Physician revenue under strain across the U.S.

How rising costs, payer complexity, and policy risk are affecting financial sustainability in care delivery

Across the country, physicians are raising a consistent concern: financial pressure is making it harder to continue delivering care. Data from the 2025 Physician Sentiment Survey (PSS), conducted by Harris Poll and sponsored by athenahealth,¹ shows that the pressure is not isolated to one care setting or specialty — it cuts across the entire healthcare landscape.

While the causes are complex, the implications are clear. Practices are managing growing financial uncertainty at the same time they’re being asked to deliver more comprehensive, coordinated, and accessible care. Addressing this imbalance requires more than payment reform. It calls for systems and tools that reflect how care is actually delivered today.

Healthcare reimbursement uncertainty is causing systemwide strain

Physicians across nearly every care setting point to reimbursement — both public and private — as their top financial concern. According to the PSS, nearly sixty percent (57%) of respondents said Medicare and Medicaid reimbursement is a major pressure point, while 46% cited commercial payer reimbursement. These concerns are held consistently across practice sizes (60% of small-practice physicians; 58% of large-practice physicians) and geographies (61% of rural physicians; 56% of urban/suburban physicians), illustrating the widespread nature of the challenge.

In fact, 56% of physicians feel somewhat to very concerned about the financial health of their practice, making it both pervasive and top of mind.

For healthcare organizations, this reimbursement uncertainty is both a policy issue and an operational one. Practices must spend significant time managing claim denials, appealing underpayments, and navigating payer-specific rules that can shift frequently, lack transparency, or vary widely.

Healthcare IT software and services can help reduce this financial burden through tools that streamline revenue cycles, such as those that support:

• Real-time insurance eligibility verification to reduce downstream denials.
• Automated claims scrubbing to flag coding issues before submission. Practices using athenahealth's platform have achieved a 98.4% clean claims rate.²
• Integrated payer rules engines to adjust workflows dynamically.
• Direct payer integrations that surface benefit details and payer-specific program opportunities at the point of care. athenaPayer’s care and diagnosis gap solutions touch members in all 50 states.³
• Claims analytics dashboards to monitor reimbursement trends, identify denial hotspots, and drive intervention strategies.

Improving visibility into revenue cycle performance, combined with automation in claims processing and outsourcing claims denials management, helps practices maintain margins — while minimizing manual effort.

According to the 2025 PSS, nearly sixty percent (57%) of respondents said Medicare and Medicaid reimbursement is a major pressure point, while 46% cited commercial payer reimbursement.

Primary care faces distinct financial headwinds

Primary care physicians (PCPs) at the heart of the nation’s healthcare ecosystem continue to report financial concerns. According to the PSS, 52% of PCPs expressed concern about their organization’s financial health, and 59% cited Medicare and Medicaid reimbursement as a top issue — slightly above the 56% of specialists who said the same.

This financial pressure stems from multiple forces. Reimbursement rates for fee-for-service (FFS) visits continue to decline in many markets. Small and independent PCPs often have less leverage to negotiate higher rates with commercial payers. At the same time, value-based care contracts are becoming more prevalent, but often bring deferred or at-risk income, expanded reporting requirements, and increased accountability for long-term outcomes.

These dynamics may limit a practice’s ability to invest in staffing, infrastructure, or care team expansion — especially among those without scale or capital reserves.

Electronic health records (EHR) software can support PCPs by enabling:

• Chronic care management workflows that track patient time and support billing
• Population health dashboards to proactively manage panels and risk scores
• Embedded quality measure reporting for value-based contracts
• Shared care plans across teams to coordinate patient goals
• Telehealth and virtual visit support to improve access and continuity
• Payer-specific program prompts at the point of care — helping PCPs capture available incentives

Integrated systems that reflect the full scope of longitudinal, team-based care can help ease financial strain and allow PCPs to focus on patients instead of payment models.

More complex payment models increase operational burden

Only 9% of physicians report working exclusively in a value-based care (VBC) model in the 2025 survey. The majority of physicians navigate a blend of payment arrangements — fee-for-service, performance-based incentives, shared savings, capitated payments, or care coordination stipends — each with its own documentation and billing requirements.

In the survey, physicians in FFS environments reported the highest financial pressure: 60% were concerned about Medicare and Medicaid reimbursement, and 55% cited strain from private payers. VBC physicians reported lower concern levels (40% public, 28% private), yet operating under multiple models requires managing different ways to get paid simultaneously.

Success under blended payment models depends on technology that can support:

• Unified documentation and billing workflows across contract types and government programs
• Performance dashboards that combine clinical and financial measures
• Patient attribution tracking and panel management
• Reimbursement logic that adjusts based on payer terms
• At-a-glance prompts for payer-specific incentives, medical coding requirements, or care gap closure programs

As payment arrangements grow more complex, it’s more important than ever for HIT vendor partners to enable practices to manage that complexity without increasing staff burden or documentation delays that exacerbate revenue cycle pressure.

Public payer strain is magnified in vulnerable markets

Financial vulnerability was felt across geographic locations nationwide but can be especially intense in underserved areas. Federally Qualified Health Centers (FQHCs) and Community Health Centers (CHCs) — in both rural and urban settings — serve a high proportion of publicly insured or uninsured patients. These organizations are deeply reliant on Medicare, Medicaid, and grant funding tied to state and federal appropriations.

In the 2025 survey, 61% of rural physicians and 56% of urban/suburban physicians identified Medicare and Medicaid reimbursement as a top concern. These numbers are especially pressing in safety-net settings, where slim margins and funding fluctuations make it difficult to sustain services or expand access.

Technology that supports revenue stability in these settings includes:

• Built-in support for sliding fee schedules and good faith estimates.
• Claims automation tailored to public payer rules, as well as automated report submission for MIPS and other programs.
• Risk Adjustment Factor (RAF) and HEDIS reporting dashboards.
• Reporting packages aligned with Uniform Data System (UDS) requirements.
• Visibility into revenue gaps from missed medical coding or uncaptured value-based opportunities.

For CHCs and FQHCs, the ability to capture and justify every dollar of reimbursement is critical to keeping doors open — and serving the communities that rely on them most. These findings highlight the importance of equipping practices in high-need areas with tools that support financial performance in a declining reimbursement environment.

Administrative burden continues to drain financial and clinical resources

Beyond reimbursement rates, physicians report continued frustration with the time and overhead required to secure payment. The PSS shows that more than three out of four physicians (77%) report that a significant portion of their time is dedicated to non-reimbursable tasks. Denials, prior authorizations, documentation, and payer communications all add friction to the revenue process — and take attention away from patient care. Over a third of respondents (37%) agreed that improved operational coordination with payers on these tasks would have the greatest impact on their ability to provide higher quality patient care.

High-performing revenue cycle teams rely on clear workflows and transparency into where claims require attention. Without strong systems, even experienced staff can struggle to keep up with evolving payer requirements.

Technology solutions that reduce administrative task friction include:

• Ambient Notes — an ambient listening tool that auto-generates clinical documentation to reduce time spent charting
• Natural Language Processing-enhanced claims tools that can help suggest accurate codes based on documentation, with appropriate clinician review and approval
• Prior authorization automation with integrated forms and status updates
• Real-time insurance eligibility verification at scheduling to reduce front-end errors
• Reporting dashboards that flag stalled or at-risk claims and provide a clear workflow for timely intervention

With the right tools, practices can recover both dollars and time — easing administrative load and allowing clinical teams to focus on care knowing that revenue can continue flowing.

A coordinated approach to financial sustainability

The 2025 PSS reveals a consistent theme: financial stress is widespread — and growing. From declining FFS rates and uneven payer contracts to delayed value-based payments and rising administrative overhead, the path to financial sustainability for healthcare organizations requires more than cost containment.

Want to learn more about our findings? Download the full 2025 Physician Sentiment Survey report.