Practice costs are climbing on every line at once: staffing, medical supplies and a technology stack that has grown at some organizations from two or three main systems to as many as 15. Reimbursement has not moved with any of it, and when the math gets that tight the reflex is to start cutting.

Physicians Practice Managing Editor Keith Reynolds sat down with Shawntea Gordon, CEO of Atlas & Perpetua Healthcare Consulting, to explain why that reflex is where most practices go wrong. A cut made without data behind it is a guess, Gordon argues, and the wrong guess costs more than it saves. She and Reynolds get into the leaks she finds most often, how to tell which benchmarks are actually worth trusting, why staffing reductions so frequently backfire and the recurring expense that has been quietly billing practices since the paper era.

Music Credits:
Groovy 90s Hip Hop Acid Jazz by Musinova - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.

0:00 – 0:23 | Cold open. Gordon on the practices that call staffing their biggest cost and then find out they were understaffed all along.

0:23 – 1:30 | Introduction. Austin Littrell introduces the episode, the guest and the gap between what practices spend and what they collect.

1:30 – 2:22 | Why the pressure feels different now. Gordon points to the widening spread between costs and reimbursement, plus staff shortages and a technology stack that has grown at some organizations from two or three main systems to as many as 15.

2:22 – 3:19 | Where the money leaks. Front desk data entry, coordination of benefits, uncaptured patient responsibility, undocumented in-office services, unappealed denials and downcoding. The one she sees most: unmanaged denials and claims sitting in accounts receivable.

3:19 – 4:01 | The first step if you have never benchmarked. Start with your own history. Pull 12 months of invoices, check what you ordered against what you paid, then look at alternatives and group purchasing contracts.

4:01 – 5:12 | Which benchmarks are worth trusting. Gordon on separating established associations from organizations that only claim to be validated, and why an apples-to-apples comparison starts with an honest read of your own size, location, service mix and payer mix.

5:12 – 6:16 | The right-sizing test before any staffing cut. Pull your administrative and clinical support ratios against validated benchmarks first. Groups convinced staffing is their biggest cost are often already understaffed, with burnout capping what they can collect.

6:16 – 7:20 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

7:20 – 7:58 | The contract nobody rereads. Practices that moved from paper to electronic and left shredding services on the same rotation, paying monthly minimums against bins that never fill.

7:58 – 9:35 | Cutting costs without creating new risk. The four questions Gordon runs before any systemic change, and the practice that switched medical supply vendors and lost access to a surgical item that was chronically backordered.

9:35 – 10:59 | Building a framework that holds. A holistic review, a 90-day improvement plan, then the same monthly block of time converted into continuous improvement. Gordon makes the case for 1% a month over an annual look back.

10:59 – 11:32 | One thing to do Monday morning. Run a monthly report comparing the CPT codes billed against the codes reimbursed. Every variance is a possible downcode.

11:32 – [END] | Closing thoughts and outro. Reynolds thanks Gordon, and Littrell wraps the episode.

S1 Ep175: Most practices cut the wrong thing first, with Shawntea Gordon of Atlas & Perpetua Healthcare Consulting

Off the Chart: A Business of Medicine Podcast

S1 Ep175: Most practices cut the wrong thing first, with Shawntea Gordon of Atlas & Perpetua Healthcare Consulting