Part 5 of 12 – 4 Problems that lead to Low Patient Volume and Your Physician Income – Here is How to Fix it

12 Part Series: MedCV Practice Financial Management – Insights & Tips You Need to Know About to Quickly Maximize Your Income

Tip 5 of 12 – How many patients do you need to see to cover your Overhead and make a Competitive Income?

Encounters per Provider/Provider Production:
a. Assessment: An evaluation of provider production should include a comparison of both encounter volume and wRVU generation against industry benchmarks.  Revenue opportunity number 4 addressed instances where encounters are meeting benchmarks but wRVU are not.  The second revenue opportunity occurs when both encounters and wRVU fall below the industry benchmark.  

The production-based revenue opportunity is determined by identifying each provider’s encounter shortfall from the organization’s specialty specific volume goals per provider full time equivalent (FTE) and then converting that encounter shortfall to wRVU shortfalls by using the actual provider’s wRVU per encounter ratio.   Multiply the wRVU shortfall by the provider specific actual net revenue per wRVU to calculate the revenue opportunity per provider.

b. Improvement Action: The cause for a performance shortfall around this opportunity must be identified before establishing a solution. 

A first step in seeking the cause will be to assess each provider’s time committed to direct patient care.  A standard for comparison is typically no less than 36 hours of direct patient care per week for each full-time provider.  The time assessment can be completed by reviewing the provider’s schedule template.  The organization should get physician leadership consensus on this time standard in order to have an effective solution.  With that standard in place the physician specialty leaders can work with the applicable physicians and their staff to expand schedules.

The next step in seeking the cause will be to identify the average number of weekly patient encounters scheduled to the provider.  Benchmark variances found in this step can be attributed to several factors, including limited demand, restrictive scheduling, above average times per encounter and a high intensity service mix.  Limited demand may be addressed through market development and referring physician outreach activities.  If these activities do not generate the needed volume, actions to right size the physician enterprise may become necessary.  Restrictive scheduling and extended encounter times can be addressed through provider to provider counseling and through compensation arrangements.  The last factor, high intensity encounters, should take care of itself as the wRVU generated per encounter in a high intensity service mix should exceed the benchmark. 

A final step in the assessment will be to identify the actual average encounters per week completed by the provider. Excessive no shows are typically the problem source when scheduled encounters meet the benchmark, but actual encounters do not.  No shows can be effectively reduced through an in-depth analysis to identify the characteristics of the high no-show populations and then conducting focused pre-service calls to address those specific populations.   Another reason for a low actual to scheduled encounter rate may be excessive clinic or encounter cancellations directed by the provider.  As with restrictive scheduling this problem is addressed through provider to provider counseling and through compensation arrangements.

If the problem is that patient volume is low as a result of COVID, you also need to be very serious about marketing and take action! Here is a link to a MedCV practice marketing and patient communications article with tips and tools you should implement NOW! Get Your Patients Back! Practices Must Communicate with Their Patients

Like we like to remind our physician members at the end of each of these 12 part series, as a physician, if this sounds like a lot of work and maybe even has your “business anxiety level” up a few notches, you are not alone. The great news is that your role in this should just be to make sure it gets done and that those who are going to be responsible and accountable for this can explain and report details about what the plan looks like and its status to you.

Share this article with your practice manager, group administration, or hospital administration to make sure they are working on this or see what resources they have to get at this work. If they need help in getting started, they should consider connecting with John Rezen at Value Health. The key is to be able to have your baseline, you would expect your team to report to you the improvement(s) made and the results.

Stay tuned for Part 6 of 12, Value-based care revenue next week. If you can’t wait that long, no problem, just contact John for the full 12 part series. Again, it’s in your best financial interest to make sure each of these 12 Key Performance Indicators are optimized, you understand them, and take action, even if the action you take is to share the series and your new found business insight with your group or hospital administration.

John Rezen

President & CEO
Value Health, LLC

MedCV Advisory Board Member

Financial Improvement

Each of the 12 part “2-3 minute reads” in this Financial Improvement series provided by John Rezen, FACHE, MHA and your MedCV team can quickly add CASH to your bottom line just by having your practice “work smarter” for you. Even if you are not directly responsible for the management of your practice, knowing this information will help you make sure you are making the income you deserve.

As hospitals and medical groups emerge from the COVID- 19 economic shutdown, they will be faced with significant pressure to improve their financial performance. The following checklist of performance measures should help physician enterprises identify financial opportunities and accelerate their improvements. Below are the 12 topics, to read a previous segment, click on the name/link. The current segment is Blue and upcoming segments are Black.


  1. Staffing minutes per encounter
  2. Average staff pay rate per hour
  3. Providers’ pay per wRVU
  4. Service costs-to-revenue
  5. Supply and drug costs-to-revenue
  6. Overhead costs-to-revenue

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Published by Niels Andersen

Founder and CEO of KontactIntelligence, MedCV, VetCV, and VeritasHealthCare. 40 Years in healthcare, 20 years in healthcare tech supporting Government and commercial health systems, physicians, as well as Veterans and their families throughout the US.

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