Practice leaders heading into 2027 rank reimbursement among their top worries, and nearly all of them see costs rising. In a Black Book Research survey of 74 attendees at the MGMA Annual Conference in September 2026, 89% named reimbursement and financial sustainability among their top three concerns, and 97% said operating costs ran higher year to date than at the same point in 2025.
What 74 conference attendees ranked as top concerns
Black Book Research published the results on September 29, 2026. It surveyed attendees at the MGMA Annual Conference in San Antonio, which ran September 27 to 30. By title, 25% of respondents were CFOs, finance directors or revenue cycle leaders, 24% were practice administrators or managers, 23% were chief operating officers or operations directors, 20% were physician owners or medical directors, and 8% were chief executives or executive directors.
Each respondent picked three leading concerns. Patient coverage, affordability and continuity of care came first at 90%. Reimbursement and financial sustainability followed at 89%, and IT performance and technology-enabled administrative relief at 87%. In a sample of 74, one respondent moves a result by 1.4 percentage points, so the three topics are effectively tied. The release covers three topics: money, coverage and technology. Black Book states that the results reflect only the people who answered, not all MGMA members or all U.S. practices.
| Concern or measure | Share of 74 respondents | Source |
|---|---|---|
| Patient coverage, affordability and continuity of care (top three) | 90% | Black Book Research, Sept. 29, 2026 |
| Reimbursement and financial sustainability (top three) | 89% | Black Book Research, Sept. 29, 2026 |
| IT performance and administrative relief (top three) | 87% | Black Book Research, Sept. 29, 2026 |
| Operating costs higher year to date than in 2025 | 97% | Black Book Research, Sept. 29, 2026 |
Costs: 97% in one survey, 84% in another
Black Book attributes the cost increase to staffing, benefits, supplies and vendor expenses. MGMA Stat, the association's weekly text poll, found a lower share in 2026. It reported that 84% of medical groups had higher year-to-date operating costs than in the same period of 2025. The gap between the two results is 13 points. Black Book asked conference attendees and MGMA polled its own panel, so the two groups of respondents differ.
MGMA's decade review shows the share has stayed high for years. It recorded 90% of groups saying costs outpaced revenue in 2022, 89% reporting higher operating costs in 2023, and 92% in 2024.
| Year | Groups reporting higher costs | Source |
|---|---|---|
| 2022 | 90% (costs outpacing revenue) | MGMA Stat |
| 2023 | 89% | MGMA Stat |
| 2024 | 92% | MGMA Stat |
| 2026 | 84% | MGMA Stat |
| 2026 | 97% (74 conference attendees) | Black Book Research |
Revenue did not rise as fast for every group. In MGMA's June 30, 2026 poll of 221 applicable responses, 47% of groups reported higher year-to-date revenue than in 2025, 14% reported about the same, 36% reported a decrease and 2% were unsure. The same question in June 2025 returned 56% higher, 13% flat and 30% lower. The lead of groups gaining revenue over groups losing it narrowed from 26 points to 11 points.
What leaders expect to add complexity through 2036
MGMA asked its panel on September 29, 2026 what will add the most complexity to practices through 2036. Of 228 applicable responses, 35% said payment, 25% said workforce, 21% said technology, 17% said regulation and 3% said other. MGMA notes the shares do not sum to 100% because of rounding. Payment, the top answer, outranked the second-place answer, workforce, by 10 points.
Payer demands have been a long-running theme in the panel's answers. The share of groups reporting that payer requirements had increased was 82% in 2016, 86% in 2017, 86% in 2018 and 90% in 2019. Groups that said quality metrics were tied to physician compensation rose from 27% in 2016 to 38% in 2019, to nearly half in 2023 and half in 2024.
Workforce pressure shows up in benefits and burnout
Staffing is the second-ranked source of future complexity, and MGMA's polling history shows how much attention it now gets. Of 216 polls from 2016 to 2019, 7 (3%) covered recruiting, retention or workforce supply. Since 2021, 66 of 285 polls (23%) have.
Spending on staff benefits has moved the other way. The share of groups adding or increasing benefits was 26% in 2021, 45% in 2022, 35% in 2023, 21% in 2024 and 16% in 2026. On October 13, 2026, MGMA reported that 6 in 10 medical group leaders said they were burned out. MGMA's polls page does not state a sample size for that poll.
Technology: 87% want relief from administrative work
Black Book frames the technology question as whether a tool removes work or moves it to another person or system. Douglas Brown, founder of Black Book, said in the release: "These are no longer separate financial, access and IT issues." In the survey, 87% of respondents placed IT performance and administrative relief in their top three concerns. The release lists the steps Black Book expects practices to take: closer review of payer contracts, stronger denial prevention, more frequent eligibility checks, referrals for enrollment assistance, consolidation of overlapping applications and testing of automation before wider rollout.
MGMA's own polls show practices already building their own tools. On September 22, 2026, 34% of medical groups said they had used AI to build an app or workflow tool in-house. About 1 in 5 MGMA Stat polls in 2026 has covered AI, and the program has run almost two dozen AI polls since 2023. On October 6, 2026, only 19% of practice leaders said they were very confident they could recover quickly from a cyberattack.
Sources
- Black Book Research via Newswire, MGMA Attendees Signal Intensifying Financial, Coverage and Technology Pressures for Medical Practices Entering 2027, September 29, 2026
- MGMA, MGMA Stat at 10: What more than 380,000 responses show about a decade of change in medical practices, September 30, 2026
- MGMA, Revenue growth narrows as costs climb: the 2026 squeeze, July 2, 2026
- MGMA, MGMA Stat polls, September and October 2026
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