Building a Visit Structure That Reflects Reality

Busy days don’t always mean productive days. Many practices still lump everything—provider encounters, imaging, therapies, and dispensing—into one “visit” count. It looks efficient on paper. It’s not.

For instance, in a typical podiatry clinic, a provider might evaluate a new patient for a diabetic foot ulcer, while across the hall, staff run a laser therapy session and fit a patient for orthotics. The schedule shows “three visits,” but only one involved a provider’s medical decision-making. When those all get counted the same way, productivity reports, compensation plans, and staffing models drift away from reality.

When your “visit” metric mixes provider work with ancillary services, your data stops reflecting reality. Staffing plans, clinician compensation, and even hiring decisions all become distorted.

Step 1: Build a Simple Visit Structure

Start by sorting your schedule into three clear lanes:

• Provider-Only Visit: A face-to-face clinical evaluation or procedure by a licensed provider acting within scope. This is the core of care delivery and the anchor for productivity metrics.

• Ancillary Appointment: A scheduled touch handled by trained staff or devices under standing protocols—imaging, laser treatments, casting, dispensing, and so on. These enhance access and revenue but shouldn’t be counted as provider productivity.

• Non-Patient Blocks: Administrative time, meetings, and holds. Essential for operations but not part of patient throughput.

Assign each lane to a schedule type and link it to the appropriate billing code family. When every slot knows its lane, your data finally makes sense.

Step 2: Align Scheduling with Billing

A strong structure only works if your systems speak the same language. Your EHR should translate:

Schedule Type → Encounter Form → Claim Lines

If an appointment is ancillary-only, it shouldn’t inflate provider totals or mislabel a returning patient as new. Provider-only visits should trigger the right templates, coding, and quality measures.

Train schedulers to use a short, locked list of appointment types—no free-text improvisation. Standardization is your best friend here.

Step 3: Make Metrics Actionable

Once your lanes are clean, your numbers become powerful. Three key metrics stand out:

• Provider-Only Visits per Day – Reveals true provider capacity.

• Ancillary-to-Provider Ratio – Shows whether ancillaries are expanding access or just masking provider shortages.

• Delegation Mix – Quantifies how effectively you shift work to trained staff without compromising outcomes.

These metrics don’t just describe your practice—they diagnose it.

Step 4: Link Structure to Compensation and Staffing

Paying bonuses on “total visits” rewards volume over value. Switch to metrics that reflect actual provider effort and quality.

Tie incentives to provider-only visits and outcomes, not blended visit counts. Celebrate ancillary growth—but assess it on its own revenue, cost, and safety metrics.

This alignment ensures you can scale technology and staffing without distorting provider benchmarks.

Step 5: Audit and Adjust

Expect some turbulence during rollout. Use a weekly “count clinic” to reconcile schedule data with billing and documentation:

Date → Schedule Type → Encounter Documentation → Claim Status

You’ll find most discrepancies trace back to misclassified visits or incomplete notes. Both are easily fixable once surfaced.

Step 6: Communicate the “Why”

Change sticks when people understand it. Explain that this structure protects fairness, prevents burnout, and keeps data honest. It ensures doctors aren’t credited—or blamed—for touches they didn’t perform.

When everyone sees fair, simple rules applied consistently, trust follows.

Bottom Line

When you build a visit structure that reflects reality, your metrics finally tell the truth. That clarity strengthens staffing, compensation, and patient care—all at once.