In my last article, I discussed the silent profit killers that drain revenue from your practice—underpayments that go unnoticed, inefficient workflows, overlooked denials, and operational blind spots that erode profitability.
But financial leaks don’t always begin in the billing office.
Poor hiring decisions, inconsistent onboarding, ineffective leadership training, missed performance conversations, and outdated human resource (HR) policies rarely create an immediate crisis. Instead, they quietly chip away at productivity, employee morale, patient experience, and ultimately, profitability.
Most practice owners don’t intentionally neglect HR. They’re focused on what they do best, caring for patients, growing referrals, and managing the daily demands of running a business. HR becomes something that’s addressed only after a problem develops.
Five HR Mistakes Quietly Costing You Money
Treating the Employee Handbook as a One-and-Done Document
Many practices have an employee handbook tucked in a drawer or saved on a computer that hasn’t been reviewed in years. Employment laws, workplace expectations, and best practices change regularly. An outdated handbook can leave managers without clear guidance when addressing attendance, performance, leave requests, or disciplinary issues.
Ask yourself: If an employee issue arose tomorrow, would your handbook support the decision you made today?
Hiring Quickly Instead of Hiring Carefully
Every O&P practice has experienced the stress of being short-staffed. When patient schedules are full and the team feels stretched, filling an open position quickly can feel like the highest priority.
But rushing the hiring process often creates a much bigger problem. The wrong hire affects more than payroll. It impacts training time, productivity, employee morale, patient experience, and often results in another recruiting cycle just a few months later.
If you take your time and find the right candidate, don’t stop there. A structured onboarding program helps new employees understand expectations, integrate into your culture, and become productive much faster. The first few weeks of employment often determine whether someone becomes a long-term team member or begins looking for a new opportunity.
Waiting to Address Performance Issues
One of the most common mistakes I see is avoiding difficult conversations.
Managers hope small performance concerns will resolve themselves. They rarely do. By the time a performance issue becomes serious enough to require formal documentation, it has usually affected coworkers, patient care, scheduling, or overall morale.
Successful leaders provide feedback consistently. Not just during annual performance reviews. The goal isn’t simply documentation. Regular coaching, timely conversations, recognition for a job well done, and clear expectations create accountability while helping employees grow before small concerns become larger problems.
Promoting Clinicians Without Preparing Them to Lead
One of the biggest misconceptions in healthcare is that exceptional clinicians automatically become exceptional managers. Clinical expertise and leadership require two very different skill sets.
New supervisors find themselves responsible for hiring, coaching, conflict resolution, difficult conversations, documentation, scheduling, and team development. They may be unprepared for these responsibilities unless they receive formal training.
Supervisors and managers have a direct influence on employee retention, engagement, and ultimately, patient satisfaction. Investing in leadership training early helps managers build confidence, strengthen communication, and create healthier workplace cultures.
Assuming Everything Is Fine
It’s easy to assume everything is fine because no one is complaining. But silence can be deceiving.
Some of the healthiest workplaces encourage open communication not because problems exist constantly, but because employees feel comfortable discussing them before they become significant issues.
When leaders assume no news is good news, opportunities to improve communication, culture, and employee engagement are often missed.
Simple check-ins, employee feedback, and regular conversations can uncover concerns long before they affect turnover or patient care. Great leaders don’t wait for exit interviews to learn what could have been improved.
Final Thoughts
As reimbursement pressures continue to challenge O&P practices, protecting your people is just as important as protecting your revenue.
Practices that invest in thoughtful hiring, strong leadership, consistent communication, and proactive HR management build teams that are more engaged, more productive, and better equipped to deliver exceptional patient care.
Just like billing errors and operational inefficiencies, HR mistakes rarely create one catastrophic event.
Instead, they quietly drain profitability over time.
The good news is these are some of the easiest silent profit killers to prevent.
HR Quick Assessment
Take five minutes and ask yourself the following questions to help identify HR vulnerabilities in your practice:
- Is your employee handbook current? Does it include detailed job descriptions, required certifications/licenses, experience levels, and continuing education requirements?
- Are all employee licenses and certifications (ABC, BOC, and/or state) verified and updated at least annually, with documentation on file?
- Is annual HIPAA training complete and documented for every staff member?
- Have employees received annual performance reviews or documented coaching, including feedback on competencies, with documentation on file?
- Could you quickly locate every personnel file, including W-2/1099/I9 forms, background checks, and credential verification?
- Would your practice be prepared if an ABC or BOC surveyor or Medicare auditor visited tomorrow?
If you answered no to any of these questions, you’ve identified an opportunity to strengthen your practice before it becomes a costly problem.
Erin Cammarata is president and owner of CBS Medical Billing and Consulting. She can be contacted at erin@cbsmedicalbilling.com.
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