Patient Financial Responsibility: The Two-Way Cost Squeeze
Cost pressure on an independent practice runs in two directions at once. Patient financial responsibility keeps rising, which changes what patients are willing to say yes to. At the same time, the cost of delivering that care keeps rising too.
The 2026 State of the Independent Practice survey shows both forces at work, and why together they may be the defining challenge of the year. Below, we look at the direction of the squeeze, and at the quieter costs that never appear on an invoice.
Patient financial responsibility is now the top barrier to care
The direction that stings most is the one that works against the reason practices exist. Cost is now the top barrier keeping patients from getting care, according to 57% of leaders, ahead of time constraints or confusion about medical information. Patients are delaying visits, skipping follow-ups, and thinking twice about the care their clinicians recommend, because of what it will cost them.
For an independent practice, that is a double loss. The patient does not get the care they need. And the practice does not see the visit, the follow-up, or the revenue that would have come with it.
What makes this different from other pressures is that it cannot be solved inside the practice alone. A leader can renegotiate a vendor contract or redesign a workflow. Deductibles are not theirs to set. What is within reach is how clearly and how early the practice communicates cost, because a surprise bill and an expected one produce very different behavior the next time care is needed.
When patients owe more, practices collect less
Rising patient financial responsibility does not stop at the exam room door. It follows the claim.
As the patient share of the bill grows, more of a practice’s revenue depends on collecting from individuals rather than payers. That is slower money and less certain money. It arrives in smaller pieces, over longer periods, with more follow-up required to get it, and it is one more place for revenue to leak out unnoticed.
It also changes what the billing function does all day. Chasing balances is different work from working claims, and most practices absorbed the change without adding staff for it. Understanding what patients want in healthcare payments has quietly become a revenue question, not just a service question. Clear statements, upfront estimates, and easy ways to pay affect how much actually comes in.
The cost of running a medical practice is the top threat to independence
Now the other direction. When we asked 360 practice leaders to name the biggest threat to staying independent, cost came first. Nearly half, 46%, pointed to rising operating costs above every other pressure. Not payer politics, not competition, not burnout, though all of those are real. The plain economics of running a practice topped the list.
That framing matters. Operating cost is not a back-office line item. It is the pressure most directly tied, in leaders’ own words, to whether they can stay independent at all. Margin is what independence is built on, and cost is what wears it down.
It is worth naming what the cost of running a medical practice actually includes, because it is rarely one big number. It is staffing, software, supplies, space, and the administrative work of getting paid, each rising at its own pace, none of them optional.
The everyday cost you never invoice
There is a related finding worth sitting with. When leaders described where the day actually goes, the single largest engagement burden was responding to patient messages, named by 51%. The work of staying connected to patients, answering questions, closing loops, keeping people engaged in their own care, has become one of the heaviest loads in the practice.
That is a cost too, even if it never appears on an invoice. Every hour spent on manual back-and-forth is an hour not spent on care. And a slow, effortful patient experience becomes its own quiet barrier to people saying yes to the care they need. Which is why strategies to elevate patient engagement are worth treating as an efficiency question as much as a satisfaction one.
What practices can actually control
Not every part of this squeeze is within reach, and it helps to separate the two.
Deductibles, payer contracts, and the broader economics of healthcare are largely fixed from where a practice sits. Arguing with them burns energy that could go somewhere more useful.
What a practice does control is the friction around cost. When a patient knows what a visit will cost before they arrive, they make a different decision than when the bill turns up three weeks later. When a balance can be paid in one tap instead of by check, more of it gets paid. When staff spend less of the day on manual back-and-forth, the same team handles more of both.
None of that lowers the price of care. It lowers the cost of collecting it, and it lowers the odds that a patient walks away over uncertainty rather than expense. For a practice defending its margin, that distinction is worth a great deal.
Managing cost is protecting the mission
Here is the throughline. When a practice lowers what it costs to deliver care, it is not only protecting a margin. It is protecting its independence, because margin is what keeps the acquisition conversation optional. And it is protecting its patients, because a practice under less cost pressure has more room to make care affordable and easy to say yes to.
That is the shift this year’s findings point toward. Practices are moving from a system of record, which documents care after the fact, to a system of work, which carries the operational load so the practice can spend less delivering care and patients can spend less receiving it.
Veradigm works with independent practices on both ends of that squeeze, from practice management through billing and payments, so less of the margin disappears into the work of running the place.
The full 2026 report lays out the cost findings in detail, by practice size and specialty. The benchmark tool shows how your cost pressures compare to the 360 practices in the survey.