How to counter medical misinformation and support engaged patients

In 2021, the American Health Information Management Association Foundation surveyed 1,059 U.S. residents age 18 or older in a nationally representative sample. The survey found that Americans typically seek out health information by contacting their doctor and the internet equally. Of those who secure health information from the internet, 86 percent are confident the information is credible.

This can sometimes be a challenge for healthcare practitioners, because health misinformation—information that is false, inaccurate, or misleading according to the best available evidence at the time—is abundant on the internet. Health misinformation is a significant obstacle in healthcare, as it can lead to misunderstandings, poor health decisions, and adverse outcomes for patients. In a recent survey of physicians by The Doctors Company, 64 percent of physicians named misinformation on social media one of the most challenging aspects of practicing medicine.

Calling Dr. Google

Patients’ engagement in their personal health can be an advantage, with the proper guidance and support from practitioners. However, when patients consult “Dr. Google,” some websites may provide inaccurate or misleading content.

This issue of accurate versus inaccurate online medical information was highlighted during the COVID-19 pandemic. In 2021, the U.S. Surgeon General’s advisory Confronting Health Misinformation focused on this serious threat to public health and called on all of us to limit the spread.

Challenges for Practitioners

Correcting misinformation requires time and effort: Practitioners are encountering longer visit times when there is a need to discuss internet-collected health information with patients. Patients can sometimes have a strong belief in and be adamant about the assembled misinformation, which can result in increased patient anxiety.

Practitioners who dismiss or criticize the online search efforts of patients may negatively impact practitioner-patient trust. It can also be a challenge to change patient perspectives when misinformation is deeply believed, even when the practitioner is providing information from a trusted source.

Addressing health misinformation with patients

Former American Medical Association (AMA) president Gerald E. Harmon, MD, noted in a 2022 press release regarding a new AMA policy addressing public health disinformation that “physicians have an ethical and professional responsibility to share truthful information, correct misleading and inaccurate information, and direct people to reliable sources of health information.”

It’s often said that trust is the medical currency of healthcare, and in partnering with patients to help them understand medicine, practitioners are making deposits. Ruth Carrico, PhD, DNP, APRN, explained to the American Association of Nurse Practitioners (AANP) her view that overcoming medical misinformation is a journey on which to partner with the patient, first understanding why patients turn to the sources they do for medical guidance.The AANP offers an infographic tool, A Clinician’s Guide to Medical Misinformation: Communication Is Key, to support clinicians in combating medical misinformation.

Patient Safety Strategies

Engaging with patients who are relying on health misinformation requires a thoughtful approach to ensure patient safety, retain trust, and promote health literacy. Here are some strategies practitioners can use:

• Listen to patients' concerns and beliefs without judgment. This fosters open communication and shows that you respect their perspective. By actively listening to concerns and providing clear, evidence-based information, practitioners can build trust and encourage patients to participate in their healthcare journey.
• Show empathy and understanding toward patients' fears and misconceptions. Acknowledge their feelings and provide reassurance.
• Use plain language to explain complex medical terms in simpler language. Avoid medical jargon and ensure that patients fully understand the information being provided. To support this, apply universal health literacy precautions—an approach that assumes all patients may have difficulty understanding health information and therefore emphasizes clear, accessible communication for everyone. Clear communication helps prevent misunderstandings and misinformation.
• Share reliable, evidence-based sources of information. Use reputable websites, peer-reviewed articles, and official health guidelines. (See the resources listed below.)
• Using the Teach-Back Method, ask patients to repeat the information in their own words to ensure they have understood correctly. This helps identify any misunderstandings.
• Use visual aids such as diagrams, charts, and videos to explain complex medical concepts. Visuals can make information more accessible and easier to understand.
• Gently correct misinformation by providing accurate information and explaining why the misinformation is incorrect. Use facts and evidence to support your explanations.
• Help patients develop critical thinking skills by teaching them how to evaluate the credibility of sources and recognize biased information. Critical thinking skills are essential in identifying and rejecting misinformation.
• Maintain a trustworthy and transparent relationship with patients. Be honest about what is known and what is still uncertain in the medical field. When patients are well-informed, they can actively participate in discussions about their care, leading to decisions that are aligned with their values and preferences.
• Schedule follow-up appointments to address any ongoing concerns and reinforce accurate information. Continuous follow-up and support maintain positive patient engagement.

Through these strategies, practitioners can effectively combat health misinformation and empower patients to make informed health decisions.

Reputable resources

These are reputable websites, known for their accuracy, credibility, and comprehensive coverage of health topics, where patients can find reliable health information:

• American Cancer Society (ACS): The ACS offers detailed information on cancer prevention, treatment, and research at https://www.cancer.org.
• American Heart Association (AHA): The AHA provides information on heart health, including prevention, treatment, and research on cardiovascular diseases at https://www.heart.org.
• Mayo Clinic: The Mayo Clinic offers expert advice on a wide range of health topics, including symptoms, treatments, and preventive care at https://www.mayoclinic.org.
• MedlinePlus: MedlinePlus, a service of the National Library of Medicine, offers reliable health information, including articles, videos, and links to other trusted sources at https://medlineplus.gov.
• National Institutes of Health (NIH): The NIH provides detailed information on medical research, clinical trials, and health conditions at https://www.nih.gov.
• WebMD: WebMD provides comprehensive health information, including symptom checkers, drug information, and articles on various health conditions at https://www.webmd.com.
• World Health Organization (WHO): The WHO offers global health information, including disease outbreaks, health statistics, and international health guidelines at https://www.who.int.

For guidance and assistance in addressing any patient safety or risk management concerns, contact Patient Safety and Risk Management at (800) 421-2368 or by email.


The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

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2026: The year for sunsetting old guard revenue cycle metrics

For decades, healthcare financial leaders have leaned on the same tired revenue cycle metrics: days in A/R, net collection rate, clean claim pass rate. While these metrics can provide a surface-level view of financial health, the big question is: what have they done for your operational margin lately?

Scaling operations is imperative for providers within the current economic climate, but when it comes to moving the needle on margin, many financial leaders are finding that traditional workflows and benchmarking are not rising to the challenge. The reason? Healthcare organizations still rely on labor heavy processes and metrics that are lagging indicators. The model is broken. We can’t keep throwing people at problems and hoping margin magically improves.

Macro-economic pressures are only intensifying as reimbursements continue to shrink, operational costs keep rising, and staffing shortages aren’t going away. Meanwhile the industry is bracing for the dual shock of Medicaid cuts and higher ACA premiums. Rural health is in especially dire shape with over 30% of rural hospitals now at risk of closure.

So, if we think that legacy revenue cycle metrics are going to carry us through 2026, we’re fooling ourselves. New challenges require new operating models. Below are four tactics financial leaders must embrace to build a sustainable, margin-positive future.

1. Embrace new benchmarking models focused on labor effectiveness

There’s a massive margin opportunity hiding in plain sight: administrative waste, which represents nearly a third of all healthcare waste.

Yet most organizations have zero visibility into how effectively staff are converting work effort into actual dollars. Until financial leaders can quantify the number of human touches required to collect a dollar, they can't measure the true cost, or opportunity, inside their revenue cycle.

A recent analysis of millions of human touches within MedEvolve’s database related to insurance claim collections found that 62% of revenue cycle touches are wasted, and 40% of denials result from pre-registration breakdowns. That’s not a workforce problem; it’s a process problem. And process problems can be fixed.

Benchmarking must evolve to focus on labor effectiveness to speed reimbursement and financial health. Some key targets include:

• >85% Zero Touch Rate—payments that received no human intervention
• <15% Avoidable Touches—actions that did not produce a financial outcome
• <10% of Touches for Denials—efforts to overturn a denial and get payment, including claims issues like pre-authorization, benefits and eligibility and coding
• >90% First Touch Payment Rate— when staff must intervene, payment is received after the first touch

These leading indicators help leaders identify where breakdowns are occurring by identifying root causes of revenue cycle hangups before the financial impact.

2. Use AI and automation where they actually drive ROI

Of all the administrative areas in healthcare where AI and automation are expected to have an impact, revenue cycle ranks high. The key is identifying and deploying solutions that will deliver the greatest ROI.

The reality is that the market is flooded with shiny new tools to improve financial performance. However, moving towards a benchmarking model built on labor effectiveness requires automation that tracks every “human touch” behind a claim and drills down into that data to uncover performance improvement opportunities. EHRs and practice management systems alone are not built for this.

Workforce automation and AI can not only deliver this kind of labor intelligence, but the right solution can also guide staff to daily activity that will speed revenue cycle and produce the greatest ROI.

3. Prioritize upstream fixes; especially in pre-registration

With 40% of denials originating before the patient even walks into the clinic or hospital, pre-registration is the single biggest choke point in revenue cycle performance.

Pre-registration accuracy has become even more critical as payers increasingly deploy bots to deny claims at scale. They simply look for errors such as eligibility gaps, missing authorizations, inaccurate demographics and deny claims instantly.

In effect, providers are competing against automated denial engines with manual processes. It’s a losing battle. If providers don’t automate financial clearance upstream, they are guaranteeing downstream denials, rework, and wasted labor.

Automation and AI that validate eligibility, benefits, authorization, and accuracy before the visit reduce downstream chaos, speed reimbursement, and massively improve zero-touch rates while allowing staff to focus on more complicated revenue cycle issues. Every dollar saved from preventing a denial is worth exponentially more than the cost of overturning one.

4. Re-evaluate outsourced vendors with real performance data

Outsourcing has long been framed as a cost-saving strategy. But lower hourly rates don’t mean lower total cost. Not when the quality of work is inconsistent, inefficient, or flat-out ineffective.Once you benchmark against metrics like zero-touch and first-touch payment rates, you might find that while you’re paying $10 per hour for offshore staff versus $20 for onshore, the difference in quality and effectiveness of work effort tells a different tale. Unfortunately, most leaders lack transparency into the actual work that’s being done by outsourced partners.

Consider what it would mean for the average provider organization to increase its labor capacity by 60% or more internally and eliminate those offshore contracts. Or, by increasing capacity for existing resources, consider how a rural health organization struggling to stay afloat could materially improve operational margin.

2026: The year for rewriting financial health

Every headline right now is about crisis: closures, cuts, staffing shortages, declining reimbursement. Communities depend on financially stable healthcare organizations and patients depend on accessible care, but healthcare organizations are only as healthy as their bottom line.

It’s easy to stay anchored to what’s “always worked” in revenue cycle. However, the industry’s economic reality demands stronger, forward-thinking leadership, and financial leaders are the ones who can reverse the trend by adopting benchmarking and technology that directly improve operational margin.

2026 isn’t the year to just survive. It’s the year to sunset the old revenue cycle metrics and focus on what truly matters: measurable, predictable, margin-positive performance.

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Navigating the complexities of staffing in modern medical practices

In today’s fast-evolving health care landscape, medical practices face a myriad of challenges, with staffing emerging as one of the most significant hurdles. As the second biggest problem confronting clinics today, effective staffing is crucial to maintaining the quality of care and ensuring operational sustainability. In this article, I delve into the multifaceted issues surrounding staffing in medical practices and share insights from my own journey to illustrate how innovative approaches can lead to meaningful solutions.

The staffing conundrum: A dual perspective

From the clinic’s viewpoint, the staffing dilemma is a complex puzzle. The current health care ecosystem is witnessing a decline in the number of individuals pursuing careers as medical assistants and licensed practical nurses. This trend, coupled with high attrition rates, leaves clinics scrambling to cover essential roles. In stark contrast to my experience in 2018, where we maintained a balanced ratio of medical assistants to clinicians, by 2022, the burden had shifted dramatically. Often, a single medical assistant was tasked with supporting three physicians, a situation that inevitably led to burnout and accelerated staff turnover.

On the other hand, the staff face a slew of external pressures that exacerbate their professional challenges. The soaring inflation rate has made everyday living increasingly difficult, and the rising costs of childcare strain family resources further. Additionally, the consolidation of medical practices under larger health systems has resulted in reduced workplace flexibility and inflated costs of health insurance, factors that heavily influence job decisions.

Innovative solutions for recruitment and retention

In response to these challenges, my transition to a direct primary care model in 2022 has been both a revelation and a relief. Our approach centers on creating a work environment that is both nurturing and sustainable, prioritizing the well-being of our staff as much as that of our patients.

1. Managing patient load: By consciously keeping patient numbers low, we mitigate the risk of burnout among our medical assistants. This strategy allows us to allocate sufficient time for each patient interaction, enabling physicians to manage their own orders directly and efficiently.

2. Valuing our team: Competitive salaries are just the starting point. We conduct regular performance reviews to ensure our staff feel recognized and compensated fairly. Bonuses are awarded to those who exceed expectations, fostering a culture of excellence and motivation.

3. Flexibility and work-life balance: Understanding the importance of time off, we offer additional holidays, such as the Friday after Thanksgiving and both Christmas Eve and Christmas Day. These gestures not only boost morale but also demonstrate our commitment to our team’s personal lives.

As well as the support staff, we also need to consider the stresses placed on clinical staff, including physicians, physician assistants and nurse practitioners. Over the past few years, the demands placed on these professionals have escalated dramatically. The relentless increase in patient numbers necessitates a considerable amount of time and energy from health care providers. Simultaneously, the administrative burden has surged, with documentation requirements expanding and bureaucratic involvement intensifying. These layers of complexity not only detract from the time clinicians can dedicate to patient care but also contribute to professional burnout, a growing epidemic within the medical community.

Moreover, the financial landscape for health care professionals is fraught with challenges. The escalating costs of medical education and training have created significant financial burdens, compelling many physicians to gravitate toward higher-paying specialties. This financial imperative often leaves primary care — a cornerstone of effective health care delivery — understaffed and overburdened. The shortage of primary care specialists is exacerbated as seasoned professionals retire, leaving a chasm that must be filled by the next generation of clinicians.

However, the future of health care remains uncertain as these younger physicians are increasingly drawn to nonclinical roles, driven by the allure of better work-life balance and fewer bureaucratic hurdles. This trend threatens to perpetuate the cycle of shortage, further straining the system and potentially compromising patient care.

The path to resolving staffing issues in medical practices is neither simple nor straightforward. However, by embracing innovative models and prioritizing the needs of health care professionals, we can begin to reverse the trends of attrition and burnout. It is imperative that we continue to explore adaptive strategies that not only attract top talent but also create an environment where they can thrive. In doing so, we ensure that our clinics are not only operationally sound but also places of healing and hope for both staff and patients alike.

The journey of transforming staffing challenges into opportunities for growth is ongoing. By sharing our experiences and insights, we can inspire others in the field to rethink traditional paradigms, ultimately paving the way for a more resilient and responsive health care system.

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MGMA poll: Denials are biggest revenue-cycle “leak” for medical practices

Denials and appeals are the leading source of revenue “leakage” for medical practices, according to a new Medical Group Management Association (MGMA) Stat poll that also points to persistent breakdowns at the front desk, in coding and documentation, and in patient collections.

In the Jan. 6 poll, 48% of respondents said denials and appeals were the biggest leak in their revenue cycle, MGMA reported in a post published Jan. 7. Another 23% cited front-end issues such as eligibility and benefits verification, followed by billing and collections (14%), coding (13%) and charge posting (2%). MGMA said the poll drew 288 applicable responses.

MGMA’s takeaway: Many organizations don’t have one failure point, they have a chain reaction. An eligibility miss at scheduling or check-in can turn into a denial, a delayed bill and an aging account, the association said.

Denials: Payer rules, prior authorization and medical necessity disputes

Respondents described denials as “overwhelmingly payer-driven and preventable,” MGMA said, citing common themes such as medical necessity determinations, noncovered services, bundling and global package edits, utilization-management friction tied to prior authorization and post-service records requests, eligibility and coordination-of-benefits problems, timely filing, and credentialing- or CLIA-related denials.

The survey findings arrive as practices continue to report heavy administrative burden tied to prior authorization. The American Medical Association has reported that prior authorization consumes staff time and contributes to physician burnout. Federal watchdogs have also flagged concerns in Medicare Advantage, with the HHS Office of Inspector General reporting that some denied prior authorization requests met Medicare coverage rules.

A fix that starts before the claim: Front-end discipline

Physicians Practice coverage has long argued that denial prevention is often an upstream problem, not a back-end heroics problem: verify eligibility, confirm deductibles, and check prior authorizations before the visit when possible.

One practical starting point is measurement. A Physicians Practice article on revenue KPIs recommends verifying eligibility for every single patient for every appointment, confirming how much deductible has been met, and tracking denial percentage, bill lag and days in accounts receivable to identify process drift.

Patient-pay pressure shows up in collections

Billing and collections ranked third in MGMA’s poll, with respondents pointing to higher patient responsibility and inconsistent point-of-service collection.

On the practice side, Physicians Practice has urged leaders to set expectations early and make it easier to pay. Recent guidance includes collecting balances at check-in with clear signage and staff scripting, plus tracking point-of-service collections for consistency.

Coding: Undercoding and documentation gaps can quietly drain revenue

Coding was identified as the biggest leak by 13% of MGMA poll respondents, with MGMA pointing to undercoding — particularly for evaluation and management services — missed codes, modifier issues and documentation gaps that fail to support medical necessity.

Physicians Practice recently published a 2026-focused coding guide that argues “simple, repeatable coding habits” can cut denials, support compliance and protect margins — the kind of operational consistency MGMA says practices need across the revenue cycle.
Where tech fits: don’t skip the fundamentals

MGMA noted that many organizations are exploring AI and automation, including documentation tools, to reduce errors and improve the completeness of clinical notes.

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Portable MRI shows promise for detecting strokes in emergency settings, study finds

A portable, AI-powered MRI system designed to bring brain imaging directly to the bedside demonstrated strong performance in detecting strokes, including very small ischemic lesions, according to results from the largest data set yet evaluating the technology.

Hyperfine Inc. said a prospective, multi-center observational study published in the November issue of Stroke: Vascular and Interventional Neurology evaluated 95 patients and found that its next-generation Swoop portable MRI system significantly improved diagnostic accuracy and efficiency compared with earlier versions of the scanner. The data support the use of portable MRI for stroke detection in multiple clinical settings, including hospital emergency departments, where time is critical.

The study combined data from the ACTION PMR study at Massachusetts General Hospital and Buffalo General Medical Center with additional patients from Yale New Haven Hospital. Researchers assessed how well the Swoop system detected ischemic lesions using diffusion-weighted imaging, or DWI, a type of MRI sequence considered essential for identifying acute stroke. Performance of the original Swoop scanner was compared with a next-generation system using an advanced, multi-directional DWI sequence.

According to the findings, the next-generation Swoop system was able to identify lesions as small as 2.8 millimeters, or 0.15 milliliters in volume, allowing clinicians to detect very small strokes. For clinically relevant lesions larger than 1 milliliter, the system achieved 100% sensitivity and 100% specificity. Scan times were reduced by about 30%, and image quality across the brain improved, boosting diagnostic confidence.

“We previously showed that using DWI in combination with FLAIR on the portable MRI system can be used as a ‘tissue clock’ for stroke detection, similar to conventional MRI,” said Taylor Kimberly, MD, PhD, chief of the Neurocritical Care Division at Mass General Brigham. “With this study, we took the next step and evaluated the capability of ultra-low-field MRI with advanced, multi-directional DWI sequences to detect very small ischemic lesions. The results show that the next-generation portable MRI system with a multi-directional DWI sequence enables detection of very small strokes in a clinically feasible timeframe. The portable MRI system’s ability to detect clinically relevant strokes opens new possibilities for transforming stroke diagnosis and management—bringing timely evaluation to more patients and care settings than ever before.”

The Swoop system is an ultra-low-field, portable MRI scanner that can be wheeled to a patient’s bedside and plugged into a standard electrical outlet. Unlike conventional MRI machines, which are fixed installations requiring shielded rooms and patient transport, the Swoop system is designed for use in settings where a full diagnostic MRI exam may not be practical. Cleared by the U.S. Food and Drug Administration for brain imaging in patients of all ages, the system uses artificial intelligence to help reconstruct images of the brain that trained physicians can interpret to aid diagnosis.

“Stroke detection represents a critical driver of the Swoop system’s expansion into emergency departments,” said Maria Sainz, president and CEO of Hyperfine. “The results from our next-generation Swoop system, combined with our new, advanced multi-direction DWI sequence that was recently cleared by the FDA, are truly remarkable. This data gives us even greater confidence that the Swoop system can reliably detect clinically relevant strokes, streamline workflows, and further strengthen the value of integrating portable MRI into stroke diagnosis and care.”

Hyperfine said it provided portable MRI systems under sponsored research agreements but was not involved in the design or analysis of the investigator-initiated study or in the decision to publish the results.

Portable imaging and AI reshape stroke diagnosis

The findings come amid broader advances in stroke imaging and neurocritical care, where speed, access and precision increasingly determine patient outcomes. Stroke treatment is highly time dependent, with therapies such as thrombolysis and mechanical thrombectomy most effective when delivered within narrow windows. As a result, researchers and device makers have focused on technologies that can shorten the time from symptom onset to diagnosis.

One major trend is the integration of artificial intelligence into medical imaging. AI algorithms are now routinely used to accelerate image reconstruction, improve image quality from lower-field scanners, and automatically flag suspected abnormalities. In stroke care, AI tools have been deployed to detect large vessel occlusions on CT angiography, estimate infarct core size, and prioritize scans for rapid review by clinicians. Applying these techniques to ultra-low-field MRI has helped overcome historical limitations in image resolution and signal quality.

Another key development is the push to decentralize imaging. Traditional MRI scanners are expensive, immobile and often located far from emergency departments or intensive care units. Transporting critically ill or unstable patients to radiology suites can introduce delays and risks. Portable imaging devices, including mobile CT and MRI systems, aim to bring diagnostic capability directly to the patient, whether in the ED, ICU or even resource-limited settings.

Advances in MRI sequence design have also played a role. Improved diffusion-weighted imaging, faster acquisition techniques and better motion correction have made it more feasible to obtain diagnostically useful scans in shorter timeframes. For stroke evaluation, the ability to visualize small ischemic lesions and distinguish acute from older injury is particularly important for treatment decisions.

Together, these developments reflect a broader shift toward faster, more accessible neuroimaging that supports clinical decision-making at the point of care. As portable MRI systems continue to improve and accumulate clinical evidence, they may complement conventional imaging by expanding access to timely   stroke diagnosis in settings where it was previously difficult or impossible.

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Prediction: 2026 is the year affordability rewrites patient behavior and health system margins

The past few years have tested health systems, but 2026 will bring an affordability shock that will alter patient behavior and health system margins dramatically. As enhanced ACA subsidies expire, Medicaid eligibility becomes more stringent, and employer-sponsored premiums reach their highest levels in over a decade, millions of Americans will transition from being insured to being un- or underinsured. The financial and clinical fallout will be immediate, and visible by the end of January as CFOs see the first signs of a measurable revenue gap.

For physicians, this shift will manifest in exam rooms, missed visits, and delayed presentations that spill over into emergency care. For health systems, it will surface as shrinking reimbursement, rising bad debt, and care deterioration tied to affordability rather than clinical need. The question is no longer whether affordability pressure will escalate, but how prepared systems are to absorb it once traditional assumptions about coverage begin to break down in Q1.

A national affordability shock arrives

The first months of 2026 will reveal instability across all payer categories. ACA marketplace enrollees will face steep premium increases as federal subsidies are set to expire. Many will fall behind on payments or drop coverage altogether. Medicaid redeterminations will continue removing eligible patients for procedural reasons unrelated to income or employment.

Even the employer market, long regarded as the most stable segment, will not be spared. Employer health plan costs are projected to increase, alongside rising deductibles. Many families will begin to feel the affordability shock in January and February, when they attempt to use their insurance during peak flu season and encounter dramatically higher out-of-pocket expense.

The IRS has already set the 2026 out-of-pocket maximum for high-deductible health plans at $17,400 for a family of four. That alone will push many insured patients into “functional underinsurance,” where care is technically covered but effectively unaffordable.

These pressures will lead to predictable behavioral shifts, including deferred primary care, postponed elective procedures, skipped tests, and inconsistent adherence to medication.

The financial breakpoint for health systems

By mid-year, affordability-driven stress will create measurable revenue pressure, likely resulting in a 3–4% revenue gap as three key forces converge:

• Delayed elective procedures among high-deductible plan members
• Faster bad-debt growth as patient liabilities climb
• Coverage churn leading to eligibility denials and preventable write-offs

Systems with large Medicaid and ACA populations will feel the sharpest strain. All organizations will face more complex conditions, driven by affordability rather than access barriers. For physicians, this will mean more unmanaged chronic conditions, higher acuity at presentation, and patients making care decisions based on cost rather than medical need.

Emergency departments become the default access point

Families priced out of upstream care will rely on emergency departments (EDs), not because EDs are convenient, but because they are the only care setting where cost cannot be used as a barrier to entry. Volume will rise, acuity will rise, and reimbursement will fall. We witnessed early signs of this behavior post-pandemic. While overall ED visits declined in early 2020, by 2021-2022, many systems experienced rising acuity, crowding, and crowding as delayed care turned into urgent needs; 2026 will accelerate this trend.

Without intervention, many EDs will become the de facto primary care home for patients who can no longer afford traditional access points, an early indicator of affordability stress.

Patient financial access becomes a core capability

To avoid major revenue disruption in 2026, health systems must proactively treat patient financial access as a primary operational focus. Provide financial clarity early and address patients’ financial status before balance issues occur. This can be done via:

• Implementing real-time segmentation tools to identify patients’ insurance and financial status
• Offering simple financing options and early cost estimates to lower no-show rates and limit bad debt
• Guiding patients through renewals, subsidy checks, and premium support applications
• Connecting patients with foundation aid and manufacturer programs for high-cost therapies
• Adopting transparent digital tools for financial interactions that meet patient expectations

What physicians should expect, and how to prepare

Physicians will feel the affordability crisis as premiums rise and subsidies fall, more insured and underinsured patients delay care, skip visits, and ration medications. Expect worsening chronic disease control, heavier ED reliance, and greater clinical complexity. Financial strain shapes clinical outcomes, so physicians advocating for stronger financial-access programs will help preserve continuity of care.

The year ahead will test the resilience of care teams and the strength of patient relationships. Systems will begin having enough data to shift from “wait and see” to restructuring their entire financial access strategy. Organizations that treat financial access as part of the care experience will be far better equipped to protect access and affordability for patients, stabilize margins, and support the communities they serve.

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5 ways to talk about affordability with patients before they get to the pharmacy

The cost of prescriptions often forces patients to make difficult choices. Our research shows that one out of five Americans say they stop taking their medications or take fewer doses than prescribed when finances are tight, making discussions about finances a critical part of patient care.

It’s heartbreaking when a patient returns to your office or arrives at the emergency department in worse shape than when you last saw them. When that happens, it’s often because the patient doesn’t have the financial means to fill crucial prescriptions.

It is far easier—and impactful—to have open and transparent discussions with patients in the moment of care when you can discuss options and access additional resources in the clinic setting. Trying to handle these issues hours or days later, in the dead of night, or worse, not at all, can lead to adverse events.

Here are five actionable tips for navigating these sensitive conversations:

1. Initiate the money conversation early

Bring up affordability as early as possible. Being upfront about costs fosters trust and reduces the likelihood that patients will avoid treatment altogether.

There’s a direct link between a patient’s financial ability and adherence to treatment plans. By regularly asking about affordability, you’re not only addressing immediate barriers but also ensuring long-term treatment success.

Conversation prompt: "This is the treatment I think is best in your situation, but I realize it might not be affordable. I do have some other options we could consider if you’d like to go over them.”

2. Ask everyone—no assumptions

Economic vulnerability isn’t always visible. Patients who seemed financially stable last year may be struggling this year. In a volatile economy, no one is immune to sudden financial changes. Get in the habit of asking all patients about their ability to afford care and never assume they’ll speak up on their own.

Conversation prompt: "I ask every patient in my practice whether treatment affordability may impact the decision to start/continue treatment. Is there anything I can do to help you with any hesitations you have about the cost or impact of the therapy?”

3. Offer to review benefit coverage

Understanding the nuances of insurance plans can be overwhelming, even for the most informed patients. Don’t assume they understand coverage details, co-pays, co-insurance, prior authorizations, or the difference between medical and RX benefits. Sometimes, simply clarifying what’s covered can make all the difference in a patient’s decision to proceed with treatment.

Conversation prompt: "Do you have questions about how much of the cost your insurance will cover?" (Then, assist them in navigating any potential barriers.)

4. Stay up to date onpatient assistance programs and other resources for affordability

Pharmaceutical companies often offer patient assistance programs that provide significant relief. Keep track of those most frequently used in your practice and support patients through the prior authorization process.

Conversation prompt: "There may be a patient assistance program available from the manufacturer of this drug. There are certain criteria required to qualify for the program. Would it be helpful to review those with you?”

5. Discuss financing opportunities

Some private practices, particularly those offering treatments not fully covered (or not covered at all) by medical, prescription, or dental benefits, offer payment plans and other financing options to make therapy more affordable.

When patients know there’s flexibility in payment, it eases the stress of managing large bills. Bringing up financing options, whether through a third-party solution or an in-house payment plan, can make treatment more accessible, encouraging patients to move forward without fear of immediate financial strain.

Conversation prompt: "Did you know you can apply for financing options if your health insurance benefits don’t cover this treatment?"

Discussing affordability is essential to patient-centered care, especially in today’s tough financial climate. When we have open conversations about cost, we can ease the pressure on patients and help them get the care they need as quickly as possible.

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