Margins in medtech don't collapse overnight. In established organizations, they erode slowly through hidden inefficiencies in field operations that compound over time. On the surface, revenue looks strong, but underneath, operational drag quietly eats away at profitability. Emerging device companies often start with a more 'simple' approach that's manageable with a small number of sellers, but then inefficiencies compound as they grow and are swept under the rug.

If you're leading a commercial or operations team, you need to know where the leaks are. Here are five signs your field operations are bleeding margin—and what to do about them.

1. Your reps spend more time on admin than selling

Field reps are supposed to drive revenue, not drown in paperwork. Yet in many organizations, highly compensated reps spend hours each week logging calls, submitting case reports, or reconciling expenses.

Every hour spent on admin is an hour not spent in front of surgeons or decision-makers. Multiply that across dozens or hundreds of reps, and the opportunity cost is staggering.

The margin impact:

• Lost selling time reduces top-line growth.
• Manual reporting increases the risk of errors, leading to disputes and rework.
• Reps become frustrated, which drives burnout and turnover.

The fix:

Automate activity capture wherever possible. A system that records rep activity in real time and ties it directly to billing or CRM workflows frees reps to focus on what they're paid to do: sell and support cases.

2. Billing cycles drag on for weeks or months

If your revenue recognition depends on disconnected systems or reps submitting case usage after the fact, you're bleeding cash flow. Long billing cycles don't just delay revenue—they create errors, disputes, and write-offs that permanently shrink margin.

The margin impact:

• Delayed cash inflows increase working capital strain.
• Errors in usage capture lead to underbilling or compliance risk.
• Finance teams waste hours chasing down missing case data.

The fix:

A closed-loop billing stack that ties rep activity directly to invoicing. When usage is captured digitally at the point of care, billing can be triggered automatically, reducing cycle times from weeks to days. Faster cash, fewer disputes, stronger margins.

3. Pilots bleed margin when free equipment isn't tracked or limited

Pilots are supposed to prove value, not quietly drain margin. Yet in many medtech pilots, equipment is offered at no charge to 'get a foot in the door.' Without tight guardrails, that free equipment can balloon—reps over-deploying trays, hospitals leaning on pilot stock longer than intended, and finance teams losing visibility into what's been consumed.

The margin impact:

• Free equipment quietly becomes a hidden cost center.
• Lack of controls risks non-compliance with regulations around fair market value.
• Pilots drag on without clear ROI, making it harder to convert into paid contracts.

The fix:

Standardize pilot tracking. Capture every piece of equipment offered at no charge, set clear limits, and tie usage back to compliance reporting. When you can show exactly what was provided, how it was used, and when it should stop, you protect both margin and regulatory credibility.

4. Your cost-to-serve keeps rising, but no one can explain why

This is the silent killer. You're hitting revenue targets, but profitability is slipping. The culprit? Rising cost-to-serve. Maybe it's extra reps needed to cover inefficient territories. Maybe it's excess time spent on low-value accounts. Maybe it's the hidden labor of manual processes.

If you can't quantify cost-to-serve by account, product line, or territory, you're flying blind.

The margin impact:

• High-revenue accounts may actually be unprofitable.
• Strategic pricing decisions are made without visibility into true costs.
• Competitors with leaner operations undercut you on price.

The fix:

Build cost-to-serve analytics into your operational reporting. Track rep time, travel, and activity costs at the account level. Once you see the true economics, you can make hard but necessary calls: repricing, restructuring, or even walking away from unprofitable business.

5. Leadership can't see what's really happening in the field

Ask your sales leader, ops manager, and finance director for the 'true' picture of field activity, and you'll often get three different answers. That's a red flag. When leadership doesn't have a trusted view of rep activity, decisions get made on anecdotes instead of evidence.

The margin impact:

• Forecasting becomes guesswork, leading to missed targets.
• Territory planning is reactive instead of strategic.
• Teams waste time reconciling reports instead of acting on insights.

The fix:

Consolidate field activity into a single system of record. When every call, case, and pilot is tracked consistently, leadership gains the visibility to make sharper, faster decisions that protect margin.

Pulling It All Together

Margins don't erode because of one big mistake. They bleed out slowly, through a thousand small inefficiencies in field operations. The five signs above—reps stuck in admin, slow billing cycles, uncontrolled pilots, rising cost-to-serve, and lack of visibility—are the most common culprits.

The good news? Each one is fixable. But it requires more than patchwork solutions. It requires building an operational infrastructure that's defensible, scalable, and credible in front of both customers and investors.

At Skuvent, we've seen firsthand how medtech companies can reclaim margin by pressure-testing their field operations. The organizations that win aren't just the ones with the best products—they're the ones with the tightest operations.

Final Thought

If you recognize even one of these signs in your business, it's time to act. Every day you delay, margin is slipping away. The companies that thrive in the next decade will be those that treat operational excellence not as back-office housekeeping, but as a strategic weapon.

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