Lessons for health care from Trader Joe's

Walking into Trader Joe’s is unlike walking into any other grocery store. From Hawaiian-shirt uniforms to bright murals and a welcoming store layout, Trader Joe’s is truly one of a kind. Its unique shopping approach is working — it regularly ranks among the best for customer experience, even surpassing Amazon.

This outstanding customer service was seen first-hand when I was in line to check out at Trader Joe’s. A customer ahead of me pointed out that some of the strawberries in their crate were spoiled. The checkout station had two employees: one to record purchases and one to bag groceries.

The checkout employee rang a bell, and within seconds, an employee appeared, took the defective crate and replaced it in less than a minute. This did not delay the customer's check-out or the check-out process for those in line. This was impressive and demonstrated that customer satisfaction was practiced at the highest level. Wouldn’t it be nice if we could function like Trader Joe’s in our practices?

This article provides examples from Trader Joe’s that are applicable to the health care profession.

1. Engage your employees

One of the most noticeable things about Trader Joe’s is its happy employees. It’s easy to tell that Trader Joe’s employees love their jobs, and a major reason is that the company invests in employee experience. Trader Joe’s pays its employees competitive wages and offers health care benefits to even part-time employees. Great companies and great practices often offer a superior customer experience because employees are valued, engaged and ready to make a difference.

At Trader Joe’s, employees’ positive attitudes are contagious, and the joy they feel for their jobs and customers is evident. Employees are encouraged to go above and beyond and are free to find unique ways to help customers. That matters to customers — they want to feel appreciated rather than treated as an inconvenience.

In our practices, we must foster an environment that engages our employees. That means creating an atmosphere where employees feel comfortable and valued. It requires recognizing employees for their contributions to a positive patient experience.

In my practice, when a patient makes a positive comment about an employee, I ask the patient to hold the compliment and have the employee come into the exam room to hear the comment firsthand from the patient. The employee appreciates the comment, and I will mention it at our weekly staff meeting. This lets employees know the practice recognizes outstanding performance. If this approach is appreciated by the employee, we hope their behavior becomes contagious among the rest of the staff.

2. Keep it simple

Trader Joe’s breaks the mold of most grocery store chains with no sales, rewards cards or coupons. It keeps the shopping experience simple by offering high-quality products at prices below competitors.

The company prides itself on delivering value by selling almost exclusively items under the Trader Joe’s label. Producing its own line of every item in the store reduces costs and lowers inventory levels — Trader Joe’s stocks only 4,000 products compared to 50,000+ in traditional supermarkets.

Instead of experiencing choice overload from multiple brands on the shelf, sizes and product bargains, customers at Trader Joe’s have only a few options in each category, which provides a simpler shopping experience. In health care, we can confuse patients by offering too many choices. I recall a physician who offered patients four phosphodiesterase inhibitors (Viagra, Cialis, Levitra and Stendra). The patient was advised to go home and to try all four. In most cases, they selected the most recent medication they tried.

Patients come to physicians for advice. The physician needs to help the patient make an informed decision with the patient's assistance. Of course, this approach is complicated by artificial intelligence (AI) and the internet, which give patients too much advice and leave them confused.

As physicians, we need to help our patients select a treatment, medication or device and explain why the recommendation is appropriate. Physicians can also direct patients to credible websites that explain medical conditions and treatment options in jargon-free language. My take-home message is to avoid offering too many options, like Trader Joe’s offering too many cereal choices.

3. Relax

Shoppers are often stressed and rushed when they go shopping. Instead of capitalizing on that, Trader Joe’s takes things in the opposite direction with a fun and relaxed atmosphere.

Small things like fun stickers for kids, a search for the hidden stuffed animal, or free samples make a difference. Each Trader Joe’s features unique artwork that reflects the local neighborhood. Trader Joe customers know from the moment they walk in that this isn’t your typical grocery store chain — it’s a fun and relaxed alternative that provides great products and value without the stodginess and “me too” of the dozens of grocery stores within the community.

Medical practices can create a relaxed atmosphere that reduces the anxiety that often accompanies a visit to the doctor. Examples of producing a relaxed atmosphere include having a fish aquarium in the reception area. Caveat: if you have a saltwater aquarium, you will probably need a regular service to avoid losing expensive fish. Nothing can make a patient lose confidence in their physician faster than dead fish floating on top of the water!

Another example of creating a relaxed atmosphere is informing patients of issues that will delay their timely appointment.

Another suggestion is to schedule vendors and pharmaceutical reps outside clinic hours. This avoids a rep entering the reception area, handing their business card to the receptionist, and being granted access to the practice before patients are taken from the reception area to the exam rooms.

4. Provide convenience

In our rushed society, Trader Joe’s offers convenience to help customers shop as quickly as possible. Although it doesn’t offer self-checkout, lines move quickly, with plenty of staff and minimal delays.

Trader Joe’s also offers a wide variety of prepackaged foods, making it easy for customers to get a quick, healthy meal or snack on the go. With unique flavors and a global flair, these items are customer favorites that can’t be found anywhere else.

Patients also value convenience and access to the practice, avoiding months-long wait times for appointments. Patients appreciate being seen promptly, without delays. For example, use technology to collect patient demographics and insurance information, and complete the health questionnaire before they come to the office.

Another convenience is the ability of patients to make payments online. And finally, have a process for answering emails and returning phone calls quickly.

5. Listen to customers

Customers are heard at Trader Joe’s. Employees are trained to listen to customers. When customers complained that the store used too much plastic packaging, especially for its produce, Trader Joe’s announced it would switch to more eco-friendly packaging and stop offering single-use plastic bags.

Stores have also adjusted their hours and products based on customer feedback, which can be collected online or in-store. Customers can also request to try any item in the store, even if it isn’t the designated sample for the day.

Listening to customers and considering their feedback improves the customer experience and helps them feel valued and understood.

Just as Trader Joe’s listens to their customers, we must listen to our patients. It is necessary to survey our patients regularly. For example, a patient reported that there was no place to hang their clothes when changing into a gown prior to their examination. We listened and placed hooks on the door for patients to hang their clothes.

Another complaint arose: when the door was opened and closed, there was excessive noise. We listened, we bought padded coat hangers and solved the problem.

Bottom line

By bucking many industry trends, Trader Joe’s creates an unbeatable customer experience that can be emulated by brands in any industry. The store focuses on creating exceptional individual experiences and building real relationships rather than just pushing products. Relaxing, having fun and valuing customers pays off at Trader Joe’s.

Trader Joe’s demonstrates that a grocery store can build customer devotion by thinking outside the box, and that health care can learn from this example.

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How to talk with patients about billing

You know how much you have invested in your career and how much money it takes to run a medical practice, but your patients may not.

If you let patients know from the beginning that you are running a business and expect to be paid, you’ll have far fewer collections problems in the long run. Fortunately, having this conversation is not as difficult as you may think.

Don’t be shy

“We’re often embarrassed about collecting money, but we shouldn’t be,” says Kenneth Hertz FACMPE, principle consultant at Medical Group Management Association (MGMA) Health Care Consulting Group. “You can explain in a friendly tone that you are a business and want to be around for a long time provide care to your patients. That means you have to collect payments.”

Once patients understand this, they are more likely to pay their bills on time. But you do have to be consistent with this message.

“Most patients understand their obligations and are willing to pay,” says Elizabeth Woodcock president of Woodcock and Associates, a physician practice consulting firm. “A few are going to resist.” For those few, you have to make it clear from the outset that you expect to be paid in a timely manner.

This means having a billing and collections policy and sticking to it - no exceptions. “Often, the doctor tells the billing staff to collect what patients owe, but then tells patients not to worry about payment. I’m always hearing from staff [who are] frustrated by doctors making exceptions to the policies,”

 Woodcock says, adding that if patients learn they don’t have to pay, they never will.

Of course, you can - and should - still make arrangements with people who can’t afford to pay. But you must have a detailed policy for financial hardship, and every employee in your practice needs to understand and abide by that policy.

Setting expectations requires more than posting a set of billing policies. If you expect patients to comply with your policies, you must stick to those policies, too.

Educate clinical staff

It would be nice to leave billing to the billing department and patient care to the clinical staff. But that’s not always possible.

Billing staff don’t know what’s going to happen before or during the visit. For example, a clinician may perform a procedure that requires an additional copay. “[Before] these things happen, someone from billing needs to come back and explain the extra charge to the patient,” says Karen Lake, healthcare consultant at the firm Pearce, Bevill, Leesburg, Moore.

Clinical staff need to be prepared proactively address these situations, too. The rise of patient consumerism means that patients are more aware of their care costs and are more likely to ask what they’ll be expected to pay for procedures, lab tests, and the like. Often, those questions come up in the exam room.

“Physician assistants and nurses deal with this all the time, so it’s a good idea if the billing department does in-service training so that the clinical staff have a better idea of billing and insurance issues,” Lake says. “They don’t need to know all the details, but they do need to know when to call in the billing department for clarification.”

Give people a chance

The majority of patients take their financial obligations seriously. They value your services and expertise. They just need to understand what they are responsible for paying. It’s your job to explain that to them.

“The conversation doesn’t have to be all ‘Thou shall,’ ‘Thou shall not,’ and ‘We reserve the right,’” Hertz says. “Be up front, human, and matter-of-fact. It’s just a matter of person-to-person communication.”

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Beyond the billing office: 5 leadership strategies for physicians managing revenue cycle staff

Most physicians did not train to spend evenings untangling denials and payment questions. Yet in an independent practice, revenue cycle performance is not a back-office detail. You do not need to become a coder to lead this well. You need shared measures, clear ownership and a steady habit of fixing the process before problems pile up.

1) Put one metric on the wall and make it everyone’s job

Revenue cycle work is a chain. Weak handoffs create rework.

Pick one “North Star” metric that reflects the full chain, such as clean claim rate or first-pass yield: the share of claims that move through without manual rescue. HFMA defines clean claim rate as the share of claims that pass edits requiring no manual intervention. Targets vary by specialty and payer mix. The point is simple: put the number in front of the team every week, understand what nudged it up or down and keep moving it in the right direction.

Spell out what the metric means in plain language, connect it to the handful of drivers behind it and keep the weekly check-in specific. If performance drops, ask what changed, where the process broke and what small fix you can test before next week.

2) Find “shadow work” that is draining clinical capacity

Shadow work is billing work that drifts to the wrong people because no one owns the workflow. Prior authorization is a common example. CAQH estimates that adopting the electronic standard can save medical providers and staff about 14 minutes per authorization. In some settings, shadow work also includes tasks like submitting zero-dollar encounter claims or correcting administrative-only billing just to keep payers satisfied.

For two weeks, ask each person to note billing-related interruptions, especially repetitive tasks or work that requires switching systems. You are looking for patterns, not perfection.

Then redesign one path at a time. Route billing questions to a single intake channel, standardize what information is required to resolve common issues and eliminate duplicate data entry when possible. Focus on removing preventable work, not redistributing it.

3) Treat retention as an operating design problem, not a bidding war

Coders and billers have options. Pay matters, but people often leave because the day-to-day is chaotic: nonstop context switching, fuzzy expectations and no clear path forward. BLS projects roughly 14,200 openings a year for medical records specialists over the next decade, a bucket that includes medical coding roles.

Make the path visible. Use a real career ladder, not a vague promise. AHIMA’s career map is a good reference point. Translate it into your team in plain terms: levels, the skills needed at each level and what it takes to move up. Keep it practical, from entry-level claims work to certified coding roles to QA, auditing or lead responsibilities.

Design roles for focus. Define what “good” looks like beyond volume, including accuracy and fewer avoidable denials. Group work where you can, so complex tasks are not constantly interrupted by low-value disruption.

Use skip-level meetings to surface friction early. Once a month, the physician owner meets briefly with one or two frontline billers or coders without their direct manager present. Keep it to three questions: what keeps showing up, what slows you down the most and what single change would cut the most rework.

4) Govern your systems before you buy new ones

Billing pain often triggers tool-shopping. More often, the practice is underusing what it already has or using it inconsistently. If your team is living inside spreadsheets and separate logs, you do not have one set of facts.

Name your practice management system as the source of truth and agree on basic definitions for denial categories, aging buckets and write-off reasons. Cut back on shadow spreadsheets where you can and tighten access controls so sensitive data is not sitting in personal files.

If the backlog is swallowing the team, use a pressure valve. Outsource a narrow, well-defined slice, such as legacy A/R follow-up or routine claim status checks. Keep ownership of definitions, access controls and escalation paths inside the practice.

5) Lead with clarity and psychological safety

When every performance conversation feels like a blame session, problems go underground until they turn into month-end surprises.

Normalize blameless problem solving. Billing staff absorb a lot, from payer pushback to patient confusion about bills. When a metric slips, stay in problem-solving mode: what changed, where did the process break and what small fix can we test this week. That tone makes it easier to raise issues early, including documentation patterns that lead to avoidable denials.

The takeaway

You do not need to become a coder to lead a coding team. You need a managed rhythm: one shared score, fewer avoidable handoffs, a team that can stay in role and a culture that treats revenue cycle as a system you can improve.

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To make better marketing decisions, track fewer metrics

Most marketing agencies can bury you with metrics — website clicks, impressions, social media engagement, and on and on. They can then put those metrics into pretty, glossy reports with pie charts, line graphs, and other visuals. If you’ve received those reports, you might wonder what it’s telling you about your practice. You might also get confused, and you’re not alone. As noted in Principles of Marketing (via OpenStax), “the sheer amount of data the metrics can yield can be overwhelming.

Metrics tell us what is happening at any point in time without context as to why it is happening."

Marketing exists to drive growth of a practice. The marketing metrics that matter have to ladder directly back up to growth. So many of the metrics that are available, while interesting to some, either do not tie directly to growth or are repetitive of other metrics that are also reported. By focusing on metrics that tie directly to growth, practices get more clarity on how well their marketing is working, and inevitably, they track fewer metrics.

Start by simplifying your practice’s growth target

To illustrate how this works, let’s work with a simplified, fictitious example of a physician-owned practice with two physicians: Family Medicine, PLLC (FM). FM is a primary care practice that finished last year with $750,000 in treatment revenue. FM wants to grow by 10% this year ($75,000), and based on historical patterns, FM expects that 10% of their patient revenue will leave the practice ($75,000). Overall, FM needs $150,000 in new treatment revenue.

Keeping track of revenue can be abstract. An easier way to track growth is in patient visits. How many new patient visits will FM need? For the purpose of revenue planning, FM will use $250 for each new patient visit. That means FM will need 600 new patient visits this year, which equates to 50 new visits per month, or between 12 to 13 new visits per week. Tracking new patient visits per week (or per month or per day) is much easier to track than revenue.

FM knows that, in reality, the revenue per new patient visit will vary. FM also knows that some new patients will visit more than one time in a year. However, using one revenue figure, $250, and one event, a new patient visit, helps keep planning simple and still realistic.

FM tracks all new patients by where they come from. On FM’s new patient registration form they ask each patient to choose one from this list: referrals from friends and family, from other physicians, from online search, and other.

New patient leads drive new patient visits

New patient visits are a lagging indicator. FM tracks what indicates new patient visits: new patient leads. FM tracks lead volume using the same options on their new patient registration form: friends/family, another physician, online search, and other.

Visibility drives new patient leads

Prospective patients can’t choose FM if they can’t find FM. FM maintains a steady online presence on search and social media, sends a communication to local referral sources once each quarter, and makes sure to ask patients to give an online review to reinforce FM’s hard-earned reputation.

Keep tracking simple

Each month FM reviews the results of new patient registrations, the performance of each lead source, and online visibility. They built a simple dashboard in Excel. The most useful part of their dashboard is the historical data: They see the current year’s performance of each metric, by month. They can look for trends, and cause and effect of marketing activity to results. FM spends about 15 minutes each month reviewing performance. If results spark a question, they tackle it separately.

It took FM a few months to tailor their dashboard to suit them best. For example, when FM started tracking metrics, they measured all of Instagram’s available engagement data. They trimmed it down only to the few they felt not only told them about their visibility, but also didn’t overlap with other Instagram metrics. FM also decided to start looking at monthly revenue alongside patient visit volume so that they can refine their assumptions about average treatment revenue per visit and patient retention. Overall, though, they keep it simple. As reported in Medical Economics, “…tracking metrics — monthly revenue, new‑patient counts, retention rates, and average revenue per visit — practices can identify what works, replicate successes, and reduce inefficiencies."

Look for patterns

While FM is looking at performance, they’re watching for patterns of consistent over- or underperformance. For example, FM noticed that new patient registrations from physician referrals are higher in the month after they send a communication compared to other months. FM will experiment with increasing communications to every other month from quarterly.

If you offer multiple treatments

Late last year FM added sleep medicine as a new treatment for their patients. FM’s goals this year are to break even and fine tune the operations around it, which includes promoting it.

The measurement process will be the same, with a few tweaks. Their plan is to start by referring their own patients who are clinically appropriate for it, based on the result of an assessment they do in the office. FM will track the number of sleep medicine appointments booked compared to the number of assessments that indicate clinical appropriateness. Ideally, those are the same. If not, then FM can dig in, learn when and why patients drop out, and implement corrections. Once FM has worked out the kinks, they’ll start promoting to referral sources and to their local market. Their tracking will follow in kind. FM hasn’t decided yet if they’ll add sleep medicine to their current dashboard or start a new one. That decision can wait.

Fewer metrics, better decisions

Physician-owned practices do not need more dashboards or more complex reporting. They need metrics that tell them what they need to know while respecting the realities of running a medical practice, including limited time, tight margins, and increasing competition.

By starting with revenue goals, translating them into patient volume, and tracking only the metrics that meaningfully support those outcomes, practices can simplify marketing oversight and improve decision-making.

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Moving to integrated payments: A roadmap for health leaders

Every year, hospitals are unable to collect the majority of balances owed by patients with private insurance or Medicare Advantage. Research shows that before the COVID-19 era, repayment rates averaged 54%; more recently, they’ve sharply declined. When patient balances exceed $7,500, collection rates can fall as low as 17%. These unpaid balances, along with other inefficiencies in revenue cycle management, have contributed to more than $36 billion in uncompensated care each year for the past three fiscal years.

While fixing these challenges require system-level change, modernizing payment solutions to meet patient demand and industry best practices is a good place to start. Yet the decision to modernize isn’t as simple as it sounds. It requires organizations to weigh system compatibility, consumer preference, and scalability, and ensure compliance to security and privacy standards.

Why change is still hard in health care payments

Change in health care technology rarely happens quickly. Even as patient expectations evolve, many organizations remain tied to older systems and processes. For example, in 2022, around 73% of health care organizations were still operating on legacy information/operating systems that are no longer supported. Likewise, around 75% of providers still use manual collections processes, despite 77% of patients believe digital payments would be beneficial. This gap underscores why modernization isn’t just a convenience, it’s essential for meeting patient expectations and improving operational performance.

Staying with the status quo is always easier over the short term, but it comes with significant costs across the board. Outdated payment systems drive up administrative costs, delay collections sometimes indefinitely, and erode patient trust. In fact, 56% of patients would switch providers for a better payment experience and the number increases to 74% for patients under age 27. Health systems may believe that by avoiding modernization they’re minimizing their risks, but it may leave them less prepared for new demands.

Building a roadmap you can follow

Every journey requires a good map. Moving toward integrated payments is no exception. It’s essential to start with a candid assessment of your health system’s current situation: what systems are already in place, what integration gaps exist and where, and how much revenue is being lost to inefficient collections and write-offs.

From here, the early engagement of stakeholders, including treasury, revenue cycle management, IT, compliance teams, providers, and even the board, can help ensure alignment around high-level technical requirements, strategic goals, and end-user needs. Pairing all this with a partner that already possesses robust integration credentials and a track record of supporting scalable, secure implementations in health care delivers the kind of value that truly makes a difference.

Key considerations for successful integrated health care payments

When evaluating integrated payment options, health leaders must weigh several key considerations. Each one directly shapes patient experience, organizational performance, and system sustainability.

• Compatibility with existing EHRs. Payment solutions must work seamlessly with existing EHRs to ensure accuracy, efficiency, and a consistent user experience for both providers and their patients alike.
• Omnichannel payment options. Patients today need and expect payment flexibility. Mobile wallet payments overall have increased by more than 105% since 2019, showing that consumers want the ability to use a variety of digital payment platforms, like Venmo, PayPal, Apple Pay® and Google Pay™.
• Compliance and security. Health care providers must maintain PCI DSS compliance to protect cardholder data. Implementing technologies such as validated point to point encryption and tokenization is essential to secure payment information and reduce the overall PCI compliance burden. Choosing payment partners that are HITRUST certified demonstrates a clear commitment to data security and risk management. With cyber threats continuing to rise, health systems are on track with 85% stating that preparing for and mitigating cyberattacks is a high priority.
• Scalability and support. Expanding care locations and payment channels (for example, online, mobile, or kiosk) shouldn’t mean added complexity. A scalable, integrated payment solution within the existing EHR simplifies training needs and ensures consistent support from knowledgeable, responsive partners with expertise in both payments and health care workflows.
• Rising costs and expectations mean payment systems can’t be an afterthought. Integrated payments empower health care organizations to develop and maintain stronger revenue cycles, improve patient experiences, and reduce administrative costs across the board. While change requires effort, the roadmap to success is clear: evaluate carefully, involve stakeholders early and often, and select partners that understand the unique and pressing needs of health payments.

By prioritizing system and patient needs, organizations can build secure, sustainable payment solutions that support long-term growth.

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Keeping telehealth profitable

Telehealth can absolutely make money for a practice, but it usually stops being profitable when it’s treated like a convenient add-on instead of a real service line. The clinics that do well tend to be the ones that define what telehealth is for, build a repeatable workflow around it and stay on top of payer rules that keep changing. If you want a quick “are we doing this right?” gut check, this Physicians Practice piece is a helpful framing device: “Video visits versus virtual care”.

What does “profitable telehealth” actually mean?

In plain terms, you’re collecting more money than it costs to deliver the visit once you account for clinician time, staff support, platform fees, documentation, billing work and the follow-up tasks that can pile up after a virtual encounter. Practices often think the math is working because visit volume is strong, then discover their margin is being quietly eaten by extra “shadow work,” like tech troubleshooting, last-second conversions, and denials tied to small billing details. If that’s your reality, it’s usually worth revisiting the basics and making sure everyone in the practice is playing by the same rules. Physicians Practice has a useful refresher in “Untangling telehealth billing”, and for coding mechanics that come up in real workflows, “Coding for telemedicine visits” can help align staff and clinicians.

Which kinds of telehealth are usually easiest to sustain financially?

The visits that tend to work best are the ones that are predictable, protocol-friendly and clearly appropriate for virtual care. Think follow-ups, medication management, stable chronic care check-ins, and straightforward acute complaints where your clinicians feel confident that a virtual visit is safe and sufficient. Profitability also improves when practices stop treating telehealth as the default “overflow” and instead treat it as a planned option with guardrails.

It’s also worth remembering that some services adjacent to telehealth can support both access and revenue when handled carefully. Patient portal-based e-visits, for example, can be a meaningful part of the mix, but they only help if the documentation matches what you’re billing and the workflow is designed to keep it efficient. Physicians Practice gets into the practical “do this, not that” details in “How to correctly document and bill for patient e-visits”. Remote patient monitoring can be another revenue stream, but it’s also an area where compliance mistakes can erase gains quickly, which is why this Physicians Practice piece is worth keeping on your radar: “Remote patient monitoring under scrutiny: Top compliance mistakes to know”.

What Medicare rules should we watch right now?

If Medicare is a meaningful slice of your payer mix, it helps to keep a short list of “source of truth” pages bookmarked, because the fastest way to lose profitability is to bill confidently under an assumption that is no longer true. CMS maintains the Medicare List of Telehealth Services, which is a practical anchor when you’re trying to confirm whether something is actually considered a Medicare telehealth service. CMS also publishes an updated Telehealth FAQ (CY 2026) that addresses operational questions practices routinely run into. If you want the broader policy lens, CMS’ CY 2026 Physician Fee Schedule final rule fact sheet is a good high-level map of what’s changing and why. It can also help to keep an eye on HHS’ running resource page, Telehealth policy updates, especially when you’re trying to understand whether something is permanent, temporary or simply extended again.

Physicians Practice’s Medicare coverage can be useful context for how these rules evolved and why practices sometimes get tripped up by old habits. For example, “Meeting Medicare requirements to report telehealth services” is still a helpful operational explainer, and “Changes to Medicare telehealth services for CY 2024” can help teams understand how quickly the definitions and lists can shift.

Why do commercial payer rules make telehealth profitability feel unpredictable?

Because commercial coverage and payment policies vary across states, across insurers and even across different plans under the same insurer. That’s why a practice can run the same visit the same way and get paid differently depending on who the patient’s coverage is with. One of the most practical ways to control that chaos is to build and maintain a simple internal “telehealth payer grid” that spells out what each major payer expects in terms of eligible modalities, place-of-service rules, modifiers and any odd documentation requirements. The state-level view is well captured in the Center for Connected Health Policy’s scan, State Telehealth Laws and Reimbursement Policies Report (Fall 2025), and MGMA has also discussed the uncertainty practices have navigated as the so-called telehealth cliff has softened, including in “Bridging strategic uncertainty as the ‘telehealth cliff’ is replaced by firm ground”.

Where do practices usually lose money on telehealth?

Not always in the reimbursement rate itself. More often, the margin gets chewed up by friction. A telehealth program that looks fine on paper can become expensive when the process is inconsistent, when no-shows are high, when staff are constantly converting visits because patients can’t get connected, or when documentation and billing aren’t standardized. That’s why telehealth profitability is oddly tied to basic access operations. If your schedule is leaking appointments through cancellations and empty slots, it’s hard to make any visit type financially strong. Physicians Practice has a business-minded take on the revenue impact of cancellations in “Turning patient cancellations into revenue”, and a broader access angle in “Patient access myths specialty practices should ditch today”. Even older process stories can be useful as operational models; for example, “Atrius Health deploys home-based Covid-19 triage call center” is a reminder that tight triage rules and clean routing matter when you’re trying to protect both clinician time and revenue.

What compliance issue can blow up telehealth profitability the fastest?

Audit risk, repayments and enforcement actions. Telehealth has been a persistent area of interest for regulators, and the financial downside comes quickly when documentation doesn’t support what was billed or when a practice’s policies don’t match what payers and regulators expect. Physicians Practice has covered the post-pandemic landscape and fraud concerns in “Examining post-pandemic telehealth fraud risks”. Privacy and security also remain foundational; Physicians Practice walks through practical risk considerations in “Managing the risks of telemedicine”, while HHS offers the official baseline in HIPAA and Telehealth.

What if our clinicians prescribe controlled substances via telemedicine?

That’s an area where you want to be extra disciplined because federal policy has been evolving and extensions have been issued. A good habit is to keep an eye on primary sources as they’re released, such as this DEA press release and the associated Federal Register notice. For operations, the key is having a written internal policy that addresses identity verification, licensure, PDMP checks, documentation expectations and follow-up rules, then training staff and auditing your own work so you catch problems before someone else does.

What should we watch each month to know if telehealth is really paying off?

Keep the dashboard simple enough that it actually gets reviewed. Practices typically learn the most from tracking no-show rate for virtual visits, denial rate for telehealth claims, the lag between the visit and claim submission, net collection rate and how many staff “touches” it takes to get a telehealth visit from scheduling to a clean claim. If you want broader workflow thinking that ties into telehealth, Physicians Practice’s Physician Productivity hub can be a useful companion.

What’s the quickest way to improve telehealth margin without a giant project?

Look for one recurring point of friction and fix it quickly. Sometimes that’s tightening your visit types so telehealth isn’t the default dumping ground for anything “quick.” Sometimes it’s standardizing documentation so coding and billing are consistent. Sometimes it’s addressing cancellations and empty slots so the schedule stops leaking revenue. And sometimes it’s a compliance sweep of your platform, vendor contracts and policies so you’re not building growth on top of shaky risk assumptions.

Telehealth doesn’t have to be a margin killer. But it also can’t be treated like an informal convenience that lives inside your schedule. The practices that keep it profitable are the ones that make the work predictable, the billing repeatable and the risk manageable.

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Access before appointment: How response time affects patient engagement and practice outcomes

Patient perception of access has quietly become one of the most important signals in healthcare delivery. Long before patients walk into the clinic or engage in a clinical assessment, they form impressions based on ease of access, responsiveness, and clarity around next steps. For busy practices striving to balance patient flow, care quality, and operational efficiency, the first response moment has become a benchmark of organizational reliability.

When Communication Becomes Care Access

Despite the rise of online portals and digital forms, phone communication remains a dominant channel for scheduling appointments and initiating care in outpatient settings. Across medical offices, research consistently shows that most new and acute visits begin with a phone call.

When calls go unanswered, patients do not always retry the same office. Many simply seek the next provider who responds faster, delaying or abandoning care.

The Operational Toll of Missed Access

Missed appointments cost the U.S. healthcare system more than $150 billion annually in lost revenue and inefficiency, with individual providers reporting an average of around $200 in lost revenue per unused appointment slot. Missed calls are frequently the first failure point that leads to unused appointments, idle capacity, and last-minute scheduling pressure.

Wait Times and Patient Perceptions

Longer hold times and slower responses correlate with poorer patient perceptions of access and lower satisfaction. Patients who encounter repeated communication barriers during scheduling or early outreach are significantly more likely to disengage and seek care elsewhere.

Efficiency vs Perfection: Rebalancing Early Responses

Applying clinical standards of completeness to the first response moment often creates unintended delays. Early acknowledgment does not require full resolution. It signals attention, reduces uncertainty, and preserves the therapeutic relationship.

Scheduling Friction and Practice Stability

When patients cannot schedule appointments that fit their routines, they delay care or request last-minute accommodations, increasing lateness and no-shows. Practices that support routine-aligned scheduling see better adherence and smoother workflows.

A Quiet Standard Shift

The practices that thrive are not perfect in every response. They are consistently responsive. Fast and friendly is not a shortcut. In medical practice, it is now the baseline expectation for access.

References

National Institutes of Health. Missed appointments and healthcare system cost impact. PubMed Central.

Agency for Healthcare Research and Quality. Patient experience and access to care.

Griffith KN, et al. Call center performance and patient perceptions of access. The American Journal of Managed Care.

Guy R, et al. Effectiveness of short message service reminders in increasing clinic attendance. PLOS One.

Parikh A, et al. Reducing no-shows through targeted communication strategies. Journal of Medical Systems.


Heather Revens is Founder and Chief AI Officer at Aligned Practice Studio. Contact:
heather@alignedpracticestudio.ai | alignedpracticestudio.ai

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