash pay services/ancillaries as well? Or just insurance payments?

It includes cash pay for self pay patients and uncovered nail care which is likely why mine is low. I don't do a lot of it but I'm the only one that does non covered nail care.

It doesn't include like if we sell a pair of powersteps. We don't really sell anything else.

 

[air bud]

I just calculated my revenue per patient over the past three years. I figured I'd put this info into a thread for other people to get a sense of numbers when they are negotiating contracts. Obviously, things change from region to region and with what insurances you take etc. But I feel like this is probably a good start.

If anyone else wants to put their number here, please go ahead.

I calculated that over the past 3 years I've averaged $143 per visit. I was the lowest in my group from $143-$181. Median $153. Mean $157.

I just wanted those people getting out to have another data point to understand how many patients they need to see in order to make x income.

For instance, if you want to make a salary of 250k, and are being paid 30% of collections, you need to be seeing 22-23 patients a day 5 days a week for 48 weeks.

Keep in mind though, we do not separate DME. So this is with DME being added to the collections. We also do not take medicaid.

Is the office manager the owners wife?

 

[AttackNME]

The problem with joining a podiatry group is that the new guy is taking patients away from everyone else. It’s hard to be so busy and so niche that the group can fill new associates without suffering. That’s why multi specialty groups or ortho makes sense for pods to join, they already need to refer out, easier to fill the new guy’s clinic. No shade, it’s just business.

 

[Feli]

I was at $161/visit startup year, $176/visit last year.
Those include no OTC... does include $0 post op globals dragging avg down and orthotic pickups I seldom charge for.

I also don't have XR in office (hospital lease).
I do full scope pod mix elective/sports/DM/derm/RFC/trauma. I do zero of the scam wound "grafts."
I take all area payers (NMex is over a third MCA overall, not even joking... but not that high in my area/county).

Is the office manager the owners wife?

Nah. His wife makes a lot more than any office mgr - and more than most podiatrists (podiatry key to success #1: high income partner).

Ditto for my partner... she's the office IT fix chica maybe every month or two, but if I asked her to work with me daily and take 80% pay cut...

 

[AttackNME]

podiatry key to success #1: high income partner

you should write a letter to podiatry schools and suggest a course titled Rizz 101 and offer to teach it for free since you got a sugar momma anyway

 

[Feli]

you should write a letter to podiatry schools and suggest a course titled Rizz 101 and offer to teach it for free since you got a sugar momma anyway

Shoot... it would be much better than advanced research, geriatrics, public health, underfilled student clinics, VA "clerkship," and a lot of the non$en$e that pod schools make students pay big money for.

 

[air bud]

How about RVUs per patient encounter?

Anyone got that? 2.25? 2.5?

 

[Hybrocure]

How about RVUs per patient encounter?

Anyone got that? 2.25? 2.5?

What’s an RVU

 

[heybrother]

What’s an RVU

1. The hospital gets $1000.
2. The doctor gets $100.
3. The American people go bankrupt.

 

[Feli]

How about RVUs per patient encounter?

Anyone got that? 2.25? 2.5?

va/ihs = 1
univ hosp pod = 1.5
private hospital pod = 2
Retro = 9
actually collected = who cares, dpm got paid

 

[air bud]

va/ihs = 1
univ hosp pod = 1.5
private hospital pod = 2
Retro = 9
actually collected = who cares, dpm got paid

 

[eyeeye_captain]

Great thread topic, thanks for reminding me to run my YTD. It’s extremely important to know your numbers while hopefully not obsessing over them.

One of the underrated parts of the original post is knowing what everybody else in a group is making too. Open books make practices democratic and have happier docs (or in solo, at least you and/or your office manager wife). I can only hope the hospital employed folks get their real metrics as well.

 

[air bud]

Great thread topic, thanks for reminding me to run my YTD. It’s extremely important to know your numbers while hopefully not obsessing over them.

One of the underrated parts of the original post is knowing what everybody else in a group is making too. Open books make practices democratic and have happier docs (or in solo, at least you and/or your office manager wife). I can only hope the hospital employed folks get their real metrics as well.

Yes, I get monthly reports. And catch errors. When I started I tracked daily and then compared. Need to get back to it. Too many errors

Hospital employed people....nobody cares how much you get paid more than you.

Now my last job...refused to give docs numbers. Everyone salary. I didn't care because I knew I was leaving within 3 months of being there. But no idea how hasn't been mutiny across board.

 

[Bluecollarmed]

We run 6 month evals for production (hospital employed). Should be every quarter but I talk to our coders weekly and they send me a message if they have questions or are making changes.

 

[Sybly]

We run 6 month evals for production (hospital employed). Should be every quarter but I talk to our coders weekly and they send me a message if they have questions or are making changes.

Production no offense , another word for over billing.

 

[Adam Smasher]

 

[dpmgrad]

va/ihs = 1
univ hosp pod = 1.5
private hospital pod = 2
Retro = 9
actually collected = who cares, dpm got paid

Hopefully, the VA's RVU per patient encounter is now greater than 1 since DPMs in VA are now being held accountable for RVU productivity.

 

[heybrother]

Hopefully, the VA's RVU per patient encounter is now greater than 1 since DPMs in VA are now being held accountable for RVU productivity.

Can you tell us more about that?

 

[dpmgrad]

Can you tell us more about that?

Starting with current FY 25, each VA Podiatry service will now need to meet a targeted average RVU productivity based on the VA hospital complexity level. For example, level 1 (a,b,c) facilities will need to meet targeted average RVU productivity of approximately 6000 for FY 25. Where as, level 2 and 3 facilities will need to meet the targeted average RVU productivity of approximately 4800 for FY 25. I am not sure how VACO determines the targeted annual RVU productivity metric. Those VA Podiatry services that are underperforming may be scrutinized. Some of the VAs have now tied part of the annual bonus to the RVU productivity.

 

[Bluecollarmed]

Production no offense , another word for over billing.

haha I wish I could finesse some of the extra cheese the PP guys get on the billing side.

 

[Homo sapien]

haha I wish I could finesse some of the extra cheese the PP guys get on the billing side.

A lot of that gets snatched back from insurance when they catch the scam

 

[MicroPod]

A lot of that gets snatched back from insurance when they catch the scam

That's why you got to stay ahead of them and start a new scam while they are still trying to figure out the old one.

 

[Bluecollarmed]

A lot of that gets snatched back from insurance when they catch the scam

Honestly DME is the only main thing I wish I was getting reimbursed on. High margins, but we use a third party distributor for CAM boots, ASO braces, and heel lifts. We recently hired an LAT though who functions like a nurse but with other office benefits and patient care who takes all the DME fitting and education. Was previously doing that and not being paid for it since we don't own it so they freed me up on that part.

 

[heybrother]

Starting with current FY 25, each VA Podiatry service will now need to meet a targeted average RVU productivity based on the VA hospital complexity level. For example, level 1 (a,b,c) facilities will need to meet targeted average RVU productivity of approximately 6000 for FY 25. Where as, level 2 and 3 facilities will need to meet the targeted average RVU productivity of approximately 4800 for FY 25. I am not sure how VACO determines the targeted annual RVU productivity metric. Those VA Podiatry services that are underperforming may be scrutinized. Some of the VAs has now tied part of the annual bonus to the RVU productivity.

Good info, thanks for sharing.

 

[Sybly]

No offense , typical podiatry over utilize and overbill. My 40 years in this mess.Thanks

 

[Feli]

No offense , typical podiatry over utilize and overbill. My 40 years in this mess.Thanks

When grads typically have 200k-400k in loans (around 7% interest),
would you expect them to try to hit bonus ... or to do charity work? 🙂

 

[MicroPod]

Found out recently the vascular surgeon who comes to see patients a couple of times a month at our facility only bills level 5 visits, 20 minutes a slot… and I kinda felt bad about billing level 4 occasionally lol.

 

[DYK343]

No offense , typical podiatry over utilize and overbill. My 40 years in this mess.Thanks

Found out recently the vascular surgeon who comes to see patients a couple of times a month at our facility only bills level 5 visits, 20 minutes a slot… and I kinda felt bad about billing level 4 occasionally lol.

yeah MDs waaaay overbill what podiatry does. Podiatry does some slimy stuff. But dissect apart the billing of your local foot and ankle ortho op report. You will be floored with the unbundling.

 

[heybrother]

Cigna sent my IPA an email saying they've decided they are going to heavily audit 4s and 5s in a few months.

 

[Weirdy]

Cigna sent my IPA an email saying they've decided they are going to heavily audit 4s and 5s in a few months.

Dam just when I was legitimately getting the hang of them.

 

[air bud]

Cigna sent my IPA an email saying they've decided they are going to heavily audit 4s and 5s in a few months.

Good. 4s are easy. Audit away.

 

[air bud]

Cigna sent my IPA an email saying they've decided they are going to heavily audit 4s and 5s in a few months.

Good. 4s are

Found out recently the vascular surgeon who comes to see patients a couple of times a month at our facility only bills level 5 visits, 20 minutes a slot… and I kinda felt bad about billing level 4 occasionally lol.

Level 4 occasionally? If you have busting crumblies sure. If you are doing any type of MSK in a MSG you are easily doing >50% level 4s

 

[Adam Smasher]

I got into the habit of documenting mdm on each of my level 4 visits. Usually it's "progression of chronic problem" + "decision for major surgery" and/or "prescription drug management." Lehrman wrote an article about this.

What they're probably looking for is docs billing 99204s simply for a new pt with an ulcer. Or these awful people who can't figure out their own chief complaint--"my feet hurt all over, and what can I do about my bunions, and do I have toenail fungus, and can you prescribe me a cream, and..."

 

[air bud]

I got into the habit of documenting mdm on each of my level 4 visits. Usually it's "progression of chronic problem" + "decision for major surgery" and/or "prescription drug management." Lehrman wrote an article about this.

What they're probably looking for is docs billing 99204s simply for a new pt with an ulcer. Or these awful people who can't figure out their own chief complaint--"my feet hurt all over, and what can I do about my bunions, and do I have toenail fungus, and can you prescribe me a cream, and..."

A new patient with an ulcer is a 99204....

Documenting MDM is how you do a note....

To be fair, a level 4 is a harder to achieve in PP. In a MSG/hospital setting, it's the standard. Even if it is acute ...someone goes to ER for heel pain? I reviewed the ER note, independently reviewed the x-ray taken there (radiology read and they billed professional component) and placed them in meloxicam. Let's say they cant do NSAIDs....I am looking at their chart and oh here is an x-ray 2 years ago of foot. I reviewed that and see progression of spur. I checked their labs already and saw they had a low vitamin D, discussed. You are at Medicaid clinic and patient says they can't afford shoes and OTC orthotics until get paid, have to walk every no car...social determinants of health and some z code for financial instability.....anyways learn how to code.......anyways having immediate access to medical records and the ability to review makes level 4 standard. Go see your GS, urologist , Ortho....that's gonna be a level 4. And more importantly leads to better communication with other providers and ultimately better patient outcomes.

On a related note and I know this is going to blow some people's minds here, Medicaid clinic is awesome. Nobody in my region accepts Medicaid I have people driving an hour and a half plus to see me. Good people, good outcomes, good pathology. Certainly location dependent and I'm in a good location...

 

[Homo sapien]

A new patient with an ulcer is a 99204....

Documenting MDM is how you do a note....

To be fair, a level 4 is a harder to achieve in PP. In a MSG/hospital setting, it's the standard. Even if it is acute ...someone goes to ER for heel pain? I reviewed the ER note, independently reviewed the x-ray taken there (radiology read and they billed professional component) and placed them in meloxicam. Let's say they cant do NSAIDs....I am looking at their chart and oh here is an x-ray 2 years ago of foot. I reviewed that and see progression of spur. I checked their labs already and saw they had a low vitamin D, discussed. You are at Medicaid clinic and patient says they can't afford shoes and OTC orthotics until get paid, have to walk every no car...social determinants of health and some z code for financial instability.....anyways learn how to code.......anyways having immediate access to medical records and the ability to review makes level 4 standard. Go see your GS, urologist , Ortho....that's gonna be a level 4. And more importantly leads to better communication with other providers and ultimately better patient outcomes.

On a related note and I know this is going to blow some people's minds here, Medicaid clinic is awesome. Nobody in my region accepts Medicaid I have people driving an hour and a half plus to see me. Good people, good outcomes, good pathology. Certainly location dependent and I'm in a good location...

What's your medicaid reimbursements like? Are you in Colorado? I heard that Colorado has functional medicaid reimbursement

 

[Adam Smasher]

A new patient with an ulcer is a 99204....

Exacerbation of chronic problem + decision for minor procedure (debridement) in pt with risk factors?

I might not buy it but I'll sell it!

 

[air bud]

Exacerbation of chronic problem + decision for minor procedure (debridement) in pt with risk factors?

I might not buy it but I'll sell it!

What is their vascular status? What's their most recent A1C? Are they on antibiotics have they been on it recently do they need to be? Has nothing to do with the debridement. And even then that's a minor procedure with risk factors so that's bumped back up to moderate.
Do they have previous amputations do they have previous x-rays in the chart? Were they in the ER? Can you review that note? Can you review their most recent note with primary care talking about glucose control? Are they compliant? Do they take the bus to get there? How does social determinants of health affect their ability to heal from this ulcer? Were they in the wound care center for something a year ago can you review those notes or pictures?

You're thinking all this stuff already now document it and show how all of that is involved in your decision making. The note is just what's going on inside of your head. This is one of the reasons why I don't believe in scribes cuz they don't know any of this stuff they are just repeating what you verbally say.



The foot bone is connected to the leg bone and connected to the heart.

ITs JuSt aN UlCUrrrrrr

Love you bro.

PS don't forget about the stem cells because they go brrrrrrr.

 

[Weirdy]

What airbud said.

Most new patients with ulcer coming in have
-uncontrolled DMII with reviewable labs
-PAD with maybe an ABI already done but mostly zero workup or hx of stents cards is seeing
-some kind of MSK related to said problem- equinus/ankle contracture
-social determinants- works part time at Walmart can't stay off of it

 

[Adam Smasher]

So, like the majority of dpms in pp, I don’t have this rich bounty of extraneous data points to review. But all this talk about PAD and ABI is just part of your history and exam, ABIs on their own aren't a lab test unless you record waveforms. And if you have the tech to do it, you're billing a 93922 and it doesn't count towards your e/m data points.

If I need to, my assistants can call PCP to find out A1c, and I'll often do this, but there's phone tag involved and it's not a billable data point if I find this info out a few days later (not same service date).

My general takeaway from e/m coding articles is that most of the time, your data points don't push you over the top. The money is in diagnostic and risk complexity. E11.621 is, by definition, an exacerbation of a chronic problem. If there's other biomechanical dx in the mix, great, but you already have your diagnosis complexity with the ulcer on its own. I've always had a problem calling a debridement a minor procedure in a patient with risk factors but I won't complain if auditors don't have this same problem. Lastly I still forget social dets of health which probably almost always apply.

Final thought, the financial payoff to ulcer care is not the new pt e/m, it's the weeks of 11042s and dme and other procedures the pt invariably requires, so that new pt e/m is a drop in the bucket in the long run.

Anyway appreciate the discussion, this has been a useful thought exercise

 

[air bud]

So, like the majority of dpms in pp, I don’t have this rich bounty of extraneous data points to review. But all this talk about PAD and ABI is just part of your history and exam, ABIs on their own aren't a lab test unless you record waveforms. And if you have the tech to do it, you're billing a 93922 and it doesn't count towards your e/m data points.

If I need to, my assistants can call PCP to find out A1c, and I'll often do this, but there's phone tag involved and it's not a billable data point if I find this info out a few days later (not same service date).

My general takeaway from e/m coding articles is that most of the time, your data points don't push you over the top. The money is in diagnostic and risk complexity. E11.621 is, by definition, an exacerbation of a chronic problem. If there's other biomechanical dx in the mix, great, but you already have your diagnosis complexity with the ulcer on its own. I've always had a problem calling a debridement a minor procedure in a patient with risk factors but I won't complain if auditors don't have this same problem. Lastly I still forget social dets of health which probably almost always apply.

Final thought, the financial payoff to ulcer care is not the new pt e/m, it's the weeks of 11042s and dme and other procedures the pt invariably requires, so that new pt e/m is a drop in the bucket in the long run.

Anyway appreciate the discussion, this has been a useful thought exercise

Yes absolutely different from private practice versus hospital-based. Having to count on some MA who hates her job to fax over a report or a lab that you see a couple days later makes all of this so much more challenging. And I actually am already cutting down at the wound care center, because I don't want to be doing weekly debridements because I disagree and I don't think the 11042 or even three are worth it. I would rather be in my main office seeing MSK stuff with new patient force. I don't need to debride a wound weekly. Now I'm just doing it more as surgical consultation. I go there for a half day every 2 weeks they line up all the new patients or anybody failing debridement have me evaluate for possible surgery and if not they continue seeing the other doctor.

I am very lucky, I have a very good setup at my new gig. My job is surgery. On all this diabetic stuff I assess them for surgery in terms of biomechanics I do that and then once the biomechanics are fixed the wound care center and the new wound care doc and get the ulcer healed up the rest of the way. Also works out great so I don't have to deal with global periods. Ymmv

 

[dtrack22]

But dissect apart the billing of your local foot and ankle ortho op report.

Yeah check out any peroneal tendon work + lateral ankle stab that F&A ortho bills. 5-6 codes easy. Not sure how it all gets paid (it very well may not be getting paid). Dyk’s billers would probably bundle the tendon repair and ligament repair into one code…

 

[Feli]

The per pt x the pts/day = total revenue. So, two ways to flex the results: per pt AND pts/day (OTC/cash stuff is another for PP, but forgetting that).

It's totally different goals (usually)...

PP generally wants well-insured fast, easy, quick stuff: warts, ingrown, injections, insoles, bunions, derm procedures, DME for basic injuries and OA, easy wounds, etc. The pts/day will almost always be same/higher versus hospital.

Hospital pod generally aren't affected by insurance much/any, and they want Rvu with wound care, inpt stuff, major surgery, injuries (things that are not great at all in most PP offices). They will usually have more staff/space for wheelchair, scooter, obesity, etc pts. They will almost always have more rvu per visit that PP.

And sure, there are exceptions (mostly in competitive / metro areas) where PP pods do more wounds or inpt stuff or big recon (or hospital pods who do derm/nail to fill schedule). But overall, the PP pods will generally refer most of that stuff complex or dump lower insured pts on hospital pods... just as hospital pods will avoid derm/nail stuff typically.

 

[GreenHousePub]

I got into the habit of documenting mdm on each of my level 4 visits. Usually it's "progression of chronic problem" + "decision for major surgery" and/or "prescription drug management." Lehrman wrote an article about this.

What they're probably looking for is docs billing 99204s simply for a new pt with an ulcer. Or these awful people who can't figure out their own chief complaint--"my feet hurt all over, and what can I do about my bunions, and do I have toenail fungus, and can you prescribe me a cream, and..."

Can you link the article please?

 

[Adam Smasher]

Can you link the article please?

Sorry, I think it was a podiatry today article from 2023, I remember reading it over on paper before putting it in the wastebasket

 

[p100]

My average per patient is $80.492. This is strictly going to assisted living facilities with no add-ons whatsoever. Clip snip and go home. Maybe two wounds a month and one matrixectomy per month.

 

[Weirdy]

Just a heads up for the private practice/group heads out there.
Got this email about Cigna.
============================

As a reminder, effective October 1, 2025, Cigna will implement a new reimbursement policy, Evaluation and Management Coding Accuracy (R49), to review professional claims billed with CPT codes 99204-99205, 99214-99215, and 99244-99245 for billing and coding accuracy. Various physician professional organizations have voiced their objection to the implementation of this policy but as of this writing, this policy will be implemented on October 1, 2025.


This means that the CPT codes referenced above are subject to an adjustment of one service level down and this is before medical records are requested. As always, it is imperative that your medical records justify the CPT codes that you bill in case you need to appeal any downward coded claims. Reference the American Medical Association (AMA) E/M service guidelines.
============================================
Looks like cigna is going after level 4s
Suspect the other insurances will start to do the same​

 

[SoleSucking]

Just a heads up for the private practice/group heads out there.
Got this email about Cigna.
============================

As a reminder, effective October 1, 2025, Cigna will implement a new reimbursement policy, Evaluation and Management Coding Accuracy (R49), to review professional claims billed with CPT codes 99204-99205, 99214-99215, and 99244-99245 for billing and coding accuracy. Various physician professional organizations have voiced their objection to the implementation of this policy but as of this writing, this policy will be implemented on October 1, 2025.


This means that the CPT codes referenced above are subject to an adjustment of one service level down and this is before medical records are requested. As always, it is imperative that your medical records justify the CPT codes that you bill in case you need to appeal any downward coded claims. Reference the American Medical Association (AMA) E/M service guidelines.
============================================
Looks like cigna is going after level 4s
Suspect the other insurances will start to do the same​

Come at me bro. I literally bill them as justified by guidelines. These insurances suck.

 

[Weirdy]

Come at me bro. I literally bill them as justified by guidelines. These insurances suck.

Is there a generic dot phrase you use?
I keep going back and forth on my notes to make sure I justify all the check boxes but havn't been able to curate a blanket statement for level 4s yet.
Plz halp if you have any.
Now that I am getting busier, want to make sure charting billing proof notes takes the least amount of time.
Insurances are a **** to deal with.