Rising costs, staffing challenges, and tightening reimbursements are putting independent practices under more pressure than ever. Yet data from Tebra’s third annual State of the Independent Practice survey shows a clear divide: While some practices feel constantly behind, others feel steady, confident, and in control.

In a recent webinar, independent practice owner Dr. John Scala and healthcare business consultant Aimee Heckman joined Tebra’s Miriam Datskovsky to unpack that divide. Drawing on national data and real-world experience, they explored what sets confident practices apart — and how others can follow suit.

Two-thirds of providers plan to stay independent, yet nearly half believe the model is under threat.

The challenge isn’t staying motivated. Rather, it’s sustainability. Flat reimbursements and rising costs are squeezing margins, making it harder to maintain stability over time.

Data supported this: Independence isn’t disappearing — but it is becoming harder to operate confidently.

Here are the factors that set confident practices apart.

Many practices are working harder than ever. But effort alone isn’t what separates those who feel in control from those who don’t.

As Aimee Heckman explained, practices tend to fall into 2 groups:

The difference is operational visibility.

Take the annual deductible reset. Every January, many practices experience a predictable dip in revenue. For some, it feels like a sudden crisis. For others, it’s already built into the plan.

Dr. Scala prepares for this cycle by setting aside reserves and maintaining strong time-of-service collections. That foresight turns a disruption into a manageable fluctuation.

Without that visibility, even small changes can escalate, delaying payroll, straining staff, and forcing reactive decisions.

The difference isn’t how hard practices are working — it’s how they’re operating.

Confidence doesn’t come from optimism. It comes from pattern recognition. Confident practices:

Rather than relying on gut instinct, they use data to guide decisions.

Dr. Scala, for example, spends just 30 minutes each week reviewing financials and spot-checking EOBs. That small habit gives him enough visibility to catch issues early — without micromanaging.

Practices that skip this step often fall into a cycle where predictable events feel like surprises.

Some practices plan for predictable cycles. Others are surprised by them.

In a low-margin environment, inefficiency adds up quickly. Every manual step, handoff, or workaround increases the risk of delays, errors, and missed revenue.

Confident practices focus on reducing operational friction by:

They also rely on the right partners to extend their capabilities.

For Dr. Scala, that includes a billing partner and an independent practice association (IPA), which provides greater leverage in payer negotiations and purchasing.

These choices don’t reduce independence — they reinforce it.

Independence doesn’t mean doing everything yourself.

Ultimately, confident practices aren’t less busy. They’re more predictable.

Predictability reduces the surprises and operational fire drills that create day-to-day stress. As Aimee noted, predictability comes from “a few simple things done consistently.” That includes:

These fundamentals matter even more as patient responsibility increases. With higher deductibles now common, time-of-service collections and clear communication are essential for stable cash flow.

So, why stay independent?

The goal isn’t to work harder just to keep the doors open. It’s to build a practice that works — financially, operationally, and personally. When operations run smoothly, independence enables:

As Dr. Scala emphasized, long-term sustainability is what makes independence rewarding.

Independence isn’t the reward. It’s the result of a well-run practice.

Watch the full discussion with Dr. Scala, Aimee Heckman, and Miriam Datskovsky to explore the data and strategies in more detail.