Building a More Profitable Practice Without Seeing More Patients

For thirty years, growth in medicine meant one thing. See more patients. Add providers, add rooms, add hours, add a Saturday clinic. Volume was the answer because volume was always there for the taking.

Volume is not the answer anymore. For a lot of groups, it is not even available, and depending on your specialty, you may not even qualify to be in any payor’s contracted networks.

Let’s start with the arithmetic. Between 2001 and 2025, the cost of running a medical practice climbed 59 percent while Medicare physician payment stayed essentially flat. Adjusted for practice cost inflation, physician payment fell 33 percent over that stretch. That is the AMA’s own math, as submitted to CMS on the 2026 Physician Fee Schedule, and MedPAC has been telling Congress a version of the same thing for years. Commercial rates in most markets did not ride to the rescue. They anchored to the Medicare fee schedule and drifted down alongside it.

So, the treadmill did not just keep running. Somebody turned up the speed and quietly removed the handrails.

You cannot outrun that with more appointments. You can get paid considerably better for the appointments already on the schedule, and that is the focus of this article.

Your payor contracts are a mortgage you never refinanced

Most practices signed their commercial agreements years ago, filed them, and moved on. The contract has been sitting in a drawer ever since, faithfully doing exactly what it was told to do in 2016 (or whatever year the contract was last negotiated, and we have seen a few active since 2007, which sets a very bad precedent).

Nobody would carry a 2016 mortgage through a decade of rate movement without ever picking up the phone. Yet that is precisely how most groups treat their single largest source of revenue. Meanwhile rent went up. Wages went up. Malpractice premiums went up. Your medical assistant did not accept 2016 compensation this year, and your landlord never sent a letter promising to hold rent flat forever.

The rate did not fall. It just stopped keeping up, which over ten years amounts to the same thing. Additionally, payors adjust fee schedule amounts, rate methodologies and many non-regulatory adjustments often without notice. Imagine if your mortgage lender did the same. It’s unlikely that they would keep any clients if they conducted business this way.

Here is the part groups consistently underestimate. A four point improvement on one mid sized commercial agreement can be worth more than adding a full time provider, and it does not require recruiting, credentialing, an exam room, or a second parking space. Modest percentage moves across a payor portfolio compound into serious money without a single new appointment.

For practices looking to strengthen their payor strategy, our payor contracting services help healthcare organizations evaluate existing agreements, benchmark reimbursement, and negotiate stronger contracts.

Revenue leakage is a hundred pinholes, not one hole

If a practice lost four percent of revenue in a single visible event, everyone would know by Tuesday. Leakage does not work that way. It arrives as a hundred pinholes below the waterline. No one of them sinks anything. Together they sink the ship.

The usual suspects:

•          Underpayments that pay short without ever denying, so nothing flags

•          Fee schedules loaded years ago and never reconciled against the current contract

•          Escalators the agreement entitles you to that nobody ever asked the payor to apply

•          Denials written off because the appeal window is a nuisance

•          Coding that is accurate but reflexively conservative

The industry data has moved from annoying to alarming. Kodiak Solutions, analyzing roughly 2,300 hospitals for its 2026 State of the Healthcare Revenue Cycle report, put net revenue leakage from denials and uncompensated care above $48 billion in 2025, up from $38.6 billion the year before. Experian Health’s 2025 State of Claims survey found 41 percent of providers reporting denial rates above 10 percent, up from 38 percent a year earlier. The AMA’s 2025 prior authorization survey found practices completing an average of 40 prior authorizations per physician per week, consuming 13 hours of physician and staff time, with 94 percent of physicians saying the process contributes to burnout.

The point is not that payors are villains. The point is that this system runs on friction, and active rate and revenue cycle diligence has to be treated as a condition of running a successful practice rather than a project you get to eventually. We specialize in putting that friction back on the payor’s side of the table, so they are held accountable for the changes happening below your waterline.

The data you collect is not the data you use

A practice generates more information in a week than anyone can read in a year. That is not the problem. The problem is a cockpit full of gauges with nobody assigned to watch the fuel.

Six numbers carry most of the story:

•          Net reimbursement per encounter

•          Collection rate by payor

•          Days in accounts receivable

•          Denial rate and denial trend by payor

•          Revenue by provider and by specialty

•          Contract performance measured against the contracted rate, not against last year

That last one is where most groups are flying blind. Knowing you collected more than you did last year tells you nothing about whether you collected what you were owed.

Stop paying twice for the same claim

A JAMA study of billing and insurance related activity at a large academic system estimated the administrative cost of a single primary care visit at roughly $20, rising to $215 for an inpatient surgical procedure, which worked out to somewhere between three and 25 percent of professional revenue. Those costs land on you whether the claim pays clean the first time or gets worked four times.

Every reworked claim is a claim you pay for twice, once through the payor and once through your own staff. Cleaner registration, real eligibility verification, fewer submission errors, consistent documentation. None of it is glamorous. It is the operational equivalent of closing the windows before you run the air conditioning.

Not every payor has earned the same seat at the table

A payor portfolio is a portfolio. No one would hold the same allocation for a decade without rebalancing, yet groups routinely carry agreements that reimburse below market and consume an outsized share of staff time, simply because the contract is old and nobody wants the conversation.

Evaluate them the way you would any other asset. Which agreements underperform the market. Which volume is actually worth what it costs to service. Which payors deserve a real negotiation, and which deserve a termination letter that gets their attention. Leverage is not something a practice has or lacks. It is something you assemble, almost always out of data you already own.

Network access belongs in the same conversation. In a growing number of markets, panels are closed and certain specialties cannot get in the door at any rate. When you are outside a network you need, the negotiation is not about the rate at all. It is about admission, and admission gets argued on different ground: access gaps in the payor’s geography, the total cost of the care its members are getting elsewhere, and what your absence is costing the plan. That is a longer campaign than a rate refresh, and it works best when you start it before your competitors do.

Sustainable growth is not more patients

The strongest groups we work with figured out something simple. They stopped trying to solve a margin problem with a schedule problem.

Strengthen the contracts. Close the leaks. Watch the right six numbers. Rebalance the portfolio. Do those four things and margin improves without another provider, another exam room, or another physician sitting in the parking lot at nine at night wondering when medicine turned into data entry.

How Accretive Health Advisors can help

Accretive was built by people who spent their careers on the other side of the table. Before founding the firm, I spent nearly 25 years at Humana, most recently as Vice President of Strategic Alliance Partnership Development. Our team has sat in the payor’s chair on the same contracts we now negotiate against, which means we know how rates actually get built, where the flexibility genuinely lives, and what a payor’s first answer of no is usually worth.

We partner with physician groups, specialty platforms, health systems, and private equity backed healthcare organizations on payor contract negotiation, reimbursement benchmarking, and revenue optimization. If you have not benchmarked your commercial rates against your own market in the last two years, you are almost certainly leaving money on the table. We can tell you how much.

Ready to improve profitability without adding a single appointment? Contact Accretive Health Advisors and let us take a look at your contracts.

Sources: American Medical Association comments on the CY 2026 Medicare Physician Fee Schedule and 2025 AMA Prior Authorization Physician Survey; Kodiak Solutions, State of the Healthcare Revenue Cycle (2026); Experian Health, State of Claims 2025; Tseng P, Kaplan RS, Richman BD, Shah MA, Schulman KA, “Administrative Costs Associated With Physician Billing and Insurance Related Activities at an Academic Health Care System,” JAMA, 2018;319(7):691.