Practice Operations and Strategy Require Strong Executive Oversight

In a primary care practice, operations and strategy are often treated as separate things though in reality, they are tightly connected. Staffing, scheduling, access, follow-up workflows, payer rules, quality performance, technology, and reimbursement all affect one another. MGMA said in August 2025 that medical group leaders’ top priorities were margin and cost containment, access and growth, staffing, payer friction, and technology and AI. [i] This list is not intended to overwhelm, though it may do that. It seems their point was that these challenges form an interconnected agenda, not a series of separate problems to be solved independently. That is part of what makes physician practice leadership so difficult right now. The landscape is constantly changing, the changes do not arrive one at a time, and solutions almost always involve a mix of operational and strategic innovation. 

CMS now lists Vermont as a Cohort 2 state in the AHEAD model, with performance beginning January 1, 2028, as part of a broader effort to move toward multi-payer alignment and system transformation. [ii] At the same time, Medicare is continuing to build new primary-care-focused payment structures. Under a program called Advanced Primary Care Management services, which began January 1, 2025, physicians and other eligible practitioners are allowed to bill a monthly bundle for a range of advanced primary care services rather than piecing together multiple separate codes. [iii] Programs like this are packaged like opportunities, and they are, but they also create operational pressure. A payment opportunity is not very helpful if workflows are not ready to accommodate it. A new reporting expectation can wreak havoc if no one on your staff has the capacity to manage it. 

Even seemingly simple, helpful flexibility can require close attention. For example, in the 2026 Physician Fee Schedule final rule, CMS finalized a simpler process for adding services to the Medicare telehealth list, and new add-on codes tied to Advanced Primary Care Management services. [iv] Those are meaningful operational developments, but they still require leadership attention to use them well. The hard part is that most physicians and practice leaders are already stretched thin. A 2023 JAMA Network Open study found that primary care physicians spent a median of 36.2 minutes in the EHR for each visit, including 7.8 minutes on the electronic inbox and 6.2 minutes of after-hours work. [v] More recently, a 2026 JAMA Network Open survey found that 39.1% of physicians reported a high level of moral distress, and physicians with higher distress were much more likely to report burnout and intent to leave. [vi]

That is why strong executive oversight matters so much. It is not just about keeping the trains running on time. It is about having someone close enough to the work to spot problems early, with the ability to connect day-to-day issues to larger strategic choices and help the practice respond before small problems become expensive ones. It is also about having someone who can see beyond the immediate fire drill: where access is slipping, where staffing strain is building, where payer rules are creating avoidable drag, where a contract or payment model may require a change in workflow, or where leadership is spending too much time reacting instead of steering.

That is where Mansfield Primary Care Support can help. Many practices do not need another distant consultant, and they do not need a stack of abstract recommendations. They need experienced executive oversight that is close at hand. They need a trusted business partner who understands operations, reimbursement, payment reform, and physician practice realities well enough to help leadership make sound decisions in real time. Mansfield helps practices sort through what is changing, decide what deserves action, and build a clearer path forward, so clinicians and practice leaders are not left trying to navigate a shifting landscape alone.

[i] https://www.mgma.com/mgma-stat/5-big-challenges-for-medical-practices

[ii] https://www.cms.gov/priorities/innovation/innovation-models/ahead

[iii] https://www.cms.gov/medicare/payment/fee-schedules/physician-fee-schedule/advanced-primary-care-management-services

[iv] https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f

[v] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812258

[vi] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2846921