How to Calculate PVA, Care Plan Completion, and Unused Visits

Patient Visit Average: Which Visits and Which Patients Count

Patient Visit Average, or PVA, is meant to tell you how many times the typical patient comes in before they stop. It is one of the most watched numbers in chiropractic and manual therapy clinics. The trouble starts with the definition: Which patients are you including, and which visits count?

To calculate PVA, start with a list of unique patients who began care during a specific period. For each patient, count the number of billed visits from their first visit through either their discharge, their last kept appointment, or the end of the measurement window. Then, add up these visit counts and divide by the number of patients.

Some clinics count every visit, including re-exams and no-charge visits. Others exclude visits for non-chiropractic services, like nutrition consults or massage. For a clear picture, stick to visits that are part of the care plan prescribed at intake. Consistency matters. Changing your inclusion rules mid-year will throw off your benchmarks and make year-over-year comparison impossible.

Decide if you will include patients who only came in once for a screening or emergency, and be strict. Counting just the "real" cases will inflate your PVA, but including everyone who ever scheduled can drag it down. Most clinics settle on only including patients who began a formal care plan.

Keep reading: A Week at a Chiropractic Front Desk: How Missed Visits Come Back

Why New Patient Months Distort PVA and How to Read Around It

PVA is sensitive to the mix of new and existing patients in your reporting period. New patients naturally start with one or two visits, so when you have a surge of new patient starts, your PVA will dip even if nothing about your retention has changed. This can happen in January after a marketing push or after a community event.

For example, if you see 20 new patients this month, and each has only had their first or second visit, these low-visit counts reduce your average compared to a month heavy with continuing care. The effect is most noticeable in small clinics, where a handful of new starts can swing the average by several points.

To get a truer read, calculate PVA for patients who started at least twelve weeks ago, or run two separate numbers: one for all patients, and one for patients past their first month. This helps you see if your care plan retention is holding steady, or if you are only seeing the effect of new patient flow.

Some practices use a rolling average over several months to even out the swings. Others track cohort PVA, which follows a batch of new patients over the life of their plan, regardless of what month they started. Both approaches give you a clearer sense of patient engagement and practice health.

Care Plan Completion Rate: Completed, Abandoned, or Still Open

Care plan completion rate measures what percentage of patients finish the plan as prescribed. This is not the same as PVA. Here, the denominator is the number of patients who started a care plan, not the number of visits. The numerator is the number who make it to their last scheduled visit, or reach the clinical goals set at intake.

For each care plan, the status is either completed, abandoned (the patient stopped showing up), or still open. The challenge is in defining "completion." Some clinics mark a plan as complete only if every visit was attended. Others accept a plan as completed if the patient finished at least a certain percentage of visits and met their goals.

To keep this number meaningful, use a clear rule. For instance, a plan counts as completed if the patient finishes 90 percent or more of scheduled visits and attends their final re-exam. Plans still in progress at the end of the reporting period are not counted as completed or abandoned yet.

Abandoned plans, where a patient stops showing up, should be tracked separately. Ignoring these cases will make your completion rate look better than it is. On the other hand, marking a plan abandoned after just a week of silence may underestimate your true retention, so set a reasonable interval (often 30 or 60 days without a visit).

Keep reading: How to Set Visit Frequency and Duration in a Chiropractic Care Plan

Counting Unused Prepaid Visits as a Liability, Not Revenue

Many clinics offer prepaid packages: the patient pays up front for a block of visits. The money comes in immediately, but not every visit gets used. Unused visits can become a hidden liability, especially if state law or card processing rules require you to offer refunds on unused services.

To track this, keep a running tally of visits paid for but not yet delivered. If a patient buys 24 visits and only uses 15 before quitting, you have nine visits outstanding. Instead of booking all the revenue at the time of sale, only recognize income as visits are used. The balance should sit as a liability on your books, money you may need to return if the patient requests it or if you are audited.

This approach also helps you see how many patients are abandoning prepaid plans and how much potential revenue is at risk. If you notice a pattern of unused visits, this may point to an issue with care plan design, patient engagement, or scheduling follow up. Regular reconciliation of prepaid visit balances keeps your financials honest and your compliance clean.

Missed Visit Rate and Reschedule Rate Are Not the Same Number

Missed visit rate tracks the percentage of scheduled appointments that patients do not attend or cancel with short notice. It helps you spot gaps in engagement and the effectiveness of your reminder systems. To calculate it, divide the number of missed appointments by the total number of scheduled appointments in a period.

Reschedule rate, on the other hand, measures how many missed visits actually get made up. It is not uncommon for a clinic to have a high missed visit rate but still keep patients on track, if staff are diligent about follow-up. To compute the reschedule rate, track missed appointments that are later rebooked and attended within the original care plan window.

For example, if ten visits are missed in a month and six are rescheduled and completed within two weeks, your reschedule rate is sixty percent. The key is to link the rescheduled visit to the original missed slot, not just any return visit. Some clinics set a policy that a rescheduled visit must occur within a certain timeframe to count, such as within the same week or care phase.

Tracking both numbers gives a better sense of patient reliability and the clinic's ability to keep patients progressing through their plans. A rising missed visit rate without a corresponding reschedule effort often signals a need to tighten recall and reminder processes, or to review patient motivation discussions during intake.

See how CarePlanTrack handles this for chiropractic and manual therapy

Collections Per Visit and What It Hides About Case Value

Collections per visit is a simple calculation: total collected revenue divided by total visits in a period. It is often used as a proxy for financial performance, but it can mask important details about your practice mix and case value.

If you have a higher-than-normal collections per visit, it could be because you had more initial visits or re-exams, which tend to be reimbursed at higher rates. Alternatively, a drop may mean more maintenance or wellness visits, which are often cash and lower in fee amount. Insurance reimbursement changes and fee schedule updates can also distort this number from month to month.

Collections per case is another important measure. This is the total collected from a patient over the life of their care plan. Divide total collections by the number of cases closed in a period. Comparing collections per visit to collections per case can reveal whether you are seeing many short, low-value plans or fewer, higher value ones.

Monitoring both numbers side by side helps you spot trends: for example, if collections per visit stays steady but collections per case drops, you may have more incomplete care plans or increased early drop-off. This can prompt a review of patient onboarding, care plan design, or financial discussions at intake.

Re-Exam Compliance as a Number You Can Actually Verify

Re-exams are a key checkpoint in most care plans, both for clinical reasons and to support medical necessity documentation. But clinics often struggle to ensure re-exams are scheduled and completed on time. Re-exam compliance tracks the percentage of care plans where required re-exams are actually conducted at the scheduled interval.

To measure this, review all active care plans in a given period. For each, check whether the re-exam was performed at the visit interval set in the care plan (for example, every 12th visit or every 30 days). Divide the number of compliant plans by the total number of plans requiring a re-exam.

This is a number you can audit directly from your schedule and patient records. High compliance means your care plans are not drifting and your documentation is defensible. Low compliance can expose you to issues with insurance payers or regulatory scrutiny, as well as indicating that patients may be slipping off-plan without timely reassessment.

Monitoring re-exam compliance also helps identify workflow bottlenecks. If re-exams routinely get missed, look at scheduling scripts, provider reminders, and patient education. Sometimes, a simple process tweak or automatic alert can lift your compliance rate by a meaningful margin.

Reading All of Them Together Across a Rolling Twelve Weeks

Looking at any one of these numbers in isolation can mislead. A high PVA might hide a low care plan completion rate if patients are drifting in and out but not finishing. A strong collections per visit number might mask a growing unused prepaid liability if many visits go undelivered. Missed visit rate and re-exam compliance, tracked together, can show whether patients are truly following the plan or just sliding through the schedule.

To get a real sense of clinic performance, track each number using a rolling twelve-week window. This smooths out short-term spikes from marketing events or seasonal slowdowns and gives you enough data to spot meaningful trends. Set up your reports to update weekly, always looking back over the prior twelve weeks, so you catch changes early and act before small leaks become big problems.

Most importantly, make sure your numbers are built from the same definitions every time. Standardize which visits count, how you define completion, and how you handle open and abandoned plans. This consistency lets you compare results month to month and year to year, supporting better decisions and cleaner compliance.

Tracking all these metrics by hand is possible, but time-consuming and error-prone. Tools that automate care plan visit tracking, show patient progress, alert you to missed visits, and manage re-exam scheduling can help clinics keep their numbers accurate and actionable, freeing time for patient care and practice growth.