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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