From cost to care: The revenue you never notice you didn't collect

Nobody on the panel claimed to know what reimbursement would look like a year out. That was the premise going in. The conversation was about what a practice still controls, and the answers had less to do with cutting than with noticing.

Lafko started with turnover, which she described as an expense practices absorb without ever pricing it. Patient dissatisfaction is the same kind of cost. Neither arrives as a line item, and both are controllable in a way a payer's fee schedule is not. Her questions for clients are practical ones: how smart is your recruiting, and how smart are your staffing patterns, given that satisfied patients are the ones who send referrals.

Jacobs sharpened the hiring thread. Practices hire off the resume, she said, when the question that matters is whether a candidate fits the mission and values the practice actually operates by. A team of like-minded people working toward the same thing is a more satisfied team, and satisfied teams produce satisfied patients.

For anyone who will touch the money conversation, she asks it directly: how do you feel about patients paying out of pocket for their health care? Then she watches. "It's more the body language response that I gauge versus the words that they actually say," she said. Lafko makes the same point from the other side, telling owners that if a role involves discussing finances, the interview itself should say so out loud.

Mehta recruits outside health care entirely. Some of her best hires came from hotels and restaurants, she said, because patients now find physicians through search engines and review sites, with fewer of them arriving on a referral from a primary care physician. They are reading reviews and judging bedside manner before they ever call. A practice operating outside the insurance rails has to communicate at a higher level, she said, because nothing else is doing the explaining.

Are you using the system you already paid for?

Gordon reframed the discussion, and hers is the point most likely to put money back in a practice. Culture and cost containment matter, she said, but a practice that is not deliberate about revenue has a failure point no amount of hiring discipline will close.

The industry is opaque in both directions, she said. Patients cannot see what they will pay, and plenty of practices are not tracking what they are actually being paid. The recurring problem she finds is a practice management system nobody is using to capacity. Allowed amounts are not loaded, so nobody is checking whether payments match what was negotiated. A down-coded procedure passes unnoticed.

When a client tells her they are ready to switch systems, her first question is whether they are using the one they have to anything near its capability. The answer, she said, is usually no, and a new system will not fix what the old one was never configured to catch.

The stakes are concrete. A practice can contain its costs and hire well and still come up short on payroll if the cash it earned never arrives.

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.