From cost to care: You touch less of the patient experience than you think

Lafko's clients tend to arrive with a specific request: train the medical assistants to de-escalate. Her response is to ask about the front desk, the schedulers and whoever picks up when a patient calls with a billing question.

With one client she mapped the full patient journey, and the physicians were shocked by what came back. Measured against everyone else in the practice who touched that patient, the clinicians' own share of the time was small. They were confident they delivered excellent, high-touch care in the room, and they were probably right. The room was not most of the experience.

The first face a patient sees belongs to whoever is at the front desk. The last interaction is often a billing question routed to someone the physician never meets. Those people, Lafko said, are just as consequential to the visit as the encounter itself.

That finding is where her hiring advice comes from. Her best front desk hire came out of a restaurant, chosen after she watched the woman stay unflappable with children running loose around her. What Lafko then had to teach her was not clinical: managing expectations from the first phone call, de-escalating a patient who is already frustrated, absorbing pressure without passing it down the line.

What patients see before they ever call

Jacobs warned against hunting for a single fix. "There's no one silver bullet," she said, because patients arrive through too many paths at once: a neighbor's recommendation, a search for a phone number, a scroll through reviews on the way in. Her framing is that reputation management now deserves the same standing in a practice as revenue cycle management, in insurance-based work as much as elective.

Mehta's differentiators follow from her model. Lower volume buys time, she said. No phone tree, and an appointment inside a week or two in a market where a large academic medical center might quote considerably longer. She sees her own patients at every visit rather than routing postoperative follow-up to a physician assistant or nurse, and she treats that as something to advertise rather than assume patients will notice. She also gives staff scripts, so they can explain what the practice offers and what a patient's out-of-network benefits might cover.

Her approach to reviews is procedural and worth copying. Ask while the patient is in front of you and happy. Frame it honestly, the way she does, by telling patients she runs a small business and a review is how other patients find her. Have the QR code ready at the desk. "Don't make it difficult," she said. Build up enough of them that the inevitable one- or two-star review from someone who sat too long in the waiting room does not move the average or ruin the week.

"You control the narrative," she said.

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.