Making Every Exam Count: Tracking, Measuring and Improving Revenue per Exam in Your Practice

In the evolving landscape of optometric care, independent practitioners face increased pressure from corporate and online competition, and stagnant or decreasing insurance reimbursements. Ask any practice owner what their top goal is, and it’s usually to increase revenue. We can do this two ways—see more patients or increase the dollar amount spent by each patient we see. While both are worthy goals, many of us are not looking to increase our volume above our current levels. 

Tracking and measuring metrics can be daunting (who has the time?). But taking the time to work smarter and not harder can free us up to work on the practice, invest in staff training or take more time away from the practice. One metric stands out as a clear indicator of how our practices are performing both financially and effectively, and can serve as a road map for practice changes and improvements we want to make: Revenue per Exam (RPE). With intentional effort, RPE can become a key driver of profitability without adding volume or compromising patient care.

What is Revenue per Exam—and Why Should You Care?

Revenue per Exam is the average revenue generated from each comprehensive (refractive) eye exam. It includes exam fees, contact lens evaluations, imaging, special testing, product sales and optical or contact lens sales associated with the exam.

RPE = Total Revenue / Number of Comprehensive Exams

While big-box retail optometry may focus on volume, independent practices thrive when each patient encounter delivers exceptional care and healthy returns. RPE gives independent ODs a lens into how effectively each visit supports the financial sustainability of the practice.

Getting the Numbers Right: Tracking RPE in Real Time

To effectively measure and improve RPE, your data must be correct.

• Track only full, billable exams (typically CPT 92004/92014).
• Tie revenue (services, optical, imaging) to the date of the exam.
• Segment results by insurance provider to understand where each exam dollar is really coming from.  (Why do this? We can eventually start to drop the plans that have the lowest per patient revenue. Remember—smarter, not harder!)

If you use platforms like EDGEPro, RevolutionEHR or Crystal PM, these calculations can often be automated. Otherwise, regular reports exported to Excel can give you what you need.

Breaking It Down: RPE by Insurance Provider

This is where the insights become actionable. By analyzing RPE by payer, independent practices can identify which insurance contracts support the business—and which may be quietly draining revenue.

Here’s a simplified example:

Private pay patients tend to yield the highest RPE due to fewer pricing restrictions and more freedom in optical choices. Conversely, Medicaid and some vision plans often fall below sustainability levels. Also, while Eyemed may bring in the most revenue, the RPE for this plan is lower than VSP. If we just looked at revenue collected, we would miss this key distinction. For the independent OD, this analysis becomes a strategic tool. Which panels should you keep, renegotiate or drop? Where should your marketing efforts go? Are you positioning your value properly to convert more patients to private pay? 

Strategies to Improve Revenue per Exam

1. Boost Optical Conversion and Capture Rate

Train opticians in lifestyle-driven recommendations. Make sure your optical selection supports and reflects your goals. Be deliberate in your recommendations in the exam room, work to improve patient communication in the optical handoff (or if you don’t have one, now is the time to start!) and make sure your optical team is trained in story telling.

Make it easy—and appealing—for patients to buy in your office.

2. Maximize Ancillary Services

Too many independent ODs underutilize tools they already own. Retinal imaging, OCT, dry eye treatment and specialty contact lenses can significantly increase RPE per patient, while offering top-tier care. Educate patients, perform the testing and bill appropriately.

3. Evaluate and Adjust Fee Schedules

Annual fee reviews are essential. If your U&C (usual and customary) pricing is out of sync with regional or national benchmarks, you may be leaving money on the table—or worse, undervaluing your services.  Don’t be afraid to raise pricing either. Pricing on everything has gone up, so make sure you are charging appropriately.

4. Look At Each Plan Separately

Not every panel deserves a seat at your table. Use your RPE by provider to inform decisions about contracting. Can you drop low-reimbursement plans and reallocate time to private pay? Can you negotiate better rates based on your data? We often make these decisions with emotion, but using data gives us concrete data. As we saw in the example above, just looking at the revenue generated by these plans can give us false information.

5. Empower Your Team

Share RPE targets with staff and set realistic goals tied to performance incentives. Make sure everyone—from front desk to optician—understands how they influence practice profitability. I’m a big fan of my team understanding the relationship between costs and revenue – and how each plays a role.

6. Communicate Value to Patients

Patients don’t always understand why one exam costs more than another. Highlight your technology, training, personalized care and long-term eye health value. Strong messaging builds loyalty and supports premium pricing. Make sure your website is updated and current, utilize social media, highlight (and ask for!) patient reviews and showcase why you are different.

Technology That Supports Your Goals

Don’t reinvent the wheel! You don’t have to do this manually. Consider integrating tools that streamline RPE reporting and decision-making:

• EDGEPro / GPN Analytics – Advanced performance dashboards with payer segmentation.
• RevolutionEHR / Crystal PM / Eyefinity – Track service codes and link revenue to visits.
• Google Sheets or Excel Dashboards – For those who prefer custom reporting.

Set aside time monthly to review trends. Patterns will emerge—and those insights will drive smart changes.  The benefit of being more efficient? Instead of trying to see more patients, you will free up time to be the CEO and business owner in your practice. Measuring and managing RPE allows independent ODs to reclaim control over profitability, strengthen patient outcomes and make data-driven decisions.

Tracking RPE, especially by insurance provider, shines a light on where your practice thrives and where it needs improvement. It enables you to invest in the right services, staff and partnerships—and, when needed, to say no to those that no longer serve your mission.

Remember: every exam should serve your patient and your practice. When measured and managed well, RPE is the bridge that lets you do both.