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Growth Alone Does Not Protect Margins A lot of healthcare organizations think they have a growth problem when what they really have is a payer contract problem. Physician groups, ambulatory surgery centers, and multisite platforms pour money into recruiting providers, tightening operations, winning new patients, and opening new locations, all while the payer agreements sit in a drawer collecting dust. Meanwhile labor costs climb, operating expenses climb, and reimbursement me

I have spent decades on the payer side of the table, and these days I spend most of my time on the other side of it, sitting across from physician groups all over the country. From that vantage point one thing has become impossible to miss. The economics of running a medical practice have not drifted. They have been rebuilt from the foundation up. A lot of operators are still running their businesses off a map that was drawn five or ten years ago. Add volume, hold reimburseme

This is the question I get more than almost any other, and for years the honest answer was a shrug and a story. Out of network feels like the bigger check because nobody is capping what you can bill. In network feels safer but smaller. Everyone has an anecdote and almost nobody has the data. We finally do. Two serious pieces of research, one in JAMA Health Forum and one in Health Affairs, let us stop arguing from feel and start arguing from numbers. Read them side by side and

After nearly 25 years on the payer side at Humana and the last several years sitting across the table negotiating against payers, I can tell you most medical practices don’t have a growth problem. They have a visibility problem. Revenue feels inconsistent. Cash flow surprises you. Margins never quite match what the financials suggested they should. And by the time the monthly close lands on your desk, the window to do anything about it has already closed. The high-performing

Top-line growth is easy to celebrate. More patients, more providers, more locations—it signals momentum. But across many physician groups and healthcare platforms, a concerning pattern is emerging: revenue is increasing, yet profitability is flat or declining. This is not a volume problem. It’s a revenue quality and cost structure problem. For private equity-backed platforms and growth-oriented practices, this disconnect can quietly erode EBITDA and compress valuation—especia

Healthcare reimbursement is entering a period of structural change. Margin compression, regulatory pressure, and increasingly sophisticated payor strategies are forcing providers—particularly multisite and private equity-backed platforms—to rethink how revenue is generated, negotiated, and sustained. The next five years will not be defined by a single reimbursement model winning out. Instead, we will see a hybrid environment where Fee-For-Service (FFS) and Value-Based Care (V

The Masters Tournament is a showcase of discipline, consistency, and precise execution. Each golfer’s success depends on mastering fundamentals and adapting to changing conditions on the course. Independent medical practices face a similar challenge. In a healthcare environment marked by reimbursement pressures, rising costs, and shifting care models, physician owners and practice leaders must apply the same principles to stay competitive and financially healthy. This post ex

For many medical group owners, revenue is the number they watch most closely. But revenue alone doesn’t tell you how healthy—or valuable—your practice really is. The metric that can matter most? EBITDA. Here is what EBITDA really means for MedicalGroups—and how to improve it. What EBITDA Really Means EBITDA (Earnings Before Interest, Taxes, Depreciation, and Amortization) measures how profitable your practice is from its core operations. In simple terms, it answers one key qu

Negotiating payer contracts remains one of the most challenging tasks for medical practice owners and healthcare executives. Many providers find themselves underpaid, struggling to secure fair reimbursement rates while maintaining positive relationships with payers. The good news is that you can improve your contracts strategically without damaging these essential partnerships. I’ll walk you through why underpayment happens, common negotiation mistakes, how to use data effect

As we move further into the 21st century, the healthcare industry is undergoing a significant transformation. From technological innovations to regulatory shifts, the landscape of healthcare is evolving rapidly, creating new opportunities and challenges for medical groups. One thing is clear: navigating these changes successfully requires a strategic approach—one that not only focuses on providing excellent patient care but also on growing revenue and enhancing operational ef