Targeted marketing to maintain existing patients and attract new ones

Of course, it is nice to attract new patients to your practice, but it is easier to keep the patients you already have. The estimated cost of attracting a new patient is $200 for primary care and $600 for plastic surgery. However, the cost and energy required to keep existing patients are modest. Most practices have dozens, if not hundreds, of patients that need follow-up and haven’t been seen in months or years. They may have fallen through the cracks. This article will discuss how to return existing patients to your practice and suggestions for attracting additional patients.

Target existing patients for appropriate services by reviewing your patients’ medical records. Just pull a few patients’ charts a day (electronic or paper) and review them for services that would be appropriate to recommend. For example, if you are a primary care physician, look for females in the 50+ years-or-older category who haven’t visited your practice in the past two years. Contact them and suggest that it may be time for a physical.

Another example is a urology practice that has patients with a diagnosis of bladder cancer. These patients need regular follow-up cystoscopy. An electronic health record review of requests can be accomplished in seconds by creating a report based on pre-defined parameters – as opposed to months of effort if you used paper charts.

Determine whom you want to target, and check with your EHR vendor to determine if the necessary patient data can be easily generated and downloaded in a convenient format. Integrate targeted marketing into your daily patient flow by identifying recommended services to guide patient care as they present. This could range from missing immunizations to cosmetic services that could benefit the patient. During the pre-visit chart review, ask employees to identify patients who may be candidates for the recommended services.

Other ways to attract patients include:

• Writing a blog. Pen an article or a posting for your own website – alternatively, provide the article to interested parties such as your local media. The easiest blog service to use is WordPress.com
• Tweeting messages or posting on Facebook. Write timely comments about issues that are relevant to patients – and pertinent to your practice, such as the pollen count if you are an allergist, or a new robotic surgery available to treat prostate cancer if you are a urologist.
• Contacting schools, senior citizens centers, religious institutions, childcare centers, and other potential sources of new patients. Ask if they will include an article by you in a future newsletter or allow you speak at an upcoming function. Or offer to perform on-site screenings to make appropriate recommendations for follow-up care.
• Volunteering for community activities. Not only is volunteering good for your community, but it also makes your name visible.
• Getting to know those in your community who routinely meet new arrivals to the area; the benefits officers of local employers and real estate agents are two places to start.
• Thanking established patients, referring physicians, and staff who refer patients to you. Show your appreciation to referral sources, but avoid lavish gifts, especially to referring physicians, because they may be construed as payment for referrals. You can make a lasting impression just by sending a note of thanks for a referral.
• Honing customer service skills throughout your practice. Patients who are impressed by the service they receive at your practice will spread the word.
• Developing an online presence. Keep your website, Facebook business page, LinkedIn profile, and other pages up to date; use an attractive design; post patient education information and profiles of you and your staff; and, if applicable, keep the navigation simple.
• Doing lunch. Have a meal with your colleagues in the medical staff lunchroom at your local hospital or offer to bring lunch to a referring physician’s office. These social interactions and networking can lead to establishing strong collegiality.
• Giving a lecture. Volunteer as a guest speaker for hospital grand rounds, hold your own conference for referring physicians, or distribute a link to a recorded copy of your lecture online. Serving as a lecturer increases your profile as an expert and offers your colleagues insight into the services you offer.
• Communicating. When caring for a patient referred by a physician, provide that physician with frequent written updates, ideally through an automated referring physician communication process.

Marketing efforts don’t require a tremendous investment. A quick response (QR) code, for example, is a smartphone-readable barcode that can store website addresses, plain text, phone numbers, email addresses, and nearly any other alphanumeric data. Develop a QR code to link to your practice’s website or online patient portal: it costs nothing to create a QR code, and it can be done in a few seconds. Use it to link to your website, phone number, and/or address. Or develop special QR codes for promotional items or events.

Marketing activities

Develop a fact sheet for your practice that can also serve as a direct-mail piece to promote it. Distribute it to potential patients using contact lists you obtain for the markets you wish to target. While a billboard, radio, and newspaper ad will get traction, consider advertising in other venues, such as movie theaters, grocery stores, and other venues in the markets you are targeting. And don’t forget about opportunities at schools (such as the student health center at a nearby university), local sports leagues, and community events. While not heavily viewed, community cable television stations can create visibility for your practice at no cost to you. Cable stations often broadcast health segments and value good content. Local broadcasters, especially those with news and public affairs programming, can be affordably targeted by sending the station a letter at least once a quarter explaining your expertise in your specialty. It may take a year – or even two – but eventually you can break through when their staff needs to interview a physician about an issue relevant to your specialty and area of expertise.

Charity auctions and similar events are another local-cost marketing opportunity: consider offering your services as part of an auction for a school or local charity. For example, I have offered a no-scalpel, no-needle vasectomy at a school auction. The title in the auction book is “School Tuition Getting You Down? A No-Scalpel, No-Needles Vasectomy May Be the Solution”. This offer was seen by dozens of parents who learned about the procedure. If they didn’t have the highest bid to receive the donation or weren't ready to have the procedure at that time, they went to my website for more information. Eventually, several parents (mostly the female parents!) called my office to make an appointment for the procedure. The cost was negligible, as was the time invested to create the offer.

If you are in a community where English is a second language, consider offering materials in other languages as well. Google Translate is an excellent (and free) option for materials placed on your website. Community-based online platforms or newspapers and radio stations can serve as links to ethnic groups that might be underserved in your market. Depending on how many patients in your practice use English as their second language, consider hiring a bilingual receptionist or nurse. Offer to give talks at community centers. It is also worthwhile to learn a few words in their language, such as ‘thank you,’ ‘nice to meet you,’ and ‘goodbye.’

If you don’t have time to execute these sorts of marketing activities yourself, hire a vendor who specializes in medical marketing and branding. If funds aren’t available to develop a relationship with a marketing agency, consider contacting a local college or university for an intern majoring in marketing. They may bring fresh ideas; you gain the resource, and they gain experience.

Bottom line:

“A satisfied customer is your best marketing tool.” That pithy marketing phrase applies to your practice just as it does to any other business.

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Is my practice required to offer a patient portal?

It's one of the most common questions practice administrators ask as they navigate the tangle of federal health IT rules: Do we legally have to offer patients a portal? The short answer is nuanced. No single law flatly mandates that every practice deploy a patient portal, but a web of overlapping regulations creates powerful incentives, and in some cases real obligations, that make offering one nearly unavoidable.

Q: Is there a law that specifically requires practices to have a patient portal?

Not exactly. No federal statute contains language saying "you must operate a patient portal." But as the American Medical Association explains, the legal landscape is more like a puzzle, with HIPAA, state laws, the Promoting Interoperability program and the federal information blocking rules all fitting together, and that puzzle strongly favors providing patients with electronic access to their records. HIPAA provides patients a right to access most of their health information in their preferred form and format, as long as the practice is technically able to do so. A portal is the most practical way to deliver that access at scale.

Q: What does the 21st Century Cures Act have to do with this?

Quite a bit. The 21st Century Cures Act was signed into law in 2016 with overwhelming bipartisan support, and information sharing is central to its requirements. The law's final rule, enforced by the Office of the National Coordinator for Health Information Technology, or ONC, prohibits what regulators call "information blocking." Beginning in November 2020, federal regulation prohibited healthcare systems and providers from blocking health information from patients, requiring the immediate release of information such as clinical notes, laboratory data, imaging and pathology reports.

As Physicians Practice has reported, that definition of information blocking is broad. ONC has provided examples of practices that may constitute information blocking, including imposing fees that make exchanging electronic health information cost-prohibitive, using organizational policies or contractual arrangements that prevent or limit sharing, and inappropriately citing HIPAA as a reason not to share information. You don't need to be doing something obviously wrong to run afoul of the rule.

Q: Does this mean my practice could be penalized for not having a portal?

Potentially, yes, though enforcement has been uneven. As Physicians Practice has covered, the 21st Century Cures Act information blocking rules carry real teeth. More than 75% of the complaints HHS has received regarding organizations barring access to patient data have involved health care providers. Complaints can be filed with ONC, and HHS has signaled that closing the enforcement gap is a priority.

It's also worth noting how the rule is framed. According to Physicians Practice's coverage of Cures Act compliance, patients who have trouble with portal technology may mistake a poor user experience as an intentional attempt at information blocking and lodge a complaint. Even a clunky or outdated portal can create legal exposure.

Q: What about the Promoting Interoperability program? Does that apply to my practice?

If your practice participates in Medicare or Medicaid and wants to maximize reimbursement, then yes. The Promoting Interoperability program, formerly called Meaningful Use, ties payment incentives to demonstrating that patients can electronically access their records. As Physicians Practice has explained, Stage 2 required that more than 50% of all unique patients seen by an eligible provider be given online access to their health information within four business days, and that more than 5% of all unique patients view, download or transmit their health information to a third party. A patient portal is by far the most common vehicle for meeting those thresholds.

Practices that fail to participate face Medicare payment reductions. In that sense, while a portal is not legally mandated, the financial consequences of going without one in a Medicare-participating practice can be significant.

Q: Are there exceptions? What if we're a small practice or don't use an EHR?

The information blocking rule applies to any practice that qualifies as a healthcare provider under the Cures Act, regardless of size. However, the rule does recognize exceptions. The information blocking rule does not require practices to store records in any particular file system or adopt any particular technology. The rule prohibits only an unnecessary delay in providing patient records from whatever storage format or system the practice currently uses. So if you do not maintain electronic health information at all, the information blocking rule's scope is limited.

That said, the information blocking law applies only to electronic health information, and therefore information that exists solely in paper form is exempt from its scope entirely. Practices that have not yet adopted an EHR face a different calculus, but as EHR adoption has become nearly universal, the practical shelter of a paper-only argument has largely closed.

Q: What kinds of information must be made available if we do have an EHR?

The scope has expanded considerably since the rule took effect. As Physicians Practice has reported, ONC expanded its definition of information blocking so that data required to be accessible applies not only to the data elements contained in the United States Core Data for Interoperability, but also to electronic protected health information as defined under HIPAA's designated record set. In plain terms, that covers a wide range of clinical and billing records.

Physicians Practice has also broken down the key definitions of PHI, ePHI and EHI, noting that knowing the exceptions to information blocking and having an alternative method to deliver patients their electronic health information is just as critical as knowing what may constitute an information blocking violation.

Q: Even if we're not strictly required to have a portal, is it still a good idea?

Most practice management experts would say it is an operational no-brainer. Physicians Practice has covered patient portal adoption extensively and the business case is strong. As reported in Patient Portals: Beyond Meaningful Use, letting patients make their own appointments on a portal has reduced call volumes by 20% to 30% at some practices, and the elimination of most faxes has allowed some practices to get by with fewer support staff.

As Physicians Practice has noted, portals help patients take a more active role in their care and control the way their information is managed. And the cost of running a practice can be reduced by using a portal. Getting patients off the phone gets staff off the phone, which either frees staff to do other tasks or reduces how many staff are needed.

The patient satisfaction angle matters too. Physicians Practice has highlighted must-have patient portal features that help practices reduce no-shows and cut phone tag, including self-scheduling with live provider calendar availability and HIPAA-compliant secure messaging routed through clinical staff.

Q: What should we do if we're uncertain about our obligations?

Start with your EHR vendor. Most certified EHR systems include a patient portal or can connect to one, and your vendor can help identify what information is automatically flowing to patients and what may require configuration. The AMA's Patient Access Playbook is a solid free resource for understanding how HIPAA, state law and the Promoting Interoperability program intersect. ONC also maintains an information blocking FAQ that is updated regularly.

When in doubt, consulting a healthcare attorney familiar with HIPAA and the Cures Act rules is prudent. The regulatory landscape continues to evolve, and the cost of a compliance review is far lower than the cost of a complaint or penalty.

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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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