Introduction
Every Monday, something is on fire. A patient’s insurance got rejected and now billing’s chasing it. The schedule’s overbooked because someone forgot to block off a provider’s half-day. A stack of unworked claims from six weeks ago just resurfaced because someone finally had a slow afternoon. You put it out, move to the next one, and by Friday you can’t remember what Monday’s fire even was. Ninety days pass this way. Then ninety more.
You’ve been busy the entire time. You could not tell someone what the practice actually accomplished this quarter.
The Practice Isn’t Drifting Randomly — It’s Following the Path of Least Resistance
There’s a story in The System, a book on how growing companies organize themselves, about Boston’s Big Dig — a multi-decade, multi-billion-dollar project to fix a road system that was a mess by the time anyone tried to untangle it. The book traces the roads back to their origin and finds something almost funny: the car routes were paved over old horse-and-carriage paths, which were paved over horse trails, which followed cow trails from the 1700s. The cows weren’t planning a city. They were just walking around whatever rock or hill was directly in front of them, one step at a time. Nobody ever sat down and designed that road system. It was never anyone’s decision. It’s just what accumulated when every single choice was made in response to whatever was immediately in the way.
That’s what a practice run entirely on urgency looks like from the outside. Nobody chose this schedule, this backlog, this way of handling verifications. It’s what accumulated from a few hundred decisions made under pressure, each one reasonable in the moment, none of them pointing anywhere in particular.
The book’s answer isn’t “work harder” or “stop having emergencies.” It’s that you need a deliberate priority for the next stretch of time — something decided in advance, not extracted from whatever’s loudest that week.
A Quarter Isn’t a Vibe. It Should Be One or Two Specific, Checkable Things.
Most owners who do try to plan ahead make the same mistake: they write something too vague to actually finish. The book draws a sharp line between a goal that sounds good and a goal you can actually check off. It compares “fix our social media” against “boost LinkedIn’s engagement metric by 20%.” The first one never ends — you can always do a little more of it, which means it’s never really done. The second one has a finish line. Either you hit 20% or you didn’t.
That distinction matters more in a practice than it does on social media. “Get billing under control” isn’t a 90-day plan — it’s a mood. It’ll survive the whole quarter untouched, because there’s no version of it that’s finished. Compare it to something like: reduce claims sitting unworked past 60 days from 40 down to under 10, by the end of the quarter. That one has a number. You’ll know in week 11 whether you’re on pace, and you’ll know in week 13 whether you did it.
The book also insists that a goal under a year needs exactly one owner. Not the team, not “billing” as a department — one person whose name is on it. Shared ownership is how a 90-day plan quietly becomes nobody’s job by week six.
Try This
Pick one thing that’s been nagging at you all quarter — the claims backlog, the no-show rate, the callback delay — and write it down as a single number with a deadline, the way you’d write a lab order: specific, measurable, done by a date. Then assign it to exactly one person, whether that’s your biller, your PCC, or your office manager, and make it clear it’s theirs alone to hit. Check it once a week, the same way you’d check any other number in the practice. If nobody can honestly say what the practice was working toward this quarter, that’s the sign the plan never actually got written — it just got assumed.
Most of the time this fixes itself once you’ve named the one thing and the one owner. But if the honest answer is that nobody currently owns billing follow-up, or nobody’s dedicated to patient callbacks and confirmations, that’s not a planning problem anymore — it’s a staffing gap. That’s the kind of role we help independent practices fill at The Coordinators, with someone experienced enough to own the number, not just work the pile.
