Stop Counting Visits. Count Revenue Per Clinical Hour.

Two providers work the same 32 clinical hours and see the same number of patients. One produces materially more collected revenue than the other.

The difference usually isn’t effort. It’s the appointment template.

Most practices still manage the schedule by visit count: patients, new visits, procedures, open slots. But new patient volume is a dangerous KPI when it hides what actually converted into collected revenue.

The better question is not, "How many visits did we see?" It is, "How much collected revenue did each appointment type produce per real clinical hour?"

Start with a rough review, not a custom analytics project. Most practices do not need a perfect appointment-level profitability model to learn something useful. Look for obvious mismatches: visits that routinely run long, procedure blocks that sit underfilled, appointments that create avoidable denials or patient-balance friction, and schedules that look full but do not convert cleanly into cash.

For each appointment type, ask:

Start with acne follow-ups, biopsies, excisions, isotretinoin visits, cosmetic consults, and post-op checks. The goal is not to create a perfect spreadsheet. It is to find the few places where the calendar and the financial reality tell different stories.

Use collections, not charges. Net collection rate sits between the work performed and the money kept, which is why a charge-based version hides the problems the audit is meant to surface.

The simplest version is: collected revenue for dates of service / real patient-facing clinical hours. Then split it by provider, location, appointment type, and payer mix. One provider may not see more patients, but may see a better procedure mix. One location may look full, but have weaker realization.

Procedure mix. We ran this arithmetic in June in Your Most Valuable Hour Isn't in the Exam Room: a first-stage Mohs (17311) pays roughly 7 times a 99213 per encounter, and per-hour yield swings 3 to 4 times across slot types. This is the measurement follow-through, and it adds a correction: 7x per encounter is not 7x per hour. Mohs earns its hourly advantage only when the provider works E/M or minor procedures while slides process. Without that parallel scheduling, a high-value procedure, cosmetic ones included, can yield less per hour than a stack of follow-ups. The 2026 repricing narrows the per-encounter multiple somewhat. Exact current dollars live in CMS's fee schedule lookup.

Payer mix. Medicaid pays roughly 75 cents on the Medicare dollar for physician services, per KFF's Medicaid-to-Medicare fee index. Commercial contracts range too widely for any published multiple; only your own contracts answer that. Cash cosmetic hours skip the payer entirely. If the number drifts and the template hasn't changed, look here first.

Room design. Parallel rooming and consolidated procedure blocks beat scattered scheduling on utilization and staffing, but the advantage rides on fill rate. A protected block running half empty pulls the metric down harder than scattered procedures did.

Realization. Net collection rate sits between the work and the money. A practice collecting 92% of what its contracts allow reads 5 points lower per hour than one collecting 97%, and no slot redesign recovers it.

No-shows. The peer-reviewed outpatient mean is 18.8%, with a standard deviation of 2.4%. Ignore the "derm runs 30%" figure that circulates in vendor decks. An empty slot is a zero over a full hour, and no-shows remain a persistent drag across the specialty.

There's no published dermatology benchmark for revenue per clinical hour. MGMA and AMGA publish collections per FTE, work RVUs per FTE, and compensation per work RVU, all annual, all per provider. The per-hour dollar bands circulating online come from med-spa consulting. Your number is only meaningful against your own prior number.

Don’t turn this into a crude ranking of "best" and "worst" patients. Ranked purely on margin per hour, a short cosmetic visit may beat a complex medical visit. Push that logic too far and you start rationing access, weakening continuity, and distorting the clinical mission.

A low-yield visit can also be an investment. The acne follow-up that preserves adherence, the hidradenitis visit that preserves trust, the medical visit that becomes a future procedure, referral, review, or long-term patient relationship: those are real economics too. Lifetime value keeps the schedule from being optimized as if each visit begins and ends on the same day.

The compliance version matters just as much. Pressure on hourly yield can show up as aggressive E/M levels, procedure stacking, or sloppy Modifier 25 use. Those are exactly the patterns behind the OIG's scrutiny of Modifier 25.

Treat revenue per clinical hour as a diagnostic, not a command. It tells you where to look. It does not tell you to redesign the practice around the highest-yield slot.

Clarity RCM manages revenue cycle for 200+ dermatology practices across 42 states. It's all we do. See how we work.