Why medical groups miss budget without a financial cause

Medical practices often focus on financial metrics when budgets go off track, but the real culprit can be harder to spot.

Melinda Mastel, financial advisor at the Medical College of Wisconsin, says undocumented shifts in how staff time is spent, workflow changes, and evolving coding standards often go unnoticed until a group is already off course.

Physicians Practice: In your experience, what's the most common reason a medical group misses budget that has nothing to do with finances?

Melinda Mastel: In a way, it all connects back to finance, but the most common thing I would say is hidden operational shifts that go below the radar. It could be slight changes in how people's time is being spent, or how effort is being deployed that doesn't get officially approved or documented and isn't built into our financial assumptions or projections. It could be a change in workflow or a change in coding standards and rules. All of these little things just drift us away from where we expected to be, and they don't get captured.