Weekly roundup
Here’s what you missed last week!
🏛️ Policy & Payers
Practices face compliance risk as 62% of Medicare Advantage enrollees are subject to chart reviews, which boost CMS payments for 17% of members.
RCM teams should brace for a tougher year as denials for hospital claims are up 12% for inpatients and 14% for outpatients in 2025.
The availability of cheaper GLP-1 alternatives is prompting payers to favor surgical weight loss options over expensive diabetes drugs.
Practice check-in times could improve as Epic and Humana partner to automate insurance sharing for 800,000 Medicare Advantage patients.
📈 Business & Tech
Thrivory's new $3.5 million funding will help clinics accelerate cash flow by enabling quick upfront payments right at the point of care.
Generative AI is enhancing audit readiness by enabling safer, cost-effective in-house HCC coding.
Practices should review the five proposed strategies to build supply chain resilience and prepare for operational disruptions caused by tariffs and global challenges.
⭐ Just for Fun
The Deep Dive
Are patient-acquisition marketplaces filling your schedule or quietly working against it?
If you’ve used Zocdoc or similar patient-acquisition marketplaces, you’ve seen the upside: the volume shows up fast and open slots get filled quickly.
But because they operate on a pay-per-booking model, the question is whether those appointments make sense once they hit your P&L and your schedule.
The unit economics trap
This type of fee structure shifts the financial risk entirely onto the practice.
Let’s look at the math on a single visit: You pay $65-$75 for a new patient who comes in for a visit that reimburses around $115.
After provider compensation, room turnover, MA support, supplies, and overhead, that visit is already underwater. That first visit breaks even only if and when the patient returns for another visit.
A filled slot is not the same as a profitable slot, and many practices don’t realize the margin leak until they run the numbers.
The “ghost patient” problem
Because the barrier to book on these apps is so low (usually just a few clicks), the commitment level is equally low. While platforms often market their users as "high-intent," peer-to-peer discussions paint a different picture.
In community threads like r/medicalpractice and r/whitecoatinvestor, providers report meaningfully higher no-show rates (sometimes as high as 50%) on marketplace bookings than platforms advertise.
And here’s the kicker: A lot of platforms will still charge the booking fee even if the patient ghosts you.
So unless your team catches the no-show and files a dispute within a strict window (typically 24 hours), that fee hits. If your front desk is swamped and misses the deadline, you just paid for empty air.
Where things really break: operational misalignment
Beyond the financials, there is the operational toll. Algorithms don’t understand your clinical rules, they only understand open blocks.
This leads to visceral misalignment. A patient selects a generic "Dermatology Consultation" because it was the first available 10-minute slot. In reality, they need a full-body skin check or a surgical excision.
They arrive, and the provider is stuck. Rushing the care isn’t an option, so they perform the procedure and the schedule falls behind. That delay creates a ripple effect that stresses your staff and frustrates the patients who actually showed up on time.
So, is the squeeze worth the juice?
Given the margin compression and operational headaches, does this mean you should cancel your contracts immediately? Not necessarily.
It comes down to your practice's lifecycle stage. These platforms are powerful tools for volume but poor tools for precision. Look at it this way:
They’re most useful when:
You’re ramping up a brand new provider with zero panel.
You’re opening a new location and need raw volume to keep the lights on.
But they can become a liability when:
Your schedule is procedural or Mohs-heavy (high risk of wrong-slot booking).
You’re established and booking out weeks in advance.
Your front desk lacks the bandwidth to aggressively triage every internet booking to prevent errors.
Bottom line: Don’t take broad ROI claims at face value. Instead, audit your last 30 bookings to see if the acquisition fees and schedule disruptions are actually worth the volume.
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That’s it for this week.
This one was super fun. Hope you enjoyed it too.
