It’s Operational Leakage.
By Christie Yoder RN, COO
There is no shortage of challenges facing independent cardiology practices today. Reimbursement pressure continues to mount. Labor costs remain elevated. Recruiting physicians and experienced staff has become increasingly difficult. Administrative requirements continue to expand while patients expect greater access, convenience, and communication than ever before.
These challenges are real, and they deserve attention. However, after working alongside cardiology practices across the country, I’ve become convinced that many practices spend too much time focused on the external forces that are difficult to control and not enough time focused on the opportunities sitting directly in front of them.
At CardioOne, we work with practices of different sizes, in different markets, and at different stages of growth. While each practice has its own unique challenges, one pattern appears consistently. The practices that outperform their peers are rarely benefiting from dramatically different market conditions. More often, they have built stronger operating models. They are better at capturing demand, converting it into care, and reducing the friction that prevents patients, providers, and staff from operating at their full potential.
In other words, they are better at identifying and eliminating operational leakage.
The Most Overlooked Growth Strategy in Cardiology
One of the most common conversations we have with physician leaders centers around growth. The assumption is often that growth requires more demand, more referrals, more marketing, or more providers. Sometimes that is true. But more often than people realize, meaningful growth opportunities already exist inside the practice.
Before we talk about adding physicians or expanding service lines, we frequently uncover referrals that are not being worked quickly enough, phone calls that are not being converted consistently, scheduling templates that no longer reflect current demand, or revenue cycle processes that contain leakage nobody realized existed. These are rarely dramatic failures. They are usually small inefficiencies that have accumulated over time and gradually become accepted as normal.
The challenge is that operational problems rarely create the same sense of urgency as external pressures. Everyone notices when reimbursement is reduced. Everyone notices when staffing becomes more difficult. Far fewer people notice when a handful of new patient opportunities are lost each week or when recommended follow-up care never gets completed because the workflow breaks down between recommendation and scheduling.
Yet when we evaluate performance across practices, these are often the issues creating the greatest opportunity for improvement. The question is not always whether a practice needs more demand. Often, the better question is whether the practice is fully capturing and managing the demand it already has.
The Difference Between Activity and Performance
One of the most common observations we make when entering a new practice is that everyone is busy. Physicians are seeing patients all day. Staff are moving constantly. Schedules appear full. From the outside, everything looks productive.
The problem is that activity and performance are not the same thing.
Some of the largest opportunities we uncover exist in practices that appear highly successful. A schedule may be booked out weeks in advance, yet new patient access continues to deteriorate. Follow-up appointments gradually consume capacity that was once available for growth. Recommended testing or follow-up care may be clinically appropriate but never completed because of workflow breakdowns. Revenue cycle performance may appear stable, while payer-specific leakage quietly persists beneath the surface.
None of these issues suggest that people are not working hard. In fact, the opposite is usually true. Most teams are doing everything they can to keep up with the demands of a busy practice. The challenge is that effort alone does not eliminate friction. Over time, small inefficiencies become embedded in the operating model and begin to feel normal.
This is one of the reasons we often talk about operational leakage as a collection of small problems rather than one large one. A missed phone call does not feel strategic. A no-show does not seem transformational. A coding inconsistency on a single encounter is easy to overlook. A service line is being built off the side of someone’s desk. But when these issues occur hundreds or thousands of times throughout the year, the impact becomes meaningful. Most practices do not have one million-dollar problem. They have dozens of smaller opportunities that collectively add up.
Why Most Practices Struggle to Fix It
The reality is that identifying operational opportunities is often easier than addressing them. Most physician leaders did not choose medicine because they wanted to redesign scheduling templates, analyze denial trends, or build referral conversion workflows. Practice administrators are balancing dozens of competing priorities. Even when opportunities are obvious, finding the time, expertise, and resources to execute can be difficult.
This is one of the reasons CardioOne has invested heavily in operational playbooks and what we call Quick Impact Initiatives. Over the years, we have found that practices do not need a complete transformation to improve performance. More often, they need a structured way to identify the highest-impact opportunities, implement changes quickly, and measure results consistently.
Our playbook was built from working across cardiology practices and seeing the same patterns emerge repeatedly. Every practice is different, but many of the underlying operational challenges are remarkably similar. The advantage of having experienced operators, dedicated technology, and proven processes is that practices do not need to start from scratch every time they want to improve performance.
The future of independent cardiology will continue to be shaped by reimbursement pressure, labor challenges, and industry consolidation. Those forces are unlikely to disappear. However, the practices that thrive will not necessarily be the ones facing fewer headwinds. They will be the ones that build operating models capable of performing despite them.
In our experience, the greatest opportunities for improvement are rarely found somewhere outside the practice. More often, they are already there—hidden in workflows, processes, and operational habits that have simply become accepted as normal.
The challenge is not finding a million-dollar opportunity. It’s finding the dozens of smaller opportunities that collectively add up to one.
To help practices identify where those opportunities may exist, we’ve created The Hidden $1M in Your Practice: 9 Operational Fixes That Quietly Drive 7-Figure Growth in Cardiology—a practical guide built from the experiences of CardioOne operators working alongside cardiology practices across the country.
Download the eBook to explore the operational levers, Quick Impact Initiatives, and proven playbooks that can help unlock growth already hiding inside your practice.