Financial pressures facing ophthalmology practices extend well beyond the annual budget, according to Heather Thomas, OCSR, administrator at Retina Vitreous Consultants Inc. and current board member of the American Academy of Ophthalmic Executives, and Claire M. Murphy, OSC, OCS, OCSR, CEO and administrator at Piedmont Retina Specialists. At the American Academy of Ophthalmology (AAO) 2026 Meeting, Thomas and Murphy explored how practices can respond to rising costs, reimbursement challenges, staffing pressures, and growing demand while maintaining sustainable performance.
Their presentation, “Beyond the Budget: Real-World Financial Strategies for Ophthalmology Practices,” centered on 5 key priorities: understanding the current financial environment, benchmarking key performance indicators (KPIs), evaluating cash flow and payer performance, identifying opportunities for artificial intelligence (AI), and strengthening financial controls and planning.
The speakers began by outlining a financial landscape shaped by staffing shortages, reimbursement pressure, payer instability, increasing patient access demands, and the growing cost of technology. Wage pressure is affecting both clinical and administrative roles, while competition for experienced technicians, billers, and scribes can contribute to turnover and reduced productivity. At the same time, practices are contending with higher operating costs, prior authorization requirements, delayed payments, and increased investment in areas including AI, cybersecurity, and digital workflows.
The team’s proposed financial leadership framework brought together 4 elements—people, data, processes, and technology—with each playing a role in sustainable performance. Practices need the right teams and accountability structures, actionable data, consistent workflows that protect revenue, and technology capable of improving efficiency and accuracy.
Working Beyond a Single Metric
A central theme of the session was the importance of measuring performance broadly rather than relying on isolated financial figures. Thomas and Murphy suggested balancing KPIs across clinical performance, finances, patient access, staffing, and patient experience.
Examples ranged from injection volume, surgical conversion, and diagnostic utilization to days in accounts receivable, denial rates, schedule utilization, labor costs, turnover, waiting times, and referral retention. Their message was straightforward: “Trends matter more than snapshots.”
Benchmarking, they suggested, should therefore begin with a practice's own month-over-month and year-over-year performance before moving outward to peer data, Academy resources, professional networks, and specialty-specific benchmarking groups.
Attention should also extend across the entire revenue cycle. Rather than waiting until billing or collections to identify problems, practices can protect revenue much earlier through effective referral management, authorization processes, eligibility verification, and accurate scheduling—effectively protecting revenue before the claim is submitted.
Making Payers Earn Their Place
Payer relationships received particular scrutiny. Practices were encouraged to examine more than headline reimbursement rates when assessing contracts. Payment timeliness, prior authorization and appeals burden, denials, and the net margin remaining after overhead can all affect the true value of a payer relationship.
As the speakers noted, the highest-paying payer is not necessarily the most profitable. Annual contract reviews should therefore consider reimbursement against Medicare and peer benchmarks alongside administrative burden, payment speed, and overall profitability. “Every contract,” the speakers added, “should earn its place in the practice's payer mix.”
Cash management also extends beyond collections. The presentation highlighted opportunities including reducing charge lag and denials, collecting patient balances earlier, aligning inventory purchases with utilization, negotiating vendor payment terms, and evaluating manufacturer rebates, distributor incentives, and early-payment discounts. The overarching principle: “Every dollar matters twice: Once when it is earned and again when it is managed.”
Where AI Fits In
During the presentation, AI was presented not as a single transformative solution, but as a collection of practical tools that could help to remove administrative friction. Ambient documentation (i.e. using AI as a way of passively listening to patient conversations) could reduce manual note-taking and after-hours charting while improving chart completion and documentation consistency. However, the speakers emphasized a “trust, but verify” approach: Physicians must remain responsible for any final documentation, making accuracy, privacy, and governance essential considerations.
Other potential AI applications included candidate screening and onboarding, workforce forecasting, appointment optimization, automated wait lists, capacity balancing, call routing, patient self-service, and after-hours support. In each case, the focus was on using the technology to free staff for higher-value patient interactions, rather than simply implementing AI for its own sake.
The session closed by widening the lens to longer-term planning. For multisite practices, standardized workflows, shared services, centralized KPIs, and site-to-site comparisons can support a more consistent operating model. Capital planning should meanwhile account deliberately for technology investments, equipment replacement, and future growth, supported by safeguards such as segregation of duties, access controls, compliance oversight, inventory reconciliation, and regular audits.
In conclusion, Thomas and Murphy reduced the strategy to 4 practical takeaways for ophthalmology practices: select 5 to 10 KPIs, review payer performance, evaluate AI opportunities, and build a 12-month financial roadmap. The closing message was equally concise: focus, measure, and improve.
Explaining why this presentation was so important for an ophthalmic audience, Thomas said: “Physicians are expected not only to deliver outstanding clinical outcomes, but also to navigate increasing financial and operational pressure. By helping practices better understand their financial performance, we can support their long-term independence and ability to continue serving patients in their communities."