From cost to care: The problems these practice leaders haven't solved yet

Closing segments usually collect wins. Moody asked instead what each panelist was still working through, and the answers were more useful for it.

Lafko's client could not keep physician assistants. The practice runs on traditional, proven methods and wanted clinicians comfortable with that. Its job postings promised a cutting-edge environment, language the person writing them found appealing but that did not describe the job. The postings worked, in the narrow sense that they attracted candidates. Those candidates arrived wanting to add and change things, ran into physicians who do not operate that way and left.

Nothing was wrong with the practice or the applicants. The advertisement described a different job. Lafko's fix was to rebuild the selection process around what would actually motivate someone to stay, and to be ruthless about it. "Don't hire the warm body," she said.

Jacobs named a supply problem she cannot solve locally. Ophthalmology is a hard specialty to recruit surgeons into, optometry is growing and absorbing some of the demand, and "there just isn't a lot coming out of residency" while the population keeps aging. Looking five to 10 years out at succession planning, she was candid that she does not know what that pipeline looks like.

When one person has run the revenue cycle for 20 years

Gordon's case is the most transferable of the four, and the most likely to be sitting unnoticed in a reader's own practice. A group in Kansas had days in accounts receivable above 70, which should never happen in private practice, and had been frustrated with its revenue cycle for years. One person had run the entire function for two or three decades, and everything was still being done the way it had always been done. That phrase is one Gordon has no patience for. "I can't stand people saying that's the way we've always done it," she said.

Rather than guess, she pulled the data. "Don't guess, don't make assumptions about what's wrong in the revenue cycle," she said. "The data exists; it's in your PM system." The root causes turned out to be unfinished credentialing and unfinished payer profile setups. That distinction is the whole lesson, because the practice had spent years appealing individual claims, treating symptoms while the underlying configuration kept generating new ones. What accumulated instead was a long run of timely-filing write-offs and uncollected revenue that is not coming back.

Her advice is not to remove the long-tenured employee. Someone who has held a role for decades is a credit to the practice's culture, she said. Keep that person, invest in them, and bring in an independent set of eyes quarterly or annually to make sure nothing is being missed. "It doesn't mean you have a bad human." It means someone has been working for a long time without an external reference point, which is a structural risk rather than a personal failing.

Mehta's open problem is patient comprehension. Many callers hear the words out of network and hang up before learning that her total cost may come in below an in-network alternative. "They hear those words and they run," she said. She is answering it with video education on her website and social channels, and she expects the need for that kind of patient explanation to grow rather than shrink.

Meet the panelists

Pamela Mehta, M.D., is a board-certified orthopedic surgeon in California's Bay Area who has practiced for more than 15 years and owned her practice for about 10 of them. Resilience Orthopedics is completely out of network, so every cost discussion in her practice happens out loud and up front, before anyone is treated. She also co-founded Learn at Pinnacle, which delivers education to women in medicine.

Shawntea "Taya" Gordon, MBA, FACMPE, is CEO of Atlas & Perpetua Healthcare Consulting. She has co-authored two revenue cycle books for MGMA and sits on the association's Government Affairs Council, which means she moves between the granular work of repairing a practice's collections and the policy fights that reshape them.

Carrie Jacobs, COE, is Executive Vice President of Operations at Chu Vision Institute in Bloomington, Minnesota, and runs the practice's ambulatory surgery center. She has spent nearly 25 years in practice leadership, in a specialty where insurance-covered and elective self-pay work sit side by side on the same schedule, and serves on the board of the American Society of Ophthalmic Administrators.

Amy Lafko, MSPT, MBA, spent two decades in health care leadership across acute care rehabilitation, home care, urgent care and medical group practices before concluding that most operational problems were people problems underneath. She founded Cairn Consulting Solutions and wrote "People First: A Proven Method for an Exceptional Healthcare Practice."

The discussion was moderated by Jean Moody, CHPC, Vice President of Specialty and Wellness Solutions at Synchrony, which owns CareCredit. Moody has spent nearly 20 years with the company and ran a LASIK ophthalmology practice before that.

This roundtable was recorded in October 2025.