Methodology
How we calculate the $80,000 average annual missed revenue figure for independent primary care practices.
The $80,000 figure cited on our homepage is a conservative estimate built from four revenue streams that Alema addresses: Annual Wellness Visits (AWVs), Transitional Care Management (TCM), no-show recovery, and inactive patient reactivation. Each line is anchored in published CMS reimbursement rates and industry utilization data from sources including MGMA, the American Journal of Managed Care, and peer-reviewed research.
We use conservative inputs at every step: lower-bound reimbursement rates, mid-range utilization gaps, and assumptions that reflect a typical independent primary care practice of two to three providers. Practices with larger Medicare panels, higher no-show rates, or more dormant patients will see higher figures than this baseline.
The Calculation
| Revenue stream |
Per-event value |
Volume assumption |
Estimated annual missed revenue |
| Annual Wellness Visits |
$150
Conservative G0438/G0439 average |
200 Medicare patients × 54% gap
Industry average gap is ~81% |
$16,200 |
| Transitional Care Management |
$200
CPT 99495/99496 blended |
100 hospital/SNF discharges/yr
× 60% missed |
$12,000 |
| No-Show Recovery |
$200
Average lost revenue per missed appt |
~3,000 appts/yr × 7% no-show rate
× 60% recoverable via outreach |
$25,200 |
| Inactive Patient Reactivation |
$150
Average first-visit reimbursement |
~150 inactive patients
× 60% re-engagement |
$13,500 |
| Conservative total annual missed revenue |
$66,900 |
The $80,000 headline figure rounds up slightly to reflect that most practices have one or more of these factors higher than our conservative inputs (more Medicare patients, higher no-show rates, longer patient inactivity tails, or add-on services billed alongside AWVs like ACP or HCC capture). Practices with 300+ Medicare patients regularly clear $100,000 in missed revenue using this same math.
Assumptions Explained
AWV gap rate
CMS data indicates only ~19% of eligible Medicare patients receive their Annual Wellness Visit each year, leaving an 81% gap. We use a 54% gap to reflect that some patients refuse, are unreachable, or transition out of the practice. The 54% figure is conservative relative to the industry baseline.
TCM volume
A typical two-to-three-provider primary care practice sees 80–150 hospital or SNF discharges per year among its panel. We use 100 as a midpoint. The 60% missed rate reflects the practical reality that without an ADT feed or automated outreach, most discharges don't get scheduled within the 14-day TCM billing window.
No-show rate
MGMA's 2024 benchmark for primary care no-show rates is ~6.8%. Industry studies in academic settings show rates as high as 18–20%. We use 7%, near the MGMA midpoint. The 60% recoverable assumption reflects that not every no-show patient can be reached or rescheduled, but a structured outreach cadence captures the majority.
Inactive patient volume
A typical practice has 100–300 patients who haven't been seen in 18–36 months but remain on the panel. We use 150 as a conservative midpoint. The 60% re-engagement rate is achievable with targeted SMS outreach offering a clear path back into care.
Sources
- AWV reimbursement rates (G0438, G0439). Centers for Medicare & Medicaid Services, Medicare Physician Fee Schedule. cms.gov/medicare/payment/fee-schedules/physician
- AWV utilization data. American Journal of Managed Care, March 2019, "Effects of the Annual Wellness Visit on Spending and Outcomes." Industry data via ChartSpan and ReportingMD client engagements documenting 19% national AWV completion baseline.
- TCM coding and reimbursement (99495, 99496). CMS Medicare Learning Network, "Transitional Care Management Services" booklet. cms.gov/medicare/regulations-guidance
- Primary care no-show benchmarks. MGMA DataDive Practice Operations 2024 report; MGMA Stat poll January 2025. mgma.com
- Lost revenue per no-show. Clearwave 2025 primary care no-show analysis (~$200 per missed appointment per physician). Peer-reviewed research: "Prevalence, predictors and economic consequences of no-shows," BMC Health Services Research. pmc.ncbi.nlm.nih.gov/articles/PMC4714455
- U.S. healthcare no-show systemic cost. Estimated $150 billion annually across the U.S. healthcare system, reported by multiple industry sources including Curogram and TransLoc analyses.
A Note on Honesty
The $80,000 figure on our homepage is a marketing headline, but the math behind it is real and conservative. We chose to publish this methodology page because we'd rather earn a practice's trust by showing our work than impress them with a number we can't defend. If you run the same math against your own practice's panel size, no-show rate, and Medicare mix, you'll likely arrive at a number close to (or higher than) ours.
If you'd like us to run this calculation against your practice's specific numbers, contact us at info@alemahealth.com.