How rising costs are changing patient behavior: What physicians need to know in 2026

For the modern independent physician, the clinical encounter is increasingly competing with the "financial encounter" as out-of-pocket costs reach a breaking point for many Americans. According to the 21st Annual Consumer Engagement in Health Care Survey (CEHCS), a comprehensive study of 2,001 privately insured adults conducted by the Employee Benefit Research Institute (EBRI) and Greenwald Research, an independent research firm, the landscape of patient behavior is shifting in ways that directly impact practice operations. While 90% of adults expressed satisfaction with the health plan selection process, a deeper look at the data reveals a growing instability in how patients access and pay for care—a reality that has profound implications for patient retention and clinical outcomes.

The affordability wall and the rolling access crisis

A key finding from the EBRI study is that cost has overtaken all other barriers to care. Six in 10 enrollees saw their health care costs increase over the past year, leading to a cascade of defensive financial maneuvers: half reduced discretionary spending, one-third struggled with other bills, and one-quarter cut back on retirement contributions. This financial stress is directly altering clinical utilization, according to Paul Fronstin, Ph.D., Director of Health Benefits Research at the institute.


"The survey found that cost was the most commonly cited reason individuals delayed or avoided needed care,” says Frontsin. “Among those who needed care in the past year, delays were most common for services such as physical therapy and mental health care, followed by outpatient or specialty visits and diagnostic testing. Prescription drugs and primary care visits were less frequently delayed but still affected for a notable share of respondents.”

The behavior is not just about avoiding care altogether but about a strategic, often risky, delay in seeking treatment. "What stands out is that affordability pressures are not only influencing whether people seek care but also when they seek it,” says Fronstin. “Some respondents reported waiting to see if symptoms improved before pursuing treatment, delaying care until they had more financial flexibility, or postponing visits because of competing financial priorities.” For a physician practice, this means that patients may increasingly space out visits, defer recommended services, or prioritize certain types of care over others when facing cost pressures.

This patient-level data is mirrored by macro-trends identified by Richard Anderson, M.D., FACP, CEO of The Doctors Company and TDC Group, who told Medical Economics that the system is currently in a "rolling access crisis.” Anderson pointed out that as the government now pays for more than 55% of all medical care in the United States, and those payments often do not cover the actual cost of care, private payers are forced to subsidize the difference. This economic instability contributes to the closure of essential services; for instance, about 60% of rural hospitals no longer provide obstetrical care, leaving a safety net that Anderson described as "dangerously frayed.” For the independent physician, this macro-environment suggests a likely increase in patient volume from surrounding areas, but often with patients who have delayed care due to a lack of options and are therefore more complex to treat.

Universal deductibles and the patient as payor

The "consumerization" of health care was predicated on the idea that high deductibles would make patients more prudent shoppers, but the EBRI survey shows that deductibles are no longer just a feature of specialized plans; they are now nearly universal. In 2025, more than three-quarters of all enrollees had a deductible for medical care, including 70% of those in traditional health plans.

This deductible creep means that even what are considered well-insured patients are now highly price-sensitive. When patients are responsible for paying the initial portion of their care costs, they inevitably become more attentive to the financial implications of every service.

For physician practices, Fronstin says that "this environment may mean patients increasingly ask questions about costs, request payment plans, or make decisions about timing and types of services based on out-of-pocket expenses. While the survey does not examine practice operations directly, the broader pattern indicates that patient financial responsibility is playing a larger role in how people approach health care decisions.” This shift may require a change in front-office operations, moving toward more upfront financial counseling and transparency.

Anderson further noted that the financing of medical care is at the root of much of this instability, observing that while the number of insured Americans reached record highs recently, that trend is starting to reverse. As more individuals face life without health insurance or with plans that provide insufficient coverage, the administrative burden on practices to manage collections and patient financial expectations will only intensify.

Closing the two-hour information gap

One of the frustrating operational hurdle for physicians is the "information gap" regarding insurance coverage. The EBRI survey found that half of enrollees spend less than one hour reviewing their health plan options during open enrollment, and most spend under two hours total. Furthermore, one in four enrollees—particularly those in traditional plans—are simply automatically re-enrolled without reviewing their options.

This lack of engagement leads to significant confusion at the practice front desk. “When plan decisions are made quickly or passively, misunderstandings about coverage details, deductibles, and cost-sharing are inevitable,” says Fronstin.

From the perspective of physician practices, Fronstin says that some billing surprises may stem from gaps in understanding about how insurance works rather than dissatisfaction with the care itself. To mitigate this, practices should consider providing clearer explanations of estimated out-of-pocket costs and billing procedures. "Some patients may also benefit from guidance about how their deductible or coinsurance works, particularly early in the year when many have not yet met their deductible,” says Fronstin. “Even relatively simple information about coverage rules or expected patient responsibility can improve transparency and reduce confusion.”

The survey indicates that patients often have limited time or information when selecting plans, so additional clarity during the care process can help bridge that gap. This lack of information often leads to patients bringing questions to alternative sources, such as artificial intelligence, before they ever reach the doctor's office. Amber Maraccini, Ph.D., vice president and head of health care and life sciences at Medallia, told Medical Economics that AI tools are now acting as a "narrator" of health data, often interpreting lab results for patients late at night. While this can cause anxiety, it also presents an opportunity for the practice to guide patients toward more meaningful interactions.

The resilience of the provider network

Despite the focus on costs, there is a silver lining for independent physicians: patients still value their doctors more than their premiums.

"The survey found that having access to a preferred network of physicians and hospitals was the most important factor when individuals selected a health plan, even ranking above the cost of premiums,” says Fronstin. This suggests that consumers place significant value on maintaining access to providers they trust or want to see. For an independent practice, Fronstin says that "this finding reinforces the importance of visibility within plan networks. Being included in networks that patients rely on can influence whether patients are able to access a practice through their coverage.” As satisfaction with plan affordability declines, your position as a "trusted provider" in the network remains your strongest competitive advantage.

AI: Trust, liability, and the narrative of care

As physicians look for ways to manage this increasing administrative and financial complexity, artificial intelligence is often presented as the solution. However, the EBRI data shows a significant trust gap, with consumers reporting substantially higher levels of trust in their health care providers than in AI for health-related decisions.

That does not necessarily suggest resistance to technology, says Fronstin. Instead, it highlights that patients continue to place a high level of confidence in their physicians and care teams. Technology may be most effective when it supports clinical care rather than replacing the clinician’s role. For practices considering AI tools, the findings suggest that transparency and integration into clinical workflows are important, as patients still expect their physician to remain the central decision-maker.

Maraccini suggests that if a patient uses AI to "pre-process" their results, the office visit can become more efficient. She says that the conversation shifts from just decoding acronyms to actually having thoughtful and meaningful questions around the patient’s life, values and goals. This shifts the physician's role to that of an interpreter of the larger context, which Maraccini believes can actually add to a clinician's credibility and trustworthiness.

However, incorporating AI into a practice also introduces significant legal risks. Anderson warned that we are in an unstable situation where medical technology is moving faster than the legal system. He highlighted a liability paradox for physicians: If you follow an AI recommendation that deviates from the traditional standard of care and have an adverse outcome, you are at high risk for a lawsuit.

This risk is compounded by the rise of "nuclear verdicts"—malpractice awards exceeding $10 million. Anderson pointed out that the 50 largest medical malpractice judgments in the U.S. have jumped from an average of $30 million to more than $56 million in just the last few years. These verdicts reset the range of value that society assigns to similar cases, making even settled claims more expensive for the entire system.

The physician as contextual interpreter

The data from the EBRI survey paints a picture of a patient base that is increasingly financially stressed and under-informed about their coverage, yet deeply loyal to their chosen providers. In this new era, the physician's role is evolving beyond clinical diagnosis to include navigating the complex financial and technological landscape that now surrounds care.

By addressing the information gap proactively and recognizing the shifting utilization patterns caused by high deductibles, independent practices can solidify their place at the center of the patient's care ecosystem.

"Technology may be most effective when it supports clinical care rather than replacing the clinician’s role,” says Fronstin. In a world of $56 million verdicts and two-hour plan selections, the human connection of trust can be a physician’s most valuable business asset.

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4 in 5 independent practices say this is what’s keeping them independent

Independent physician practices increasingly view technology as the lever that will keep them independent, even as acquisition offers and operational pressure intensify, according to a survey released May 6 by Veradigm.

Seventy-nine percent of respondents said technology is very or extremely important to their practice's ability to remain independent, and 57% said better automation would provide significant or major improvement. Eighty-eight percent said artificial intelligence (AI) and automation could deliver at least moderate improvements to practice efficiency.

Donald Trigg

The survey, conducted in March 2026, polled 360 leaders from independent ambulatory practices, including 210 physicians and clinical leaders and 150 practice managers and administrators. All respondents were screened to confirm their practices were not affiliated with a hospital system, health system or integrated delivery network.

"Our mission at Veradigm is to help independent practices stay independent," Donald Trigg, CEO of Veradigm, said in a statement. "In our survey, almost 80% say technology is pivotal to their long-term financial and operational performance."

Acquisition pressure is now routine

Sixty-nine percent of respondents said they are extremely or very confident their practice will remain independent over the next three to five years, but only 6% reported they had not been approached about acquisition or consolidation in the past two years. More than one-third said they had fielded such approaches four or more times, and 26% advanced to serious negotiations before deciding to remain independent.

Operational pressure tops the threat list

When asked to identify the biggest threats to long-term independence, respondents pointed to the business of medicine rather than the practice of it. Increased operating costs ranked first at 46%, followed by administrative and regulatory burden at 39% and reimbursement pressure at 38%.

The pressure is not distributed evenly. Among practices with more than 40 clinicians, 82% reported increased financial pressure over the past 12 months, and 60% described that increase as significant. Smaller practices reported less acute financial escalation but more concentrated administrative strain, with documentation, prior authorizations and follow-up work often falling on a small number of staff or the physician.

Across the full sample, 54% of practices reported increased financial pressure over the past year and 48% reported rising claim denial volumes.

Revenue cycle visibility lags the work

The survey points to a revenue cycle operating model that often catches problems only after they have hit the bottom line. Only 24% of respondents reported high or complete visibility into sources of revenue leakage, including denials, underpayments and delayed collections. Twenty-nine percent described their visibility as limited or nonexistent.

Detection timing reinforces the gap. Forty-one percent of practices said they do not learn about denied claims for one to two weeks, and only 8% reported receiving real-time notifications. Sixty-eight percent said they have only moderate or limited real-time visibility into their accounts receivable status.

Denial drivers were spread across the revenue cycle rather than concentrated in any single workflow. Eligibility or coverage issues led at 39%, followed by coding errors at 38%, missing or incomplete claim information at 34%, prior authorization issues at 34%, payer policy changes at 34% and documentation gaps at 33%.


"The health care industry's ability to secure higher reimbursement rates is constrained, so as costs rise, our most reliable lever is operational efficiency — streamlining processes to decrease and control expenses while maintaining quality," Juliet Breeze, M.D., CEO and founder of Next Level Medical, said in the announcement.

Documentation time and workforce strain remain widespread

Administrative workload continues to bleed into clinician time outside the exam room. Sixty-five percent of clinicians reported spending at least one hour per day on documentation outside scheduled appointments, and 26% reported spending two or more hours.

Workforce challenges showed up across nearly every role. Physicians were cited as the hardest position to recruit and retain, selected by 48% of respondents.

They were followed by billing staff at 44%, clinical support staff at 42%, nurses at 39%, coders at 38%, front desk personnel at 32% and nurse practitioners or physician assistants at 31%. Every staffing category in the survey was selected by at least 31% of respondents.

Value-based care: Willing, but constrained

Sixty-two percent of respondents said they feel prepared to succeed in value-based or risk-based reimbursement models, and 56% rated payer collaboration as very or extremely effective. The friction is in the execution. Forty-nine percent cited administrative requirements as the top barrier to value-based care participation, followed by financial risk at 38%.

Respondents also pointed to limited data sharing, difficulty tracking quality measures and inadequate analytics as compounding challenges, with many describing their visibility into payer requirements, quality metrics and care-gap opportunities as moderate or limited.

A confidence gap on current tools

Top technology priorities cited in the report include reducing administrative burden tied to prior authorization, documentation and billing; improving revenue cycle visibility and denial resolution; and strengthening payer data visibility for value-based care.

Sixty-four percent of respondents said they are extremely or very confident in their current technology tools to reduce documentation and administrative burden, a figure that trails the 79% who said technology will be central to long-term stability — a gap that suggests demand for better tools is outpacing what's already in place.

The full report, "The State of the Independent Practice in 2026," is available on Veradigm's website.

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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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