Reimbursement challenges in healthcare today

Understanding reimbursement challenges in healthcare for independent practices

Independent practices face growing financial pressure as reimbursements haven't kept up with inflation and the rising cost of care. The AMA has long supported tying Medicare updates to the full Medicare Economic Index (MEI), or practice cost inflation, noting that after adjusting for these rising costs, Medicare payments to physician practices have dropped by 33%.¹

At the same time, payment agreements with commercial payers vary widely, making it difficult to generalize trends in reimbursement rates. However, it’s harder than ever for practices to get paid reliably by commercial payers due to increasing claim denials, delayed payments, and complex payer requirements. This combination of reimbursement challenges forces difficult decisions about staffing, technology investments, and patient access.

Unlike larger health systems with multiple revenue streams and centralized administrative support, independent practices have less financial flexibility to absorb payment shortfalls, putting reimbursement challenges and operational efficiency front and center.  

The revenue pressure: Reimbursement challenges impacting healthcare providers

While Medicare payments have generally not kept pace with inflation, independent practices face broader reimbursement challenges that threaten financial stability. Even if payments remain flat or vary, rising operational expenses — from staffing and compliance to IT and software maintenance — continuously erode thin margins.

Cash flow uncertainty further compounds stress. Claim denials, delayed reimbursements, and slow payer responsiveness interfere with critical financial planning, including payroll and vendor payments. Meanwhile, fixed expenses such as rent, EHR fees, and salaries remain unchanged, reducing available funds to reinvest in patient care or technology.

Operating with fewer revenue streams and slimmer margins than large health systems, independent practices feel reimbursement challenges more immediately. Larger networks can leverage negotiating power and centralized billing to mitigate impacts, placing independents in a uniquely difficult position today.

Financial impact on independent practice stability and care delivery

When revenue falls short, independents must consider hiring freezes, delayed technology upgrades, and reduced hours or services. These decisions shrink access and can create longer waits for specialist appointments, test results, and preventive care. With fewer back‑office resources, clinicians shoulder more administrative work — chasing denials, reconciling payments, and filling gaps left by vacant roles — which drives burnout and turnover.

Fewer staff and higher workloads mean shorter visits and less time for complex care, creating a cycle that undermines both clinician well‑being and patient outcomes.

By streamlining revenue cycle management (RCM), practices can submit cleaner claims, track payments, and resolve denials proactively — all before revenue is affected. Built-in eligibility checks, claim edits, and automated follow-up reduce administrative rework and accelerate the time between service and payment.

How medical software for independent practices addresses revenue and operational challenges

Independent medical practices face mounting financial pressures requiring solutions that do more than digitize paperwork — they must connect patient care, billing, and business operations in a single, seamless platform. Integrated medical software for independent practices empowers these practices to manage cash flow and maintain financial stability despite tightening margins by combining automation, real-time data, and smart workflows.

By streamlining revenue cycle management (RCM), practices can submit cleaner claims, track payments, and resolve denials proactively — all before revenue is affected. Built-in eligibility checks, claim edits, and automated follow-up reduce administrative rework and accelerate the time between service and payment. These tools lighten the administrative burden, enabling staff to focus on higher-value activities such as patient engagement and scheduling optimization.

Together, these capabilities help practices protect revenue, minimize delays, and create a more predictable financial foundation — without adding headcount or outsourcing billing.

athenaOne® — A comprehensive platform built for independent practice success

athenahealth designed athenaOne® with the realities of independent practices in mind, combining EHR, RCM, and patient engagement in a unified system. This single platform delivers the efficiency of a large health system without the complexity, helping practices operate with autonomy while enhancing coordination and sustainability.

• Integrated Revenue Cycle Management

  Every encounter, order, and charge flows seamlessly from the exam room to billing. Real-time eligibility checks and claim edits prevent costly rework. Automated claim submission and follow-up reduce days in accounts receivable, accelerating payments and improving accuracy without requiring additional staff or outsourcing.
   

• Automation and AI-Driven Support

  Smart tools minimize administrative workload so clinicians and staff can spend more time on patient care. Task routing, coding assistance, and AI-driven suggestions streamline daily workflows, enhance accuracy, improve compliance, and help reduce burnout.
   

• Connected Data and Actionable Insights

  Consolidated data from clinical and financial sources empowers practices with visibility into performance. Dashboards highlight trends in reimbursement, denials, and payer performance, supporting smarter decisions on staffing, scheduling, and contracts.
   

• Stronger Connections Across Care Settings

  Referral management and interoperability tools facilitate coordination with payers and partners. Streamlined referrals prevent revenue loss and close care loops faster, while seamless data sharing supports continuity of care and timely follow-up.

In summary, athenaOne offers powerful, integrated medical software for independent practices that simplifies revenue management, enhances clinical-business coordination, and establishes a sustainable path to long-term financial stability—while avoiding unnecessary complexity and preserving independence.

Sustaining independence through smarter revenue management with an EHR for independent practices

Financial pressure isn’t going away, but independent practices can meet it head-on with the right tools. Flat reimbursements, rising costs, and growing administrative demands don’t have to define the future of care. With an integrated, intelligent EHR for independent practices, practices can strengthen their revenue cycle, reduce burnout, and stay focused on what matters most: delivering high-quality care to their communities.

athenaOne combines automation, data-driven insights, and connected workflows to protect revenue and improve efficiency. By uniting clinical, financial, and operational processes, it helps practices maintain both financial stability and independence — creating a stronger, more sustainable foundation for the future of care delivery.

Explore how athenaOne helps independent practices thrive — financially, operationally, and clinically.