What a Visit Actually Costs: Consumables, Time & the Service Mix
A clinic can be busy, well-run and quietly losing money on half of what it does, because consumable cost per visit is never calculated. How to build the number from records you already keep, and what it usually reveals about your service mix.
Ask a clinic manager which service is most profitable and you will get an answer. Ask how they know and the answer is usually revenue — the service that bills most. Revenue is the easy half. The consumables, the staff time, the equipment sitting idle between uses and the stock that expired unused are the other half, and they are rarely attached to anything.
The result is a familiar pattern: a clinic works hard, bills steadily, and cannot explain why the bank balance does not reflect it. The explanation is nearly always in the mix — a subset of services being delivered below cost, subsidised by the rest, invisibly and consistently.
Four costs, and only one is obvious
| Cost element | How clinics usually treat it | What that hides |
|---|---|---|
| Consumables used | A monthly stores figure | Which service consumes what — the whole question |
| Clinical staff time | Salaries, fixed and unallocated | That a 40-minute procedure and a 5-minute review cost very differently |
| Equipment and its upkeep | Capital, then repairs as they arise | That a machine used twice a week still costs the same as one used daily |
| Expired and wasted stock | A write-off at the count | That the waste concentrates in specific low-volume services |
The last row deserves attention because it behaves counter-intuitively. Waste concentrates where volume is lowest — a reagent or consumable bought in a pack size suited to a busy service, used twice, and discarded at expiry. So the least-used services carry the highest waste cost per patient, which is exactly the opposite of how most people assume it works.
Waste concentrates where volume is lowest. Your least-used service is quietly your most wasteful one, and it is the one nobody is watching.
Build the number from what you already record
You do not need an activity-based costing exercise. You need a reasonable consumable cost per service type, and it can be assembled in an afternoon.
-
List your services by volume, and take the top eight
The tail does not matter yet. Eight service types typically cover the large majority of a clinic's activity, and the exercise stays finishable.
-
Write the standard consumable list for each
What is used for one typical instance — gloves, syringe, dressing, reagent, gown. This is a clinical conversation of about twenty minutes per service, and it is the only part that needs a clinician.
-
Price the list from your own stock costs
Not from a supplier list — from what you actually paid, landed. This is where the number becomes yours rather than theoretical.
-
Compare against what the service bills
Consumable cost against price is a floor, not a full margin. If a service does not clear it, nothing else in the calculation will save it.
One procedure, honestly costed
Illustrative, in KES. The useful output is not the margin percentage but the comparison across services. Once eight of these exist, the question stops being "are we profitable" and becomes "which three of these should we do more of, and which one is being subsidised by the rest?"
Reconciling issues against activity
Once a standard consumable list exists per service, a second and rather powerful check becomes available: compare what should have been consumed, given the month's activity, against what was actually issued from the store.
A persistent gap has three honest explanations — the standard list is wrong, wastage is higher than assumed during procedures, or stock is leaving for another reason. All three are worth knowing, and none of them is visible from a monthly stores total. Most clinics that run this comparison for the first time find that their standard list was simply incomplete, which is itself worth the exercise.
Issue to a department, not to the clinic
The comparison only works if stock issues have a destination — theatre, laboratory, dressing room, dental. Issuing to a named department costs seconds and converts an unusable monthly total into a per-service consumption figure. Without it, this entire calculation stays theoretical.
What the answer usually changes
Three decisions typically follow, and they are rarely the ones the clinic expected before running the numbers.
What clinics assume
- Prices need to rise across the board
- The busiest service is the most valuable
- Waste is a discipline problem
- Low-volume services are harmless if occasionally requested
What the numbers usually show
- One or two specific services are the problem, not the price list
- A high-volume, low-margin service can consume capacity that a better one needs
- Waste is mostly a pack-size and volume problem
- A rarely-used service with expiring stock can cost more than it earns, every month
The pack-size finding is the most actionable and the least intuitive. A clinic buying a reagent in the only pack size the supplier offers, using a third of it before expiry, is paying three times its assumed cost per test — and the fix is a supplier conversation or a service decision, not a staff briefing about carefulness.
What we do and do not do
What AWRA OpsHub does today
- Stock issues by department or destination, which is what makes per-service consumption computable.
- Landed cost on stock items, so the consumable figure reflects what you actually paid to have it on the shelf.
- Write-offs with reasons, so expiry and wastage are separable from ordinary consumption.
- Batch and expiry tracking, with a horizon view of what is approaching expiry.
- Purchase history and supplier performance, which is the evidence for a pack-size or supplier conversation.
- Reporting on issues and costs, schedulable to whoever runs the monthly review.
More we can add to your workspace
- A consumable bill of materials per procedure. A standard consumable list held against each service, so cost per visit derives itself instead of being maintained on a spreadsheet beside the system.
- Patient billing against a visit. An invoice raised from the recorded visit and the consumables it consumed.
- Activity-to-consumption reconciliation as a report. The monthly comparison described above produced for you, rather than assembled by a person each period.
Where we point you to a specialist
- Patient records, the appointment book and clinical activity counts belong in your clinical system. Visit and procedure volumes come from there; the cost side comes from here.
- Insurer claims and capitation go to a specialist claims system. The formats, rules and adjudication involved are a category of their own, and we would point you at it rather than approximate it.
The division is consistent and worth stating once: activity comes from your clinical system, cost comes from here, and the comparison is a monthly exercise by a person until the reconciliation report above is built. That is still considerably more than most clinics have today.
Anything above that you need, we can build for you
Everything listed above as something we can add describes what ships in the standard product today — it is a starting point, not a limit on what AWRA OpsHub can do for your organisation. Kenya's eTIMS integration and its maintained payroll engine are both in the product because clients needed them and commissioned them; neither appeared by itself, and the same door is open for whatever you just read about. One qualification so this is worth what it claims: a small number of things on this blog we deliberately leave to a specialist rather than build — a statutory ledger we will not sign our name to, a rule that would decide a tax question for you, a clinical or member-funds record that belongs in a regulated system — and where that is true the post says so in those words. Everything else is a scope, a timeline and a price.
The operational work, which is what most commissions actually are
An extra approval stage in a chain that does not match the standard one, a custom field set on employees or assets that only your sector needs, an expiry that has to block an order rather than send an email, a report your board asks for in a shape nothing produces, or a scanner or weighbridge feeding the goods-in door. These are the commissions we are asked for most often and the smallest ones we quote — and unlike a revenue-authority pipeline, none of them waits on a regulator.
The module-shaped additions, which are the ones readers ask for most often
A price list with real discount authority, a customer-facing quotation that expires, a bill of materials or recipe costing, a staff advance that is issued, acquitted and chased, a member or unit ledger, a matching rule that holds a payment. Each of these is a build rather than a setting, and each has been quoted before — a bigger piece of work than a custom field, with a written spec and a date instead of a roadmap slide.
The report, document or pack nothing currently produces
The board pack in the shape your board actually asks for, a donor or funder layout, an invoice or receipt template carrying what your regulator or your customer expects, a dataset the report builder cannot reach yet. Usually the fastest thing on this list to deliver, because the data is already in the system.
Systems, rails and hardware you already run
The accounting package, CRM, online store, core banking or custom database you intend to keep — connected through our API so a fact is entered once and appears everywhere it is needed. Plus the physical edge: a scanner, a scale, a weighbridge or a till peripheral feeding the door it belongs to.
How it works: you describe the requirement, we return a written scope, timeline and cost, and once agreed it is built into your environment and maintained as part of the product. Nothing here waits on a regulator or a published specification, which is why operational builds are the ones we quote fastest. Tell us the requirement that would otherwise rule us out — that is a better first conversation than a demo.
Tell us what your operation needsOur take
Issue stock to departments rather than to the clinic, write a standard consumable list for your top eight services, and price it from landed cost. One afternoon produces a floor price for each service and, almost always, one uncomfortable discovery about a low-volume service whose expiring stock costs more than it earns.
See inventory for clinics
Stock issued by department, landed costs on items, batch and expiry tracking, and write-offs with reasons you can separate from consumption.
Explore inventoryFrequently asked questions
Do we need patient-level costing to do this?
No, and attempting it is how the exercise never finishes. A standard consumable list per service type, priced from your own landed costs, gets you most of the insight for a fraction of the effort. Patient-level variation matters clinically and rarely changes the commercial conclusion, which is usually about a service or a pack size rather than about individual cases.
Where do the visit and procedure volumes come from?
Your clinical or practice management system — there is no patient record, appointment book or activity count here, and this is not an EMR. In practice this means one number per service type typed into a monthly review, which is a real limitation and still leaves you far ahead of a clinic working from a single monthly stores total.
Why does our stores figure not match what services should have used?
Three honest possibilities, and the first is the most common: the standard consumable list is incomplete, because it was written from the procedure rather than from what actually gets opened. The second is that in-procedure wastage is higher than assumed. The third is that stock is leaving for another reason. Running the comparison monthly narrows it down quickly, and the first two are usually fixed within a quarter.
How do we reduce expiry waste on low-volume services?
Attack the pack size before the discipline. Waste concentrates where volume is lowest, and the usual cause is buying a reagent or consumable in a pack sized for a busy service and using a third of it. The conversations that actually help are with the supplier about smaller packs or more frequent delivery, and with yourselves about whether a rarely-requested service earns the stock it ties up. Staff carefulness is rarely the binding constraint.
Should we raise prices if a service does not cover its costs?
Sometimes, but check the mix question first. A service that fails on consumable cost alone has a pricing or a pack-size problem. A service that clears consumables but consumes disproportionate clinical time may be crowding out something better, in which case scheduling changes what a price rise cannot. The value of costing eight services rather than one is precisely that it shows you which of those two situations you are in.
