Why is Measuring Sick to Well Ratio Important for your Pediatric Practice?

Simply put, measuring wellness-to-sick ratio estimates the focus a practice has on preventive care. And how can this info help your practice? Data shows that practices that have fewer sick visits to well visits tend to be practices with better financial outcomes.

But there are other reasons why measuring sick to well ratios are beneficial to your practice. Practice Management extraodinaire Chip Hart from PCC has some really good reasons as to why measuring this number is good for your practice. Chip says that “with the massive fluctuations in sick visit demand (look at the 2010 flu season and look at now), consistent well visit placement is crucial to business stability.” Chip also adds that well visits establish a practice’s value more than runny noses and sore throats. “It’s a chance to really get to talk about what YOU want while also listening to the parents. It’s a doctors chance to look at the whole health of the child, not just fix an acute problem which, most of the time, common sense fixes anyway.”

To calculate your wellness-to-sick ratio, divide total sick visits by total well visits (both new and established patients). Some offices remove the 99211 from the calculations and only use 99212 thru 99215 as well as the new patient codes.

To give you perspective, the national average in 2010 is 2.06. In other words, nationally, practices see 2.06 visits for every 1 well-child visit. Better performing pediatric practices rate between 1.9 and 1.6 sick visits for every 1 well visit.

Of course every practice is not the same and the numbers will most likely be different. But experts say that if your practice is within the 3:1 or 4:1 range, your practice is heavily focused on acute visits; which can lead to difficulty in making ends meet.

Just remember that the benchmark is designed to give you a rough idea. Ideally, you should calculate your ratio as far back as you can, compare it year over year to determine how your practice is doing, and use those numbers as a benchmark.

Fundamentally, measuring your sick to well ratio (and improving them) will not only give  your practice a stronger financial footing, but the practice will enhance the healthcare needs of your community by being more proactive with prevention wellness.


  1. Right on! :-)



  1. […] recently read this article by Brandon Betancourt in his blog, Pediatric, Inc. It’s worth a read if you’re a […]


  2. […] Well visits revenue is different than sick child revenue, so you can manage these two visits and make a big difference in how your practice does financially. […]