Every practice-management system prints a productivity report, and every one of them leads with volume. So many units of this, so many of that, ranked down the page. It is the easiest report in the building to read, and it quietly answers a question nobody asked.
Volume tells you what you do most. It does not tell you what you earn most, and in the practice behind the published sample the two rankings disagree so sharply that reading one as the other would send a doctor after the wrong service entirely.
Here is what that looked like across two months, 3,097 units of service and 28 distinct codes.
Two rankings, and they disagree
Rank the practice's services by what each one collects per unit, and the top of the list looks nothing like the busiest part of the schedule.
| Code | Service | Units | Paid per unit |
|---|---|---|---|
| 99203 | New patient, detailed (30 min) | 63 | $112.10 |
| 97124 | Massage therapy (60 min), self-pay | 92 | $66.34 |
| 97039 | Laser therapy, self-pay | 37 | $56.49 |
| 99213 | Established patient, expanded (30 min) | 58 | $30.56 |
| 98941 | CMT, 3–4 regions | 1,232 | $29.36 |
| 97110 | Therapeutic exercise (15 min) | 153 | $17.57 |
| 97012 | Intersegmental traction | 507 | $12.92 |
| 97014 | Electrical stim, unattended | 352 | $11.26 |
| G0283 | Electrical stim — Medicare/UHC | 173 | $8.93 |
| 72040 | Cervical x-ray, 2 views | 27 | $4.53 |
Ten of the seventeen codes with twenty or more units, from the Procedure Code Analysis, pages 3 and 5. All seventeen are ranked in the published report.
Read the two columns against each other. The three busiest services on that list — intersegmental traction at 507 units, electrical stim at 352, Medicare electrical stim at 173 — collect $12.92, $11.26 and $8.93 per unit. Of everything shown, only the cervical x-ray collects less, and that happened 27 times. Meanwhile the highest-earning service on the page, a detailed new patient exam at $112.10, happened 63 times.
The published report states the disagreement plainly: a detailed new patient exam ranks first on rate and second on revenue, while the spinal adjustment ranks fifth on rate and first on revenue. Neither column on its own tells you where a practice makes its money.
A busy service and a valuable service feel like the same thing at the front desk, because both of them fill the schedule. They are measured by different columns, and only one of those columns is on the report most doctors read.
Why the disagreement costs money
It matters because the money is concentrated. In this practice the five largest codes by collections account for 80.4% of everything collected, and one of them — the 3–4 region spinal adjustment, 98941 — brought in $36,167 on 1,232 units. That is 48.6% of all collections, more than five times any other single code.
So nearly half the revenue rests on the service with the fifth-highest rate on the list. That is not a problem in itself; it is what a chiropractic practice looks like. It becomes a problem the moment a decision gets made against the wrong ranking.
Price the busiest service and you are moving the rate on the thing that carries the practice. Add capacity to the highest-rate service and you are growing something that happened 63 times. Both can be right. Neither is obvious from a report that prints volume and stops.
A rate means nothing without volume behind it
There is a second way to get this wrong, and it runs in the opposite direction. A per-unit rate computed on a handful of occurrences is not a rate at all — it is one payment wearing a rate's clothing.
In the published sample, every code is graded into one of three tiers by how often it occurred in the window.
| Tier | Volume in the window | Codes | What it supports |
|---|---|---|---|
| Reliable | 20 or more units | 17 | Stable enough to price, staff and schedule against |
| Caution | 5 to 19 units | 2 | Directionally useful. Watch it another period |
| Low-N | Fewer than 5 units | 9 | Shown for completeness only |
Reliability tiers from the Procedure Code Analysis, page 2. Seventeen of twenty-eight codes, 61%, clear the Reliable threshold.
The bottom tier is where the illusions live. In this window a moderate new-patient exam shows $347.00 per unit — on a single visit. Three-arch orthotics show $285.00 per unit, on one pair. Both are real payments. Neither is a rate, and a ranking that mixes them in with the rest would put them at the top of the page.
Two months is a short window, which is why only seventeen codes clear the bar here. Over a quarter more would. That is a property of the window, not of the practice — and it is the kind of thing worth saying out loud rather than letting a reader assume the practice is thinner than it is.
How to do this with your own report
You need one export: whatever report lists what you sold, how many times, and what was collected against it. In ChiroTouch that is Procedure Code Productivity by Provider. Then four steps.
- Divide collected by units for every code. That is your paid-per-unit. It is not what you charge, and the gap between the two is usually large — in this practice, $208,439 charged against $74,458 collected.
- Mark every code with fewer than twenty units. Keep them in the table so the count reconciles, but take them out of any ranking you plan to act on.
- Sort twice. Once by paid-per-unit, once by total collected. Put the two orders side by side. Where a service moves a long way between them, that movement is the finding.
- Add a running total to the revenue ranking. Find where it crosses 80%. However many codes it took to get there is how concentrated the practice actually is.
It is an afternoon in a spreadsheet, and the first time you do it the surprise is usually not which service earns the most. It is how few of them matter at all.
Open your productivity report and find the service you perform most often. Then work out what it collects per unit, and where that figure sits against everything else you do. If those two facts are not already in the same sentence in your head, you have been making decisions against one column of a two-column problem.