Revenue per OD Hour: One Metric That Helps Tell the Truth About Your Practice
You're busy. Your schedule is packed. Patients back-to-back from morning until the end of the day. You collapse into your chair at lunch wondering where the morning went, and by the time you lock the doors at night, you're exhausted.
But at the end of the month, when you review your numbers, you wonder: "If I'm this busy, why doesn't my revenue reflect it?"
The answer lies in understanding not just how many hours you're working, but how productively you're using those hours. And there's one metric that reveals this truth with startling clarity: Revenue per OD Hour.
Why This Metric Matters
Most practice owners track total monthly revenue, which is important. But total revenue alone doesn't tell you whether you're working efficiently or just working hard.
Two practices can both generate $80,000 monthly, but if one doctor works 35 hours weekly and another works 50 hours weekly, they're not equally successful. The first doctor is generating $571 per hour worked, while the second generates $400 per hour. Same revenue, dramatically different productivity.
Revenue per OD Hour measures the financial output of your clinical time—the most limited resource in your practice. Unlike staff hours, which you can scale by hiring, your personal clinical hours are capped. You can't clone yourself. You can't add a 25th hour to the day.
This makes maximizing the value of each clinical hour the single most powerful lever for practice profitability.
How to Calculate Revenue per OD Hour
The formula is straightforward:
Total Monthly Revenue ÷ Total OD Hours Worked = Revenue per OD Hour
Let's break down each component:
Total Monthly Revenue: Use your collections, not charges. Collections represent money that actually hit your bank account. Charges include services you billed but haven't been paid for yet. For this metric, focus on collected revenue.
Total OD Hours Worked: Count only the hours you're providing clinical care—seeing patients, conducting exams, performing procedures. Don't include administrative time, meetings, or non-clinical work. If you work four 8-hour days per week, but 2 of those hours daily are spent on paperwork and practice management, your clinical hours are 24 per week, not 32.
Monthly calculation: Multiply your weekly clinical hours by 4.33 (the average number of weeks per month).
Example Calculation:
Monthly collections: $80,000
Weekly clinical hours: 32
Monthly clinical hours: 32 × 4.33 = 138.5 hours
Revenue per OD Hour: $80,000 ÷ 138.5 = $578
What's a Good Revenue per OD Hour?
Industry benchmarks vary by practice type, location, and service mix, but here are general guidelines:
$400-500/hour: Below average. Your practice may be underutilizing available revenue opportunities, running significant inefficiencies, or dealing with reimbursement challenges.
$500-700/hour: Average range. You're performing reasonably well, but significant room for improvement exists.
$700-900/hour: Above average. You're running an efficient practice with good revenue capture and productivity.
$900-1,200+/hour: Excellent. You've optimized most aspects of clinical productivity, likely through specialty services, strong optical capture, efficient scheduling, or premium service positioning.
Keep in mind these benchmarks assume you're spending clinical time on revenue-generating activities. If you have significant unpaid administrative burden eating into your clinical hours, your effective rate will be lower.
What This Metric Reveals
Revenue per OD Hour functions as a diagnostic tool for practice health, revealing issues that might not be obvious from total revenue alone:
Low revenue despite full schedule? You may have scheduling inefficiencies—short appointments with long gaps, high no-show rates, or under-billing for services provided.
High revenue but burnout? You might be working excessive hours rather than working strategically. There's opportunity to maintain revenue while reducing clinical time through better efficiency.
Flat revenue despite steady patient volume? You're likely leaving revenue on the table—missed optical sales, unbilled procedures, or underpriced services.
Declining revenue per hour over time? Insurance reimbursement cuts, increasing overhead, or practice inefficiencies are eroding profitability faster than volume growth can compensate.
This single number cuts through the subjective feeling of "busy" and reveals the objective truth about productivity.
The Weekly Improvement Framework
Once you know your baseline Revenue per OD Hour, the question becomes: how do I improve it?
The good news is you don't need massive overhauls. Small, focused improvements compound quickly. A 5% improvement in revenue per hour is worth $4,000+ annually for a practice generating $80,000 monthly.
Here's a practical toolkit of improvements you can implement one at a time, week by week:
Week 1: Strengthen Exam-to-Optical Handoffs
The opportunity: If your optical capture rate is below 70%, you're leaving significant revenue on the table every single day.
The improvement: Implement the confident handoff script from our optical capture rate post. Instead of "You can pick frames up front," say: "I've updated your prescription, and I want to make sure you're seeing as clearly as possible. Let's have [staff name] help you find the right lenses for your lifestyle."
Then physically walk the patient to optical and make the warm handoff.
Expected impact: A 5-10 point improvement in capture rate can add $50-100 per clinical hour to your revenue.
This week's action: Train your optical staff on receiving handoffs enthusiastically, then commit to personally walking every patient needing eyewear to optical for one week.
Week 2: Add One High-Value Test Daily
The opportunity: Many practices under-utilize available diagnostic testing that provides clinical value and generates revenue.
The improvement: Identify one test you should be performing more frequently: OCT for diabetics, visual fields for glaucoma suspects, retinal photography for baseline documentation, dry eye imaging for symptomatic patients, or corneal topography for irregular astigmatism.
Choose one category and ensure every appropriate patient receives it.
Expected impact: Adding 4-5 billable tests weekly at $50-100 net each can add $10-25 per clinical hour.
This week's action: Review your patient schedule each morning and flag 1-2 patients who would clinically benefit from your chosen test. Ensure staff are prepared to perform and bill it.
Week 3: Fill Last-Minute Cancellations
The opportunity: Every cancelled appointment without a fill-in represents lost revenue—often $200-400 of production time that can't be recovered.
The improvement: Build a "short notice" list of patients who can come in with 24-48 hours' notice. These might be:
Patients needing frame adjustments
Contact lens patients due for checks
Patients with minor concerns they've been meaning to address
Anyone on your recall list who hasn't scheduled yet
When you get a cancellation, immediately call 3-5 people from this list to fill the slot.
Expected impact: Filling just 2-3 cancellation slots weekly can add $20-40 per clinical hour.
This week's action: Have your front desk build a 20-person short-notice list this week. Train them to call immediately when cancellations occur rather than waiting to see if the slot fills.
Week 4: Reduce Appointment Gaps
The opportunity: If you have consistent 10-15 minute gaps between patients due to inefficient scheduling templates, you're losing 30-60 minutes of productive time daily.
The improvement: Audit one full day's schedule. Track when patients actually checked in, when you actually saw them, and when they completed. Look for patterns:
Are you scheduling exams for 45 minutes when they consistently take 30?
Do you have built-in buffers that aren't necessary?
Could you schedule different appointment types back-to-back more efficiently?
Adjust your scheduling templates to minimize dead time while maintaining quality care.
Expected impact: Recovering 30 minutes daily of productive time can add $50-100 per clinical hour (by increasing your total clinical hours without working longer).
This week's action: Shadow your schedule for two days, noting actual vs. scheduled time. Identify one specific scheduling adjustment to test.
Week 5: Implement Add-On Services
The opportunity: Many patients would benefit from services beyond the basic exam but aren't offered them because you haven't systematized the offering.
The improvement: Create a standardized "recommended add-on" list for common scenarios:
Blue light filtering for computer users
Polarized sunglasses for drivers
Contact lens solution upgrades for dry eye patients
Annual supply contact lens purchases (instead of 6-month)
Specialized lens designs for specific visual demands
Train your optical team to present these as recommendations, not upsells.
Expected impact: Even modest adoption of add-on recommendations can add $30-60 per clinical hour.
This week's action: Choose one add-on to focus on this week. Ensure every patient in the relevant category receives a recommendation.
Week 6: Optimize Fee Schedule
The opportunity: Many practices haven't reviewed their fee schedule in years. You may be charging 2019 prices in a 2025 market.
The improvement: Review your top 20 most common procedures and services. Compare your fees to:
What Medicare allows (a common benchmark)
What other practices in your area charge (if you have this data)
What your costs justify (calculate your cost to deliver the service, then add appropriate margin)
Identify services where you're significantly underpriced and make strategic adjustments.
Expected impact: A 5-10% fee increase on select services can add $25-50 per clinical hour with no additional work.
This week's action: Pull your fee schedule and identify your five most common services. Research appropriate pricing and plan adjustments for the new year.
Week 7: Improve No-Show Rate
The opportunity: Every no-show is wasted clinical time that could have generated $200-400 in revenue.
The improvement: Implement a multi-touch reminder system:
Email reminder 7 days out
Text reminder 2 days out
Call reminder 1 day out for high-value appointments
Also implement a sensible cancellation policy: "We understand things happen. If you need to reschedule, please give us 24 hours' notice so we can offer your spot to another patient who needs care."
Expected impact: Reducing no-shows from 10% to 5% can add $20-40 per clinical hour by increasing productive utilization of your schedule.
This week's action: Review your current reminder process. Add one additional reminder touchpoint you're not currently using.
Week 8: Delegate Lower-Value Activities
The opportunity: You're probably doing things that don't require your level of training: frame adjustments, simple contact lens teachings, insurance pre-authorizations, etc.
The improvement: Audit one week of your time. Note every activity that doesn't technically require a doctor. Identify what can be delegated to trained technicians or administrative staff.
Train your team to handle these activities, freeing your clinical time for higher-value doctor-only work.
Expected impact: If you can delegate 3-4 hours weekly of lower-value activities, you've freed time for 3-4 more revenue-generating appointments. This can add $50-100 per clinical hour.
This week's action: Shadow yourself for two days. Make a list of everything you do that someone else could handle with proper training. Choose one thing to delegate starting next week.
The Compound Effect
Here's what happens when you implement just one improvement per month:
Starting baseline:
Monthly revenue: $80,000
Clinical hours: 138.5 monthly
Revenue per OD Hour: $578
After implementing 4 improvements over 4 months:
Optical handoff improvement: +$75/hour
Add-on service adoption: +$40/hour
Filling cancellations: +$30/hour
Reducing appointment gaps: +$60/hour
New revenue per hour: $783
New monthly revenue at same clinical hours: $783 × 138.5 = $108,445
Monthly increase: $28,445 Annual increase: $341,340
This is achieved with the same number of clinical hours, the same patient volume, and no major equipment investments. You simply made four focused improvements over four months.
Tracking Your Progress
Calculate your Revenue per OD Hour monthly. Put it on a simple spreadsheet or dashboard:
Collections
Oct - $80,000
Nov - $83,200
Dec - $86,600
Clinical Hours
Oct - 138.5
Nov - 138.5
Dec - 138.5
Rev/Hour
Oct - $578
Nov - $601
Dec - $625
Watch the trend line. Even small monthly improvements compound into substantial annual gains.
Share this number with key team members (office manager, optician). When they understand how their contributions impact revenue per hour, they become active partners in improvement rather than passive employees following instructions.
What This Metric Can't Tell You
Revenue per OD Hour is powerful, but it's not the only metric that matters:
It doesn't measure patient satisfaction, clinical quality, or staff morale. You could theoretically maximize revenue per hour by rushing through exams, pressuring optical sales, and overworking yourself—none of which are sustainable.
Use Revenue per OD Hour as one tool in a balanced dashboard that also includes:
Patient satisfaction scores
Staff retention rates
Your personal quality of life and work-life balance
Clinical outcome measures
The goal isn't maximum revenue per hour at any cost. It's optimized revenue per hour while maintaining excellent care and sustainable practice.
Taking Action This Week
Pull your numbers right now:
What were your collections last month?
How many clinical hours did you work last month? (Be honest—count only patient care time)
Divide collections by clinical hours
That's your baseline Revenue per OD Hour.
Now choose one improvement from the toolkit above to implement this week. Just one.
Next month, calculate again and see if your number moved.
Then choose another improvement for the following month.
Small, focused, consistent improvements compound into dramatic results over time.
You don't need to overhaul your entire practice. You just need to make steady, intentional moves that compound week after week.
