MGMA Acting CEO urges practices to recover lost revenue before chasing new volume
Physician groups are under pressure from flat Medicare reimbursement, rising overhead and administrative drag that slows collections long before a claim ever becomes revenue. Akash Madiah, MGMA’s acting CEO, framed the answer in operational rather than aspirational terms: practices should first recover the money they have already earned before trying to generate more visits, procedures or encounters.
That advice lands at a moment when many organizations are feeling squeezed from both sides of the ledger. Payment has not kept pace with costs, while prior authorization, denials and staffing strain keep pushing more work onto already thin office teams. In that environment, a practice can add volume and still finish the quarter with less cash on hand if the revenue cycle is leaking at multiple points.
Denials, payer performance and staffing ratios are the real balance sheet
Madiah pointed to the basics of practice finance: know productivity, staffing ratios, payer performance and denial trends. Those are not abstract management buzzwords. They are the operational variables that determine whether a visit translates into payment, whether a physician’s work is recognized accurately and whether staff have the bandwidth to chase underpaid claims, correct billing errors and appeal denials.
A practice that does not know its denial pattern is essentially flying blind. If one payer is routinely delaying or rejecting claims, the issue may be coding, prior authorization workflow, documentation quality or contract terms; if the problem is spread across payers, the weakness may lie in front-end registration, charge capture or follow-up on outstanding balances. Each of those failure points has a different fix, and none are solved by simply seeing more patients.
The financial pressure is compounded by the staffing problem. Recruitment often gets more attention because it is visible and urgent, yet retention may produce a higher return when onboarding costs, turnover disruption and the learning curve for new hires are all counted. Experienced staff know the local payer rules, the quirks of the electronic health record and the shortcuts that keep accounts moving. Losing them can be expensive in ways that never appear neatly on a single line item.
The easiest revenue is often already sitting in the queue
One of Madiah’s most direct recommendations was also the most practical: collect every dollar already earned before adding volume. In a reimbursement environment where Medicare payments may be flat while labor, malpractice and supply costs continue to rise, practices cannot assume that more encounters will fix the margin problem. If claims are aging, undercoded, missing modifiers or stalled in appeals, growth only magnifies the leakage.
A single unworked denial can turn into a recurring loss if the same error keeps happening across similar visits or procedures. A missing authorization can convert a reimbursable service into uncompensated care. A weak fee schedule review can leave a group accepting payer terms that no longer reflect the true cost of delivering care. The revenue cycle is not a back-office detail; it is the point where clinical work becomes financial survival.
MGMA’s member feedback points to access gaps, digital tools and local support
Madiah also described what MGMA is hearing from its members as the organization moves through its centennial year. The first member pulse survey found strong trust in the association, but members want easier access through digital tools, education and local engagement. That combination matters because practice leaders are not only asking for more information; they are asking for information they can use quickly, without pulling staff away from patient care for long stretches.
His own background shapes that emphasis. Before becoming acting CEO, he used MGMA data to redesign physician compensation plans in practice finance work. That experience seems to have hardened a simple filter: if a product, report or recommendation cannot help a practice leader make a better decision on Monday morning, it is not useful enough.
The same operational mindset showed up in his description of what he heard in San Antonio. Reimbursement and administrative burden dominated the discussion, but so did a desire among members to get involved and volunteer. For an organization that depends on field-level feedback, that matters because the problems practices face are increasingly granular and local, even when the broad policy backdrop is national.
One metric, one peer conversation and one week at a time
Madiah offered two actions practice leaders can start immediately. First, identify the one metric that matters most to the organization and review it every week. Second, schedule one conversation with a peer outside the organization. Both steps are deceptively simple, and both are aimed at breaking the isolation that often keeps practices repeating the same mistakes.
A weekly review of a single metric creates accountability. If that metric is denial rate, days in accounts receivable, charge lag or provider productivity, the point is to stop treating performance as a quarterly surprise. Regular review can reveal small deteriorations before they become structural losses. A peer conversation can do something different: it can surface a process or benchmark another group is using that may be impossible to invent from inside the same office culture.
Those habits may sound modest compared with the scale of Medicare payment pressure, but practice management rarely turns on one dramatic intervention. It is built from cleaner workflows, better follow-through and faster recognition of where money is being lost. In a margin-constrained environment, the difference between survival and erosion often lies in whether leaders are measuring the right thing frequently enough to act on it.
Retention, benchmarking and data products will define MGMA’s next chapter
Looking ahead to MGMA’s second century, Madiah described three priorities: evolving the association’s data products, engaging members from early-career staff to veterans and strengthening the organization’s voice as an industry leader. Each of those priorities reflects the same premise running through his comments on practice finances: data only matters if it is usable, trusted and tied to real operational decisions.
For practice leaders, the immediate implication is less about grand strategy than disciplined execution. Benchmark against peers. Examine payer behavior. Audit denial trends. Protect retention. Review the number that matters every week instead of waiting for the quarter to close. Those are not glamorous moves, but they are often the only defense against a reimbursement environment that rewards precision and punishes drift.
The conversation leaves one practical truth in place: many practices do not need to invent a new revenue stream before fixing the one they already have. They need to stop losing the money sitting in front of them.