Off the Chart with Medical Economics: Recent Episodes
Medical Economics
Off the Chart with Medical Economics features lively and informative conversations with health care experts, opinion leaders, and practicing physicians, about the challenges facing medical practices today.
Practice costs are climbing on every line at once: staffing, medical supplies and a technology stack that has grown at some organizations from two or three main systems to as many as 15. Reimbursement has not moved with any of it, and when the math gets that tight the reflex is to start cutting.
Physicians Practice Managing Editor Keith Reynolds sat down with Shawntea Gordon, CEO of Atlas & Perpetua Healthcare Consulting, to explain why that reflex is where most practices go wrong. A cut made without data behind it is a guess, Gordon argues, and the wrong guess costs more than it saves. She and Reynolds get into the leaks she finds most often, how to tell which benchmarks are actually worth trusting, why staffing reductions so frequently backfire and the recurring expense that has been quietly billing practices since the paper era.
Music Credits:
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A Textbook Example by Skip Peck - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.
0:00 – 0:23 | Cold open. Gordon on the practices that call staffing their biggest cost and then find out they were understaffed all along.
0:23 – 1:30 | Introduction. Austin Littrell introduces the episode, the guest and the gap between what practices spend and what they collect.
1:30 – 2:22 | Why the pressure feels different now. Gordon points to the widening spread between costs and reimbursement, plus staff shortages and a technology stack that has grown at some organizations from two or three main systems to as many as 15.
2:22 – 3:19 | Where the money leaks. Front desk data entry, coordination of benefits, uncaptured patient responsibility, undocumented in-office services, unappealed denials and downcoding. The one she sees most: unmanaged denials and claims sitting in accounts receivable.
3:19 – 4:01 | The first step if you have never benchmarked. Start with your own history. Pull 12 months of invoices, check what you ordered against what you paid, then look at alternatives and group purchasing contracts.
4:01 – 5:12 | Which benchmarks are worth trusting. Gordon on separating established associations from organizations that only claim to be validated, and why an apples-to-apples comparison starts with an honest read of your own size, location, service mix and payer mix.
5:12 – 6:16 | The right-sizing test before any staffing cut. Pull your administrative and clinical support ratios against validated benchmarks first. Groups convinced staffing is their biggest cost are often already understaffed, with burnout capping what they can collect.
6:16 – 7:20 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
7:20 – 7:58 | The contract nobody rereads. Practices that moved from paper to electronic and left shredding services on the same rotation, paying monthly minimums against bins that never fill.
7:58 – 9:35 | Cutting costs without creating new risk. The four questions Gordon runs before any systemic change, and the practice that switched medical supply vendors and lost access to a surgical item that was chronically backordered.
9:35 – 10:59 | Building a framework that holds. A holistic review, a 90-day improvement plan, then the same monthly block of time converted into continuous improvement. Gordon makes the case for 1% a month over an annual look back.
10:59 – 11:32 | One thing to do Monday morning. Run a monthly report comparing the CPT codes billed against the codes reimbursed. Every variance is a possible downcode.
11:32 – [END] | Closing thoughts and outro. Reynolds thanks Gordon, and Littrell wraps the episode.
Joanne Frederick, CEO of Government Market Strategies, has spent more than 30 years working inside Medicare, Medicaid, Tricare and VA health programs, and she opens with the one most physicians know least. Tricare covers 9.4 million service members, families and retirees, and pays at a discount off Medicare rates that plenty of practices already say don't cover their costs.
From there Frederick makes a broader argument: that insurance was never designed to sit between a patient and a physician for routine care, and that the administrative layer built around that arrangement now consumes an estimated 15% to 30% of every health care dollar. She and Medical Economics senior editor Richard Payerchin work through what a cash-based system would look like at the practice level, where artificial intelligence genuinely helps, and the one piece she thinks direct primary care is still missing.
Music Credits:
Her Name by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.
0:00 – 0:25 | Cold open. Frederick on a system built around fixing a problem that may have been smaller than the fix.
0:25 – 1:44 | Introduction. Austin Littrell introduces the episode, the guest and the Tricare reimbursement problem at the center of it.
1:44 – 3:00 | Meet Joanne Frederick. Richard Payerchin introduces the guest, who has worked in public sector health programs since the late 1980s and founded her first firm in 1992.
3:00 – 4:46 | What Tricare is. The program covers roughly 9.4 million service members, families and retirees, about 400,000 of them overseas, and picks up the care military treatment facilities cannot deliver.
4:46 – 6:29 | Where beneficiaries are, and the readiness mission. Frederick on the density around large installations and the twin goals of a ready medical force and a medically ready force.
6:29 – 7:45 | Paid below Medicare rates. Tricare reimburses at a discount off Medicare, sometimes a steep one, in a market where physicians already say Medicare does not cover their costs.
7:45 – 10:36 | What the rest of health care could borrow. Frederick argues readiness is the idea worth exporting, and calls the physician the most valuable player on the field of our lives.
10:36 – 13:53 | Defining a cash-based system. Insurance was never intended to be a first-dollar payer, Frederick says, and administrative costs run an estimated 15% to 30% of health care spending.
13:53 – 14:45 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
14:45 – 18:00 | Prior authorization and the case insurers make. Payerchin puts the industry's value argument to Frederick, who questions what is gained when a request cycles back and forth two or three times and gets approved anyway.
18:00 – 22:18 | Where artificial intelligence actually helps. Frederick calls today's note-taking applications the tip of the iceberg and makes the case for navigation tools, with the caveat that nothing replaces the physician-patient relationship.
22:18 – 25:18 | Direct primary care and the missing piece. Frederick, a direct primary care member herself, asks whether physicians have the panel time to serve as health coaches, and floats an annual health improvement plan as the wraparound.
25:18 – 26:50 | A message to primary care physicians. Frederick on the administrative burden the system places on primary care, and an open invitation for ideas on how to reduce it.
26:50 – 27:40 | Outro. Littrell thanks the guest and wraps the episode.
Nearly half of the health care organizations in Experian Health's 2026 State of Patient Access Survey say patient access improved over the past year. Among patients, fewer than one in five agree. Medical Economics Managing Editor Todd Shryock sat down with Mindy Fortson, chief operating officer of Experian Health, to work out what's behind that split, why 73% of respondents on the practice side say patients delay or forfeit care when they can't get a cost estimate up front, and how much of the prior authorization burden a practice can realistically fix on its own. Fortson also gets into the survey's most counterintuitive finding: after years of pushing patients toward portals and mobile billing, paper is coming back.
Read Experian Health's 2026 State of Patient Access Survey here.Music Credits:
Sleepy Sunday by Buurd - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:26 | Cold open. Fortson names the survey finding that unsettled her most and explains why she reads it as a public health problem rather than a billing one.
0:26 – 1:39 | Introduction. Austin Littrell introduces the episode, the guest and the perception gap at the center of the survey.
1:39 – 1:53 | Meet Mindy Fortson. Todd Shryock introduces the guest and the 2026 State of Patient Access Survey.
1:53 – 3:04 | Why practices and patients score access differently. Forty-six percent of organizations say access improved. Eighteen percent of patients agree. Fortson traces the split to two groups measuring different outcomes: staffing and digital adoption on one side, affordability and speed on the other.
3:04 – 4:07 | Prior authorization and what a practice can actually fix. Thirty-six percent of patients reported authorization difficulties. Fortson puts most of the burden on payer and policy reform, since requirements are plan specific and carry heavy clinical review.
4:07 – 5:43 | Insurance verification delays. Nearly three in 10 patients hit one. Fortson frames these as administrative rather than clinical problems and points to front-end coverage discovery, eligibility checks and MBI lookups as the automation targets.
5:43 – 7:42 | The cost estimate problem. Seventy-three percent on the practice side say patients delay or forfeit care without an up-front estimate. The bright spot: surprise billing complaints have fallen considerably where estimate tools are in place.
7:42 – 8:55 | Why training deficits keep surfacing. Thirty-nine percent cite training gaps. Every payer is different and every encounter is different, which makes front-end registration a heavy manual lift.
8:55 – 9:46 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
9:46 – 11:28 | Where automation and AI pay off first. Twenty-eight percent report adopting AI, a figure the survey didn't measure at all last year. Fortson expects AI to move out of pilots and into general infrastructure within one to two years.
11:28 – 12:46 | Ninety-three percent say patients struggle to pay. Fortson on Medicaid uncertainty, regulatory ambiguity and employers shifting costs onto employees.
12:46 – 14:33 | Access to practitioners, four years running. Still the top patient-reported challenge. Scheduling and portal tools help, but a meaningful share of patients either lack a smartphone or won't navigate a portal.
14:33 – 15:41 | The paper billing surprise. Snail mail metrics jumped this year against the mobile trend. Fortson points to regulatory and HIPAA notices that default to mail, plus cybercrime anxiety about entering personal information online.
15:41 – 17:17 | The metric to watch next year. Speed to access shows up as both a top frustration and a top success, depending entirely on whether the practice has adopted the tools.
17:17 – 18:35 | Closing thoughts and outro. Littrell points listeners to the survey in the show notes and wraps the episode.
Cyclosporiasis presents like a lot of other summer illnesses, but it runs six weeks untreated and the routine ova and parasite panel will not find it unless you ask your lab specifically.
Molly O'Shea, M.D., has owned an independent pediatric practice in Michigan for more than 30 years, putting her at the center of the largest cyclospora outbreak on record in the United States. She talks with Medical Economics Senior Editor Richard Payerchin about how the infection presents, what to order and how to have that conversation with the lab, when to treat on symptoms alone, and what to tell patients arriving with questions about ivermectin and cleanses. She also explains why she believes reported case counts substantially understate what is happening in the community.
CDC tracking: https://www.cdc.gov/cyclosporiasis/index.html
FDA recall: https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/taylor-fresh-foods-recalls-iceberg-lettuce-central-mexico-because-possible-health-risk
Music Credits:Palm Trees in Cyan Glow by KBH Production - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:12 | Cold open** O'Shea previews the episode's central premise: the reported case counts are almost certainly an undercount.
0:12 – 1:36 | Introduction Austin Littrell introduces the episode, the guest and the scale of the outbreak.
1:36 – 2:00 | Meet Molly O'Shea, M.D. Richard Payerchin introduces the guest and opens at the beginning.
2:00 – 5:11 | What cyclospora is, and how to make produce safer A parasitic infection contracted from contaminated fresh produce, not spread person to person. O'Shea walks through washing technique, a vinegar solution for raspberries and cilantro, and why she still wants patients eating fruits and vegetables.
5:11 – 6:26 | Does buying local help? Not automatically. You still don't know the irrigation system or the equipment that brought it to market.
6:26 – 8:20 | What it looks like in the office Bloating, cramping and long duration. How to separate it from Giardia, enteroviruses and norovirus, and why her practice tells families to wait three or four days before coming in.
8:20 – 9:21 | Why the routine stool panel misses it Detection requires a special stain, and it will not be run unless it is ordered. Talk to your lab about what to send and in what container.
9:21 – 11:43 | The two-week incubation problem Why the exposure history is nearly impossible to reconstruct, why dose matters, and why she tells parents to stop trying to trace it.
11:43 – 13:40 | Treatment Bactrim for about a week. False negatives after long symptom duration, and when to treat on symptoms alone.
13:40 – 15:20 | Hospitalization, and how badly cases are undercounted Who gets sick enough to be admitted, and why dehydration is the complication to watch.
15:20 – 16:11 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
16:11 – 17:04 | What to say about ivermectin The best available evidence supports Bactrim. Ivermectin has not been studied well enough to place in either the treatment or prevention category.
17:04 – 19:29 | Cleanses and other things patients found online The body is already doing what a cleanse claims to do, and the added physiologic stress isn't warranted.
19:29 – 22:00 | Reassuring worried patients without ordering the test Listen, acknowledge the worry, then give a plan and say exactly where the test fits in it.
22:00 – 24:55 | The federal surveillance gap What changed in July 2025, what states still require, and why O'Shea says the national response has been disjointed.
24:55 – 26:05 | This isn't only a Michigan problem Why Michigan's counts are high and other states' may not be.
26:05 – 28:07 | What a fast federal response would look like An HHS proclamation, a coordinated information effort and an emergency response team.
28:07 – 32:13 | Fragmented care, Medicaid and who never gets diagnosed Coverage losses, high deductibles and a shift away from prevention.
32:13 – 34:00 | Closing thoughts and outro Littrell points listeners to current case counts and the recall notice, and wraps the episode.
CMS has released its proposed 2027 Medicare Physician Fee Schedule, and once again it carries a conversion factor cut: 1.68% for physicians outside an alternative payment model and 1.19% for those inside one, as the 2.5% congressional patch expires.
Physicians Practice Managing Editor Keith Reynolds sits down with Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association, to sort out what the rule actually does. They dig into the budget neutrality rules that force CMS to cut one specialty to pay another, the agency's push to move away from the AMA's valuation process without new data to justify it, the sunset of traditional MIPS into MIPS Value Pathways and what that reporting burden means for multispecialty groups, and a sleeper change to modifier 25 that could hit same-day billing hard.
Public comments on the proposed rule are due Sept. 14.
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A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00** Cold open: Anders Gilberg on why these are real cuts, not cuts to the growth rate
0:17 Introduction
1:39 Keith Reynolds welcomes Anders Gilberg
2:11 The recurring themes in the proposed 2027 fee schedule
3:56 Five years of cuts, and what MGMA members are feeling
5:38 Congress's game of chicken and the new Patients First Act
6:58 Budget neutrality and robbing Peter to pay Paul
8:09 CMS's 20-year-old cost data and the move away from the AMA process
10:34 The end of traditional MIPS, and why MVPs are "MIPS on steroids"
13:20 P2 Management Minute
14:35 What small and rural practices should do now
16:13 The sleeper provision: modifier 25 and same-day billing
18:13 Comments are due Sept. 14, but will CMS budge?
20:20 The next fiscal cliff and the year-end lame duck session
22:29 Outro
Female physicians spend more time with patients, write longer notes and field more messages, and research suggests their patients do better for it. They also leave clinical practice at a median age of 49, compared with 64 for male physicians.
Lisa Rotenstein, M.D., MBA, M.Sc., a primary care physician at the University of California, San Francisco and director of the Center for Physician Experience and Practice Excellence, is the corresponding author of a new study in the Journal of General Internal Medicine examining physician attrition by sex, age and specialty. She joins Medical Economics Senior Editor Richard Payerchin to explain what's behind that 15-year gap, why it holds in rural and urban settings alike, and which fixes could actually keep women physicians at the bedside, from time-based billing to ambient documentation to giving physicians back control over their own workflow.
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A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00** Cold open. Rotenstein previews the episode's central paradox: the practice patterns that serve patients well may be making the job unsustainable.
0:17 Introduction. Austin Littrell introduces the episode, the guest and the study's headline finding.
1:32 Meet Lisa Rotenstein. Rotenstein introduces her work directing the Center for Physician Experience and Practice Excellence and outlines what the study set out to measure.
2:58 What a 1.55 hazard ratio actually means. Female primary care physicians are among the likeliest to leave, and Rotenstein explains how the study defined leaving: no Medicare billing for three consecutive years.
5:17 The 15-year gap. Median attrition age is 49 for women and 64 for men. Rotenstein describes the bimodal pattern in the data and why the first decade and a half of practice is the critical window.
7:53 Rural and urban alike. The sex-based attrition gap holds regardless of setting, with particular consequences for access in rural communities.
9:02 What the payment model rewards. Female physicians generate 80 cents of revenue for every dollar earned by male primary care physicians, even while spending more time with patients. Rotenstein makes the case for time-based billing and value-based payment.
11:22 P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
12:13 The math health systems are missing. Physician turnover runs $500,000 to $1 million per physician, but Rotenstein says the near-term cost of retention is what keeps the conversation from happening.
14:35 What to tell medical students. More than half of matriculating medical students are women, and Rotenstein argues the profession has to show them clinical medicine is a sustainable path.
16:17 Can AI keep women physicians in practice? A Physicians Foundation-funded study found burnout reductions tied to AI scribes across two health systems. Rotenstein says prior authorization and paperwork are the next frontier.
18:35 Control, not ownership. Clinician-owned practices show lower burnout, but Rotenstein says the real variable is agency, and systems can give some of it back.
21:03 What she wants physicians to take away. The profession is losing decades of expertise from a highly trained workforce.
21:55 Closing thoughts and outro.
Direct primary care has been around long enough that most physicians know the pitch: drop the billing, charge a monthly membership, keep a smaller panel and spend real time with patients. What takes longer to answer is whether the economics hold up once you're in it.
Josh Umbehr, M.D., co-founder of Atlas MD in Wichita, Kansas, moved into DPC straight out of residency in 2010 and has spent the years since helping other physicians make the same jump. He joins the show to walk through the real math of a DPC practice, what happens when a patient needs a specialist and why he thinks the window for insurance-based primary care is closing fast.
Music Credits:Distant Memories by Buurd - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 Cold open: putting the hospitality back in health care
0:22 Introduction
1:44 How Umbehr found direct primary care
3:40 The basic math of a DPC practice
6:38 Panel size, and why bigger isn't the goal
8:11 Setting prices and the good-better-best tradeoff
11:18 What low overhead actually looks like
13:50 Specialists, imaging and hospitalizations
17:38 P2 Management Minute with Keith Reynolds
18:47 The honest timeline and runway to convert
22:31 What AI changes about primary care
26:38 The biggest misconceptions physicians have
29:42 How patient relationships change in DPC
32:34 Where DPC is headed, and 'peak insurance'
34:18** Closing thoughts
The same low-risk procedure can cost five to 12 times more in a hospital outpatient department than in a physician's office. That gap is giving hospitals the money to recruit physicians out of independent practice, and in growing parts of the country there is no independent practice left to choose.
Medical Economics Senior Editor Richard Payerchin sat down with three advocates working with the U.S. Women's Health Alliance: Jack Feltz, M.D., the Alliance's president and a founding member; Rebecca Herrero, M.D., MBA, FACOG, president and CEO of Women's Health Associates of Southern Nevada; and Daniel B. Frier, Esq., co-founder and co-managing partner of Frier Levitt.
They walk through the Independent Medical Practice Sustainability and Patient Access Act, the Stark and Anti-Kickback definitions the bill would tighten, and the counterintuitive core of their proposal: pay physicians more for office-based procedures and total cost of care goes down. Feltz and Herrero also make the case for why they're on Capitol Hill instead of in an exam room, when going hospital-employed would almost certainly pay them better.
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A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:14** | Cold open
Feltz on why the Alliance is fighting: private practice is the cornerstone of health care in the country, and it should be reinforced rather than left to disintegrate.
0:14 – 1:18 | Introduction
Austin Littrell introduces the episode and the three guests.
1:18 – 2:07 | Meet the guests
Richard Payerchin introduces Jack Feltz, M.D., Rebecca Herrero, M.D., MBA, FACOG, and attorney Daniel B. Frier, Esq.
2:07 – 2:52 | What the U.S. Women's Health Alliance is
Feltz describes a membership organization of independent OB/GYN practices operating in 37 states and the District of Columbia, with roughly 5,000 members caring for more than 10 million women.
2:52 – 4:06 | The financial reality for independent OB/GYNs
Herrero on the specialty's shortage, the office-all-day-plus-call-all-night lifestyle, and what younger physicians coming out of residency are asking for instead. The result is an access problem.
4:06 – 6:39 | Why they fight for it
Feltz on opening his first office 40 years ago, with curtains his mother sewed and a reception desk his father built, and what corporatization and vertical integration have done to that relationship since. Herrero is now delivering the babies of babies she delivered.
6:39 – 8:17 | The bill and the trip to Capitol Hill
Frier on building the Independent Medical Practice Sustainability and Patient Access Act with the Alliance's advocacy committee, and why physicians are left out of nearly every conversation about how physicians get paid.
8:17 – 10:27 | The five-to-12-times problem
Frier on how the site-of-service gap gives hospitals the cash to recruit physicians out of private practice, why student loan forgiveness at not-for-profit hospitals is nearly impossible to compete against, and what happens to patient choice once the local independent practices evaporate.
10:27 – 11:35 | What patients actually pay
Feltz on rising copays and deductibles, double-digit insurance inflation, health care debt as the leading cause of family bankruptcy in America, and the studies showing no difference in quality between hospital-based and independent physicians.
11:35 – 12:34 | Why office-based procedures win
Herrero on why patients are more satisfied when low-risk procedures happen in a familiar office, often without an anesthesiologist, and at a fraction of the patient responsibility.
12:34 – 13:25 | P2 Management Minute
Keith Reynolds shares practice management tactics and invites listeners to submit their own workflow ideas.
13:25 – 15:52 | "We could easily become hospital-employed physicians"
Feltz on why he and Herrero would both rather be seeing patients than testifying, why leaving for a hospital would likely pay them more, and why they aren't. Herrero adds where she goes for her own care, and why.
15:52 – 18:56 | Inside the legislation: fair market value and the HOPD delta
Frier on tightening what "commercially reasonable" and "fair market value" mean under Stark and the Anti-Kickback Statute, and the counterintuitive ask: narrow the office-versus-hospital gap by paying physicians a little more, not by cutting hospital rates.
18:56 – 19:57 | Where hospitals and practices should be spending their energy
Feltz argues the current competitive landscape benefits no one, hospitals included, and that Congress cannot let health care inflation keep running.
19:57 – 21:33 | Physician-owned hospitals and the conflict-of-interest argument
Frier says the bigger conflict already exists: employed physicians who are judged on patient leakage and risk their jobs if they refer outside the system.
21:33 – 22:41 | Nevada's OB/GYN hospital
Herrero on a physician-owned obstetrics hospital and why the overutilization argument struggles when every pregnant patient eventually delivers.
22:41 – 25:15 | "I don't even call myself an OB/GYN anymore"
Feltz on the shift to whole-woman care, the roughly 80% of health care dollars he says are spent on women's decisions for themselves and their families, and 40-year patient relationships. Herrero on why she refers to independent specialists whenever she can.
25:15 – 27:07 | Do physicians still want independence?
Feltz says the desire is enormous and the economic model is stacked against it, pointing to the AMA House of Delegates speaker who couldn't afford to stay. Herrero is seeing pockets of physicians leave hospital systems and come back.
27:07 – 28:04 | An open invitation
Feltz invites any hospital or health plan executive to come talk about a path where both sides prosper and patients get the best care.
28:04 – 29:05 | Outro
Littrell thanks the guests and wraps the episode.
Independent practices are being squeezed from every direction: rising labor costs, shrinking reimbursement and an administrative load that keeps growing. Andy Colbert, senior managing director at Ziegler and leader of the firm's physician advisory practice, has spent nearly two decades helping physician groups decide whether to stay independent, merge or sell.
In this conversation with Medical Economics Senior Editor Richard Payerchin, he lays out the scale it takes to remain independent today, what a practice is actually worth when an offer arrives, and how private equity, hospital partnerships and management services organizations really compare. Physicians weighing their next move get a clear framework for the decision, and a reminder to build a strategic plan before someone else sets the agenda.
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A Textbook Example by Skip Peck - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:28 | Cold open — Colbert on why clinical work alone no longer builds practice value.
0:28 – 1:31 | Introduction — Austin Littrell previews the episode.
1:31 – 3:18 | Meet Andy Colbert — from a family of physicians to leading Ziegler's physician advisory practice.
3:18 – 8:27 | The biggest shift in physician M&A — waves of consolidation, the roughly 40 to 50 physician threshold it takes to stay independent, and why ownership now means thinking like a business person.
8:27 – 15:39 | What a practice is actually worth — cash flow as the real measure of value, the 30% "scrape," and how the math shifts with years left in practice.
15:39 – 16:30 | P2 Management Minute — Keith Reynolds.
16:30 – 20:47 | Hospital deal vs. private investor — day-one reimbursement bumps, the defensive play, and platform vs. tuck-in.
20:47 – 24:56 | The private equity debate — Colbert's case for PE as a healthy third option between hospital employment and the health plans.
24:56 – 28:54 | The AI question — where artificial intelligence helps practice economics, and why it favors scale.
28:54 – 31:48 | Staff and overhead in a deal — why headcount usually holds, and how to communicate change without spooking staff.
31:48 – 34:55 | The MSO strategy — using a management services organization to think and act like a real business.
34:55 – 37:56 | A message to primary care physicians — build scale and write the three-to-five-year strategic plan before someone knocks.
37:56 – 39:05 | Closing thoughts and outro
More physicians are turning to concierge and hybrid concierge models to shrink their panels and steady their finances, but the move carries legal exposure that's easy to miss until it becomes a problem.
Ericka Adler, J.D., health care practice group manager at Roetzel & Andress, joins Medical Economics Managing Editor Todd Shryock to walk through the rules that trip practices up: why a membership fee has to be tied to a service insurance doesn't already cover, how Medicare and commercial contracts can quietly prohibit what a practice is planning, and what physicians have to put in writing so patients are never left feeling like they have to pay up or walk. She also lays out the planning, market research and runway it takes to make the transition actually work.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:26** | Cold open Ericka Adler on why calling yourself a concierge practice doesn't let you cut legal corners.
0:26 – 1:33 | Introduction Austin Littrell previews the episode and the legal considerations behind concierge medicine.
1:33 – 1:53 | Meet Ericka Adler Todd Shryock introduces the guest and the topic.
1:53 – 3:07 | Choosing the right entity Why entity selection for a concierge practice is no different than for any medical practice, and how state law drives the choice.
3:07 – 5:36 | Hybrid vs. cash-only, from a legal view In a hybrid model the membership fee has to cover something insurance doesn't, and what counts as "not covered" changes year to year.
5:36 – 9:02 | What physicians overlook in the switch Proper notice, terminating contracts and why you can't force insured patients to pay a concierge fee to stay.
9:02 – 11:43 | The Medicare problem Annual physicals are covered now, 24/7 access may already be required, and old membership documents can leave you charging for things you no longer can.
11:43 – 14:12 | The patient contract What the agreement has to spell out: the fee, what it covers, proration and what happens when a patient dies, moves or leaves.
14:12 – 15:03 | P2 Management Minute Keith Reynolds shares practice management tactics and invites listener submissions.
15:03 – 16:48 | The documents you still need Informed consent, HIPAA, financial forms and good faith estimates all still apply, no matter the specialty.
16:48 – 18:30 | Risks unique to concierge How a cash-based practice's exposure differs from a hybrid model that still bills insurance.
18:30 – 21:25 | The 24/7 access marketing trap Why "24/7 access" can't be the basis of a hybrid membership fee when most plans already require equal treatment.
21:25 – 25:29 | Planning, patients and market research Giving patients runway, avoiding abandonment and making sure your community can actually afford the fee.
25:29 – 28:27 | Building the transition the right way The financial, marketing and legal steps to take in order, plus the private equity money moving into concierge care.
28:27 – 28:42 | Closing thoughts and outro Todd thanks Ericka and Austin wraps the episode.
Physician compensation has never been simple, but in 2026 it is especially fraught. Medical groups and health systems are contending with workforce shortages, flat or declining reimbursement, rising operating costs and the regulatory limits that come with employed and affiliated models all at once — and a competitive offer, on its own, no longer closes the deal.
Medical Economics Associate Editor Austin Littrell sits down with Tynan Kugler, M.P.H., MBA, CVA, a principal in PYA's consulting practice, to break down the four forces pulling physician pay in competing directions and what physicians and organizations tend to get wrong about how compensation actually gets built.
Music Credits:
Rooftops by Buurd - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:32 | Cold open — Kugler on the central problem: once compensation is set it creates a floor, and that floor is very hard to step back down.
0:32 – 1:26 | Introduction — Austin Littrell welcomes listeners back from the Fourth of July weekend and previews the episode.
1:26 – 9:04 | The four forces — Supply-and-demand imbalance, the shift to employment and affiliation, reimbursement pressure and the productivity-versus-value tension. Kugler walks through how each is pulling on physician pay, plus the 2026 Medicare conversion factor and the coming 2027 unbundling of global obstetric codes.
9:04 – 13:22 | Competitive pay without runaway costs — Why the strongest groups redesign their models instead of raising salaries each year: hybrid base-plus-incentive structures, quality and access measures, shorter guarantee periods and smarter advanced practice provider strategy.
13:22 – 17:22 | Why pay is so hard to walk back — Compensation sets a floor that keeps ratcheting up. With demand outstripping supply, flat reimbursement and regulatory limits on changing contract terms, employers have little room to pull pay back down.
17:22 – 18:13 | P2 Management Minute — Keith Reynolds shares practice management tips and invites listeners to send in their own workflow ideas.
18:13 – 21:59 | Where there's room to move — Base pay and productivity metrics are the least flexible, because they track market data most closely. The give tends to live in quality incentives and recruitment tools like signing bonuses and forgivable loans.
21:59 – 27:58 | How an offer actually gets evaluated — Most systems work from a board-approved compensation philosophy, then run each physician's facts through it. Kugler contrasts three cases — a physician new to a market, a resident coming out of training and an owner leaving private practice — and walks through how benchmarking decides whether an offer is supportable.
27:58 – 29:17 | Closing thoughts — Not all roles are equal, alignment matters as much as the number and compensation is complicated. Kugler's parting advice: know what you need going in.
29:17 – End | Outro** — Austin Littrell wraps the episode.
For the first time in years, physician compensation and productivity have moved in opposite directions — pay is up, encounter volume is down — and practice leaders are trying to work out what it means heading into a turbulent year. Physicians Practice Managing Editor Keith Reynolds sits down with Andy Swanson, chief customer success officer at the Medical Group Management Association (MGMA), to unpack the group's latest provider compensation and productivity data report and the forces behind the split. They dig into why encounters are falling while acuity and pay climb, whether rising compensation against flat reimbursement can hold, and how the new Medicare efficiency adjustment — a 2.5% cut to the work RVU value of roughly 7,700 codes — will land hardest on procedural specialties.
Music Credits:
Paper Cranes by Buurd - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:25 | Cold open — Swanson sets up the central tension: if costs keep climbing while reimbursement stays flat or falls, the current path isn't sustainable.
0:25 – 1:10 | Introduction — Austin Littrell previews the episode and the guest.
1:10 – 1:39 | Welcome and setup — Keith Reynolds welcomes Swanson and introduces MGMA's latest provider compensation and productivity data report.
1:39 – 3:15 | What's behind the split — Encounters are down but carry higher acuity, and compensation rose roughly 1.5% to 3% even as work RVUs slipped. Swanson cautions against reading the volume dip as lower physician effort.
3:15 – 4:29 | Can the split last? — Two long-term problems: pay can't rise indefinitely as production falls, and rising costs against flat or negative reimbursement eventually hit a breaking point.
4:29 – 6:50 | The Medicare efficiency adjustment — A 2.5% cut to the work RVU value of about 7,700 codes hits procedural specialties hardest. Swanson explains how to benchmark around it and defend against the paper-only reimbursement hit.
6:50 – 9:19 | Recruiting into the squeeze — Cutting starting salaries in hard-to-recruit specialties won't land top candidates. Swanson makes the case for schedule management and smarter APP staffing ratios instead.
9:19 – 10:25 | P2 Management Minute — Keith Reynolds shares practice management tips and invites listeners to send in their own workflow ideas.
10:25 – 12:12 | Is burnout the new baseline? — Swanson says the industry has hit a new baseline, with one in three doctors citing burnout as a reason to leave, and argues it's still unsustainable.
12:12 – 14:43 | Why AI's payoff is so uneven — The clear win has been ambient scribes at the bedside. Swanson urges patience on the next wave of gains and pushes back on the industry's short attention span.
14:43 – 14:57 | A quick aside on the OpenAI IPO — A brief, lighter exchange. (Swanson: no personal investment advice.)
14:57 – 17:37 | The one number beyond work RVUs — Total visit volume. Swanson makes the "back to the future" case for panel size and encounters, and a rethink of base-plus-production pay models as APPs absorb more volume.
17:37 – 18:30 | Closing thoughts — Swanson expects 2026 baselines to be wonky and is already looking ahead to 2027.
18:30 – End | Outro — Austin Littrell wraps the episode with a Fourth of July send-off.
For years, Medicare and Medicaid effectively excluded coverage for the medications proven to treat obesity. That is starting to change. In 2026, CMS rolled out two new programs, the Medicare GLP-1 Bridge and the Medicaid-focused BALANCE Model, that open access to GLP-1 drugs for eligible beneficiaries and signal a shift toward treating obesity as a complex chronic disease.
In this episode, Medical Economics Senior Editor Richard Payerchin speaks with Tracy Zvenyach, vice president for advocacy and research at the Obesity Action Coalition, about what those programs do and what they mean for primary care. Zvenyach explains how the two programs differ, the central role physicians will play in determining eligibility and why CMS's move represents a real policy shift after years of debate. She also digs into the persistent problem of drug pricing, where compounded GLP-1 drugs fit in, the place of metabolic and bariatric surgery in comprehensive care and the weight bias and stigma that still shape how patients are treated across the health care system.
Music Credits:
Cherry Blossom Memories by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:26 | Sponsor message** Copic medical liability insurance
0:26 – 0:53 | Cold open Zvenyach previews the throughline of the episode: the workarounds patients rely on are a direct result of a system that wasn't built to support people living with obesity.
0:53 – 1:42 | Introduction Austin Littrell introduces the episode and guest, previewing the federal push to expand coverage of GLP-1 drugs and what it means for primary care.
1:42 – 2:50 | Meet Tracy Zvenyach and the OAC Richard Payerchin opens the conversation, and Zvenyach introduces the Obesity Action Coalition, a national nonprofit focused on access to evidence-based obesity care and reducing weight bias and stigma.
2:50 – 4:19 | Is obesity finally treated as a disease? Zvenyach reflects on 15 years of advocacy and says the old "eat less, move more" framing is fading as medical guidelines and policymakers increasingly recognize obesity as a complex chronic disease.
4:19 – 6:46 | What primary care physicians are saying Zvenyach describes a spectrum of clinician comfort with obesity medicine, from fully fluent to resistant, and says policy and coverage barriers make it hard for any of them to get patients the full range of treatments.
6:46 – 8:59 | What the BALANCE model does Zvenyach explains the Medicaid-focused BALANCE model, which pairs GLP-1 access with a lifestyle support program at a negotiated $245 price, and notes the Medicare arm was recently split off into a separate program.
8:59 – 10:32 | BALANCE vs. the GLP-1 Bridge The two programs share the same negotiated price and nearly identical clinical criteria, Zvenyach says, but are now split by population: Bridge covers Medicare from July 2026 through 2027, while BALANCE is a voluntary program for state Medicaid plans.
10:32 – 12:30 | Eligibility and the physician's role GLP-1 access won't be automatic. Zvenyach explains that clinicians must attest a patient meets BMI-based criteria, giving physicians a central role in identifying candidates for the programs.
12:30 – 13:21 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
13:21 – 14:50 | Will there be enough time to prove it works? With Bridge set to run only through 2027, Zvenyach explains CMS's plan to gather outcomes and cost data and potentially fold it into BALANCE in 2028, though carrying it forward depends on insurers opting in.
14:50 – 17:31 | Why covering these drugs is a policy shift Responding to the long debate over whether Medicare and Medicaid should pay for GLP-1 drugs, Zvenyach explains how prior administrations read the statute as barring coverage of "weight loss drugs," and argues these are obesity treatments, with weight loss being an outcome rather than the disease itself.
17:31 – 19:47 | The drug pricing problem Zvenyach summarizes the OAC's stance on antiobesity drug pricing: costs have fallen over the past 12 to 18 months, but coverage still isn't part of most standard benefits, leaving many patients unable to afford treatment even through alternative programs.
19:47 – 21:34 | Where compounded GLP-1s fit in Zvenyach frames the rise of compounded GLP-1 drugs as a symptom of system failure, and urges patients to weigh the different safety and risk profile of compounded versus FDA-approved products while the OAC works to close the coverage gaps that push people toward them.
21:34 – 23:15 | The role of surgery Zvenyach makes the case for the full continuum of obesity care, including metabolic and bariatric surgery and newer endoscopic procedures, noting many patients need more than one type of intervention over the course of their treatment.
23:15 – 26:21 | Weight bias, stigma and people-first language In her closing thoughts, Zvenyach points to weight bias and stigma as the root of many barriers, from exclusionary policy language to how exam rooms are equipped, and calls for people-first language and more respectful media representation.
26:21 – End | Outro Austin Littrell thanks the guest and wraps the episode.
Health care hiring is in a strange place. Clinical job applications jumped 10% at the start of 2026, yet the gap between open positions and actual hires keeps widening, a sign that getting candidates in the door is only half the battle.
In this episode, Medical Economics Managing Editor Todd Shryock speaks with Trent Cotton, head of talent insights at iCIMS, about what the data reveals and what physician practices can do with it.
Cotton explains why so many candidates drop out between the application and the offer, how smaller practices can out-recruit enterprise hospital systems by competing on candidate experience and why pay transparency in a job posting keeps the hiring funnel clean. He also digs into the friction that drives applicants away, the two factors that most influence whether staff stay and where AI genuinely belongs in hiring, from automated scheduling to the conversations that should always stay human.
Music Credits:
Steady State of Mind by Yigit Atilla - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:26 | Sponsor message** Copic medical liability insurance.
0:26 – 0:57 | Cold open Cotton frames the question driving the episode: how do practices fast-track top talent from hello to hire?
0:57 – 1:39 | Introduction Austin Littrell introduces the episode and guest, previewing what the latest data reveals about health care hiring and how physician practices can compete for talent.
1:39 – 3:14 | What's behind the surge in clinical applications Todd Shryock opens the conversation, and Cotton explains the January jump in clinical applications, tying it to post-pandemic turnover leveling off and clinicians looking for better compensation.
3:14 – 4:35 | Why hires lag behind openings Clinical openings are up far more than actual hires. Cotton points to a steep drop-off after the application, the gap between recruiter and hiring-manager interviews and the bureaucracy of offer approvals, with the fastest-moving practices winning.
4:35 – 5:57 | How a small practice out-recruits a hospital system Cotton's answer is candidate experience. He argues smaller practices win by making hiring feel personal and frictionless, citing survey data that 60% of candidates abandon applications that are too long, opaque on pay or unclear on qualifications.
5:57 – 8:17 | Compensation and the case for pay transparency Cotton says the data doesn't show practices have regained leverage on pay, and makes the case for listing compensation in the posting: it keeps the top of the funnel clean and avoids wasting everyone's time, even as he acknowledges why some employers hesitate to post pay.
8:17 – 10:55 | The non-clinical side Non-clinical applications are outpacing both openings and hires. Cotton attributes the slow pace to the same screening and scheduling bottlenecks, and urges understaffed practices to build a pipeline now, re-engaging strong past applicants before the candidate pool tightens.
10:55 – 11:47 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
11:47 – 13:44 | Removing friction from hiring Cotton defines friction as any point where candidates drop off, and explains how AI-driven skills matching and job simulations are reshaping the process, including a notable shift among Gen Z candidates who now prefer assessments to compete on skills rather than résumés.
13:44 – 14:46 | What drives retention Retention comes down to two things, Cotton says: hiring for genuine skill fit and giving employees a visible career path, especially in high-volume and entry-level roles where people often leave simply because they can't see a future internally.
14:46 – 16:33 | Where AI belongs in hiring Asked whether a hands-on practice has an edge over a hospital using AI, Cotton, a self-described AI advocate, says it depends entirely on where it's applied. He keeps the hiring-manager interview, the deeper recruiter conversation and the offer human, and automates much of the rest.
16:33 – 17:28 | The next 12 to 18 months Cotton points to growing concern about a shrinking candidate supply, and says recruiters are already getting creative, partnering with local universities to build talent pipelines and shape curriculum.
17:28 – 18:43 | Final advice and close Cotton's parting advice: map your candidate journey, decide what only a human can do and what can be automated, then share that roadmap with applicants for transparency. Todd Shryock thanks Cotton.
18:43 – End | Outro Austin Littrell thanks the guest and wraps the episode.
When a patient is treated by an out-of-network physician at an in-network hospital, the resulting payment dispute is supposed to be settled through the No Surprises Act's independent dispute resolution process. A newly finalized rule is meant to make that process work better, and for practices, the headline change is significant: the fee to initiate a dispute has dropped from $115 to just $15.
In this episode, Physicians Practice Managing Editor Keith Reynolds sits down with Anders Gilberg, senior vice president of government affairs at MGMA, to unpack what the rule actually changes, where administrative burden still weighs on practices and why so many physicians win in arbitration only to never see payment from insurers. Gilberg also responds to the insurance industry's criticism of the process, explains which specialties are most affected and lays out the regulatory developments practices should be watching through the rest of the year, from two pending HIPAA rules to the physician fee schedule.
Music Credits:
Moonlit Whispers by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:23 | Sponsor message** Copic medical liability insurance.
0:23 – 0:56 | Cold open Gilberg previews one of the episode's central frustrations: physicians win the vast majority of payment disputes through arbitration, only to never receive payment.
0:56 – 1:46 | Introduction Austin Littrell introduces the episode and guest, previewing what the new independent dispute resolution rule changes for practices.
1:46 – 4:06 | What the IDR rule is and where it came from Keith Reynolds opens the conversation, and Gilberg recaps how the independent dispute resolution process grew out of the No Surprises Act to settle out-of-network payment disputes, often involving specialties like emergency medicine, radiology, pathology and anesthesia.
4:06 – 5:17 | What the final rule changes Gilberg explains the two biggest wins: the fee to initiate a dispute dropped from $115 to $15, and new remittance codes will tell practices which claims actually fall under the No Surprises Act.
5:17 – 6:12 | What the delay cost practices With the rule under regulatory review for more than two years, Gilberg says the lag kept fees high and left practices to navigate ambiguity over which claims were even eligible.
6:12 – 8:20 | Where the administrative burden still sits New transparency codes will help, but Gilberg says the process remains cumbersome and points to a bigger problem: physicians win arbitration more than 80% of the time and still go unpaid, with enforcement legislation needed to make payers actually pay.
8:20 – 11:01 | The payers' pushback Responding to insurers who say the rule does too little to stop ineligible claims, Gilberg argues they are hiding behind a handful of egregious cases while ignoring how often physicians legitimately prevail, and acknowledges that a few profit-driven ownership arrangements are rare exceptions.
11:01 – 11:52 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
11:52 – 14:08 | What it means for administrators Gilberg notes the IDR process mainly affects hospital-based specialties like emergency medicine, anesthesia and radiology, but advises any administrator to treat denials more seriously now: the path from a 30-day negotiation to baseball-style arbitration is clearer, cheaper and tends to favor the practice.
14:08 – 16:41 | What practices should watch for next Gilberg doesn't see the rule as a signal of broader change, but flags a busy regulatory year ahead: two pending HIPAA rules on privacy and security, the physician fee schedule due in early July and payment issues set to expire at year's end, with a post-election lame-duck session likely to determine the rest.
16:41 – End | Outro Austin Littrell thanks the guest and wraps the episode.
Selling a medical practice is one of the most consequential financial decisions a physician will ever make, and many start the process far later than they should. In this episode, Medical Economics Managing Editor Todd Shryock speaks with Kevin Baker, director of business development at Emergency Care Partners, about how practice owners can prepare for a sale or succession years before they actually need to.
Baker breaks down the most common mistakes sellers make, the factors that drive a practice's valuation, the financial and legal documents to have in order before approaching a buyer and how selling to a hospital system, a private equity-backed strategic partner or a junior partner each changes the outcome. He also digs into the parts of a transaction physicians tend to underestimate: the tax implications of deal structure, the emotional weight of handing off a practice that represents their life's work and how to protect staff and clinical quality through the transition.
Music Credits:
Jazz Warm Lo-Fi by Nadezhda Pilitskaia - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:23 | Sponsor message** Copic medical liability insurance.
0:23 – 0:46 | Cold open Baker sets up the episode's central message: good decisions are rarely made under pressure, and failing to prepare is preparing to fail.
0:46 – 1:39 | Introduction Austin Littrell introduces the episode and guest, previewing how physicians can prepare to sell their practice and plan for succession long before they actually need to.
1:39 – 3:49 | The biggest mistakes sellers make Todd Shryock opens the conversation, and Baker points to four recurring errors: not lining up experienced advisors early, waiting too long to prepare, keeping financials that satisfy the IRS but not a buyer and fixating on the headline price instead of deal structure.
3:49 – 6:08 | How far in advance to start Baker argues the best transactions are intentional and begin years ahead, framed around one question: what would need to be true for the practice to thrive if you stepped away in three to five years?
6:08 – 8:04 | What drives valuation Value comes down to financial performance, risk profile and growth potential. Baker explains how EBITDA anchors the starting point and which risks can drag a number down, from hospital subsidy reliance and locums dependence to ED contract renewals and payer mix.
8:04 – 10:21 | Getting your documents in order Before approaching a buyer, Baker says practices should understand the tax implications of their legal entity structure, clean up the cap table, document partner buyout arrangements and begin assembling a data room of vendor contracts and payer agreements.
10:21 – 13:22 | Hospital, strategic buyer or your partners Baker compares the three paths: partner buyouts that pay out slowly and modestly, hospital deals that often open with teaser compensation before dropping to productivity-based pay and strategic acquirers who can pay more by realizing synergies and offering equity.
13:22 – 16:14 | Staff, patients and the identity transition Baker addresses the emotional side physicians tend to underestimate, urging sellers to define what success means beyond the closing table and to be wary of any buyer who doesn't put clinical quality and staff first.
16:14 – 17:05 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
17:05 – 19:24 | How open to be with your staff Discretion matters early in the process. Baker suggests routing buyer requests through a third-party CPA or advisor where possible, and having a candid one-on-one with a key operations or finance leader when documents and data are needed.
19:24 – 22:40 | Tax implications and deal structure With a "consult your tax advisor" disclaimer, Baker walks through the value of taking equity in the acquiring company, the difference between ordinary income and long-term capital gains treatment and the net present value advantage of receiving several years of earnings up front.
22:40 – 24:19 | Staying on part time after a sale For physicians who want to keep practicing, Baker's advice is to communicate it upfront, make sure there are enough physicians on the schedule to absorb the hours and understand how moving from full time to part time affects benefits.
24:19 – 25:22 | Final advice and close Baker's closing message: start the conversations now, since signing an NDA opens the door to information without committing you to a deal. Todd Shryock thanks Baker.
25:22 – End | Outro Austin Littrell thanks the guest and wraps the episode.
Urgent care was never designed to be the front door to American health care, but that's increasingly what it has become. As the country faces a projected shortage of as many as 80,000 primary care physicians by 2037 and nearly 40% of Gen Z patients go without a primary care physician at all, more Americans are turning to urgent care as their first and often only point of contact with the health care system.
Medical Economics Associate Editor Austin Littrell speaks with Andrea Giamalva, M.D., FAAFP, chief medical officer at Experity, about what urgent care is actually handling today, where its relationship with primary care breaks down and why she believes AI-enabled technology may finally help clinicians get the right patient to the right place at the right time. The conversation covers the generational shift away from primary care, the payer and cultural barriers that complicate care-gap closure, the growing role of advanced practice providers and how tools like AI scribes could bring humanity back to the exam room.
Music Credits:
Coffee Shop Sketches by Buurd - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:24 | Sponsor message** Copic medical liability insurance.
0:24 – 0:51 | Cold open Giamalva previews the episode's central theme: the national shortage of primary care has turned urgent care into the front door to health care for many Americans.
0:51 – 1:44 | Introduction Austin Littrell introduces the episode and guest, previewing the data behind the primary care shortage and the case for using technology to get the right patient to the right place at the right time.
1:44 – 2:20 | Meet Andrea Giamalva Giamalva introduces herself as a family medicine physician and chief medical officer at Experity, the leading platform for on-demand health.
2:20 – 4:28 | How urgent care became the front door From its 1970s origins to today, urgent care has grown from a cough-and-cold clinic into a multichannel digital front door offering employer-paid services, weight loss therapy, hormone therapy and mental health care.
4:28 – 7:15 | Choice or access? The generational data Roughly 10% of baby boomers lack a primary care physician, rising to nearly 40% of Gen Z. Giamalva ties the generational shift, projected shortages of up to 80,000 primary care physicians by 2037 and health care deserts to the "Amazon-Uber-DoorDash" expectations now shaping patient behavior.
7:15 – 9:49 | Right patient, right place, right time Giamalva argues the hardest problem in health care is matching patients to the appropriate setting, and that technology could let urgent care safely handle straightforward cases while primary care focuses on complex, time-intensive ones.
9:49 – 11:28 | Reducing burden without adding fragmentation With one study finding it would take 27 hours a day for a primary care physician to manage their full panel, Giamalva says clear communication across the patient journey and better tools at the point of care are what let urgent care act as a partner rather than a competitor.
11:28 – 14:02 | Treating patients like customers Giamalva makes the case that patient experience directly affects outcomes, and describes tools like Care Agent and AI scribes that aim to keep patients informed and bring human interaction back to the visit.
14:02 – 14:53 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
14:53 – 17:55 | What primary care can learn from urgent care Urgent care's scheduling flexibility and retail DNA give it a head start on on-demand care. Giamalva says primary care could adopt a more hybrid, risk-stratified approach that routes patients to telehealth, urgent care or a full primary care visit based on need.
17:55 – 19:43 | The expanding role of advanced practice providers As APPs take on larger roles in both settings, Giamalva calls for team-based models, clear expectations and proper training so urgent care teams can manage common chronic conditions like diabetes, hypertension and thyroid disease.
19:43 – 22:01 | Closing the primary care gap Giamalva walks through what it takes for urgent care to help patients without an established primary care relationship, including patient willingness, payer contracts that can prohibit preventive care and the cultural shift required of clinical teams.
22:01 – 22:53 | The case for AI-enabled technology In her closing thoughts, Giamalva argues AI-enabled technology is more than a fad and could finally reverse the administrative burden that has chipped away at the patient-provider relationship.
22:53 – End | Outro Littrell thanks Giamalva and wraps the episode.
The consolidation of outpatient medicine has swept many independent physicians into larger systems, private equity arrangements or hospital employment. John C. Cianca, M.D., FAAPMR, a physiatrist in Houston, Texas, and president of the American Academy of Physical Medicine and Rehabilitation, went the other way.
More than two decades ago, he left his Baylor-affiliated medical college to build a true solo, cash-only practice — no front desk, no MAs, no prior authorizations, no step therapy requirements.
Medical Economics Senior Editor Richard Payerchin talks with Cianca about why he made that move, what it cost him early on and what it freed him to do for patients. They also cover what primary care physicians consistently misunderstand about physical medicine and rehabilitation, how AAPMR became an early leader in documenting and advocating for long COVID patients, and how AI is already reshaping medical education in ways that may make traditional professional society programming obsolete.
Music Credits:
CALM CHILL RELAXED SMOOTH JAZZ (OWE YOU) by Tasty Tunes - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:26 | Sponsor message** Copic medical liability insurance.
0:26 – 0:58 | Cold open Dr. Cianca on the consolidation churn pulling outpatient practices into larger, less autonomous systems — and why he went the other direction.
0:58 – 1:55 | Introduction Austin Littrell introduces the episode, the guest and the key topics.
1:55 – 2:43 | Meet Dr. John Cianca Dr. Cianca introduces himself: private practitioner in Houston, adjunct faculty at Baylor College of Medicine and UT Medical Sciences, and president of AAPMR. His practice is a solo, cash-only outpatient musculoskeletal clinic.
2:43 – 4:43 | The biggest challenge facing PM&R Physical medicine and rehabilitation is a broad specialty spanning acute catastrophic injuries to day-to-day musculoskeletal care. The persistent external challenge: rehabilitation is still treated as an afterthought in care delivery, when earlier involvement produces faster, more efficient outcomes.
4:43 – 9:10 | PM&R's place in the primary care landscape Many early misconceptions about physiatry have cleared, but it's still not the first call for non-operative musculoskeletal problems — orthopedics tends to get the referral. Dr. Cianca makes the case for physiatry as a long-arc specialty rather than an incident response, and traces the field's evolution from hospital-based rehabilitation to outpatient care.
9:10 – 12:34 | AAPMR and long COVID Drawing on the specialty's history managing post-polio rehabilitation, AAPMR recognized early that post-COVID conditions would require sustained attention. Dr. Cianca says access to long COVID care has become harder over time, not easier, as the health care system's urgency has faded and the broader public has moved on.
12:34 – 15:11 | The pressures on independent practice Administrative burden, consolidation and private equity have pushed many small practices into larger systems. Dr. Cianca describes the churn that has reshaped outpatient medicine and explains why he deliberately went the other direction — and why he was fortunate to start when he did.
15:11 – 19:03 | Why Dr. Cianca went cash-only Twenty-two years ago, Dr. Cianca left his medical college affiliation to build a solo, insurance-free practice. His motivation wasn't money — he says he earns less than most colleagues — it was time: time to speak with patients, teach them and change their course rather than treat volume. He acknowledges the financial difficulty of the early years and cautions that the model is genuinely hard to build.
19:03 – 23:10 | The practical reality of a cash-only solo practice No front desk, no MAs, no PAs — and no chasing approvals or unpaid claims. Dr. Cianca explains what it means to deliver care without having to justify clinical decisions to someone who may not fully understand what they're approving. On step therapy: it's not a savings, it's just a delay.
23:10 – 24:01 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
24:01 – 26:25 | Remote therapeutic monitoring and technology in PM&R Dr. Cianca describes how the specialty has long used implantable technology for spasticity and pain management and explains how PM&R's practically oriented culture has made it an early and consistent adopter of new tools — including outpatient microsurgical techniques that send patients home the same day.
26:25 – 29:24 | AI and the future of PM&R AI may be the biggest change Dr. Cianca has seen in his career, and it's already reshaping medical education. Residents are turning to AI for literature synthesis instead of reading primary articles, and professional societies are trying to figure out how to stay relevant without being made obsolete.
29:24 – 32:04 | PM&R and the "Make America Healthy Again" initiative Dr. Cianca's view: physiatry has been doing this work all along. The specialty's whole-person, function-first approach to care predates the policy framing. A colleague recently put it simply: "You've already been doing this anyway."
32:04 – 34:16 | A message to primary care physicians and outro Primary care is physiatry's gateway, and Dr. Cianca's message to PCPs: for non-operative musculoskeletal problems, physiatrists offer something orthopedics doesn't — long-term partnership across a spectrum of time, not just an incident response. Payerchin wraps the interview; Littrell closes the episode.
Strategic thinking is often treated as an executive skill — something reserved for leadership retreats and long-range planning sessions. Melinda Mastel, MBA, MS, FHFMA, CMPE, PMP, a financial advisor at the Medical College of Wisconsin, argues it belongs on every finance professional's desk on a normal Tuesday.
Physicians Practice Managing Editor Keith Reynolds speaks with Mastel about what actually drives budget misses in medical groups, why the culprit is almost never the numbers themselves, and how small changes in the way financial data is tracked and presented can produce bigger operational shifts than most practice leaders expect. They also cover what a minimum viable product approach looks like in a health care finance context, why scope creep is the quiet killer of practice improvement projects, how to align cross-functional teams that can't agree on what the problem actually is, and why curiosity is the skill that most reliably turns an early-career finance professional into a trusted advisor. Mastel closes with two concrete tips practice leaders can implement immediately: challenge your assumptions about what can and can't change, and expand who you're hearing from.
Music Credits:
Retro Disco Lounge Groove by MotifLab Music - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.0:00 – 0:24 | Sponsor message Copic medical liability insurance.
0:24 – 0:48 | Cold open Mastel on why launching a new program at 50% or 20% of the ideal scope isn't failure — it's strategy.
0:48 – 1:39 | Introduction Austin Littrell introduces the episode and Melinda Mastel.
1:39 – 2:42 | The first question to ask when someone brings you a budget problem Stop at the numbers themselves and ask what changed. Workflow shifts, staffing changes, documentation drift and altered coding standards all show up in the data before they show up anywhere else.
2:42 – 3:26 | The most common reason medical groups miss budget Hidden operational shifts — small, undocumented changes in how time is spent or how effort is deployed — drift practice finances away from projections without ever triggering a formal review.
3:26 – 4:37 | What strategic thinking actually looks like on a Tuesday Strategic thinking is not an executive skill — it is a set of questions anyone can apply to anything on their desk. Do we agree on the actual problem? Who is affected downstream? What decisions upstream are landing here? Mastel argues the practice of asking those questions consistently is what separates finance professionals who execute from those who are sought out for advice.
4:37 – 6:13 | When reframing data changes a decision A growing subspecialty program at the Medical College of Wisconsin was tracked in aggregate with several other programs, making it nearly impossible to evaluate performance. Separating it in the accounting structure — a simple change — gave senior leaders clear metrics and produced more intentional investment decisions almost immediately.
6:13 – 8:54 | Launching something new on a tight budget: the blind spot We underestimate uncertainty and over-commit to the ideal version from day one. Mastel makes the case for a minimum viable product approach: launch at 50% or 20%, test it, gather feedback and preserve contingency for the things you cannot control. On the revenue side, she points to sponsored funding, organizational partnerships and philanthropic sources as underused options in academic medicine and beyond.
8:54 – 9:58 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
9:58 – 11:47 | The project management tools that actually matter in health care Two principles from formal project management apply directly to practice finance work: stakeholder management — bringing the right people, including end users and cross-functional contributors, into the conversation at the right time — and scope clarity, because projects that don't define what they are not tackling tend to drift and lose momentum.
11:47 – 13:03 | Aligning a cross-functional team that can't agree on the problem When urgency is high and definitions differ, the instinct is to move fast. Mastel argues for the opposite: slow down, document the shared definition of the problem before moving to solutions, and come back to it when decisions downstream get contested. That investment upfront eliminates far more rework than it costs.
13:03 – 14:33 | The skill that turns a finance professional into a trusted advisor Curiosity — not technical fluency, not communication skills, not change management frameworks, though all of those matter. Asking questions when there is extra time at the end of a meeting, understanding what pressures sit outside your own role and building a reputation for caring about causes rather than just executing tasks is what moves someone from analyst to thought partner.
14:33 – 16:33 | Two tips for practice leaders Challenge your assumptions about what is fixed. Some things genuinely cannot change quickly, but others can — and they won't unless someone asks the question. Then expand who you're hearing from. Office hours, rounding, an open-door policy — anything that gets the same voices out of the same room and brings in the perspective of people on the front lines.
16:33 – 16:51 | Closing remarks Keith Reynolds thanks Mastel and wraps the interview.
16:51 – end | Outro Austin Littrell closes the episode.
Social drivers of health (SDOH) — food security, housing stability, transportation, utilities access and interpersonal safety — account for roughly 80% of what determines whether a patient stays healthy or gets sick. Yet most of the health care system is still organized around the 20%: treating illness after it arrives.
Medical Economics Senior Editor Richard Payerchin speaks with Dhruv Khullar, M.D., M.P.P., a practicing physician and associate professor of health policy and economics at Weill Cornell Medical College who directs the Physicians Foundation Center for the Study of Physician Practice and Leadership, and Paul C. Harrington, former executive vice president of the Vermont Medical Society and a board member of the Physicians Foundation. They discuss why a patient's zip code can predict life expectancy more reliably than the care they receive, why SDOH screening falls short when the community resources to act on it aren't there, and the moral injury clinicians feel when they identify a need they cannot meet.
Music Credits:
Morning Coffee by Keyframe Audio - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.0:00 – 0:27 | Sponsor message Copic medical liability insurance.
0:25 – 0:52 | Cold open Dr. Khullar on the moral injury clinicians feel when they can identify a patient's social need but cannot meet it.
0:52 – 1:44 | Introduction Austin Littrell introduces the episode and both guests.
1:44 – 5:06 | Meet Paul Harrington Harrington introduces himself as a former Vermont legislator, U.S. Senate health policy director and longtime Physicians Foundation board member, and explains how a foundation-commissioned study by Dr. Buzz Cooper reframed health care spending as a demand-side problem — and drew the foundation into SDOH.
5:06 – 9:02 | SDOH is not a rural problem or an urban problem Palm Beach County data shows a 16-year life expectancy gap between two zip codes 10 miles apart. Harrington argues that access to food, transportation, safe housing and economic opportunity — not geography — determines whether a patient thrives.
9:02 – 11:36 | What works on the ground Three examples from the foundation's grant program: a Rush University cardiology program that places residents in food shelves to understand what their patients face outside the clinic; a Wichita, Kansas initiative embedding SDOH screening into electronic medical records and tracking whether identified needs are actually being addressed; and North Carolina's Medicaid managed care model, which improved health outcomes by adding food vouchers, housing support and transportation to the care contract.
11:36 – 12:27 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
12:27 – 13:46 | Meet Dr. Dhruv Khullar Dr. Khullar introduces himself as a practicing physician and health services researcher at Weill Cornell Medicine, where he directs the Physicians Foundation Center for the Study of Physician Practice and Leadership. The center focuses on incentives in health care, value-based payment, consolidation, physician well-being and the social needs of patients.
13:46 – 16:18 | The science behind SDOH SDOH is not a new idea or a trend — the evidence that social and community factors shape health outcomes, by some measures more than the care delivered in clinics and hospitals, is well established. The open challenge is not validation but intervention: once a social need is identified, what actually works to address it?
16:18 – 18:17 | The five core drivers of health Food security, housing stability, transportation access, utilities access and interpersonal safety. Dr. Khullar identifies food insecurity as the broadest challenge facing the most patients and unstable housing as the most individually devastating.
18:17 – 20:17 | The screening gap Community resource partnerships work — when they exist. The problem is that many communities lack those resources, leaving screening without the infrastructure to act on it. Going forward, the priority is aligning payment and policy to incentivize health systems to meet social needs, not just clinical ones.
20:17 – 21:46 | The SDOH billing codes and why physicians aren't using them The Physicians Foundation was instrumental in establishing billing codes that allow physicians to document patients' social needs. Adoption has been slow because awareness remains low — and because adequate reimbursement is still needed to create a durable incentive to use them.
21:46 – 23:25 | How to talk about SDOH with patients Empathy first. Dr. Khullar describes building the kind of trust that makes patients comfortable disclosing a housing or food problem — and argues that doing so matters not just for patient outcomes but for the sustainability of the workforce, which bears real moral weight when needs go unmet.
23:25 – 25:28 | Reaching beyond the clinic Dr. Khullar's three-part framework: identify who needs help through relationship-building and, carefully, AI-assisted screening; build durable relationships with community organizations over years and decades; and push for adequate public funding of social services, because screening and referrals can only go so far without a functioning safety net behind them.
25:28 – 27:10 | The case for investing upstream Both primary care and social services carry the same logic — large upfront investment, enormous long-term return. Dr. Khullar argues the case is both financial and moral: the political and social will to act is the only thing missing.
27:10 – 29:57 | State policy and how physicians can get involved States are laboratories for SDOH policy, and Harrington argues that elected officials actively want physician input. Working through state medical societies is the most direct path — legislators seek out physicians during recesses, and when physicians show up, they are heard.
29:57 – 31:15 | Dr. Khullar's message to primary care physicians Primary care is harder year over year, and unless health care financing, administrative burden and social support infrastructure change substantially, the workforce is at risk. Dr. Khullar calls this one of the most important issues in health care reform.
31:15 – 33:21 | Paul Harrington's message to primary care physicians Primary care physicians are the bedrock of American health care — underappreciated and underfunded. Harrington closes with a direct thank-you, a tribute to rural physicians embedded in the fabric of their communities and the Physicians Foundation's commitment to make the work of addressing social drivers of health easier, not harder, for the physicians doing it every day.
33:21 – 33:42 | Closing thoughts and outro Payerchin thanks both guests and wraps the interview portion of the episode.
Physicians are among the highest earners in the American workforce. They're also among the most financially stressed.
Panacea Financial's 2026 survey, "The Financial Lives of Doctors," puts numbers to that tension. Financial confidence rises from just 2.33 out of 5 in medical school to 3.27 among practicing physicians. More than half of respondents said they would not choose medicine again, or weren't sure, if federal student loans were capped at $200,000 (which they will be next month). Nearly two-thirds cited tax complexity as a top career challenge.
Medical Economics Associate Editor Austin Littrell speaks with Michael Jerkins, M.D., M.Ed., president and co-founder of Panacea Financial, and Jillian Vestal, J.D., head of legal services at Panacea Legal, about what's driving those numbers. The conversation covers what physicians consistently miss when reading their own contracts, how student debt shapes nearly every major financial decision a doctor makes, the tax traps hiding in signing bonuses and relocation reimbursements, and what the financial services industry keeps getting wrong about physicians as clients.
Read the report: https://panaceafinancial.com/survey-2026/
Music Credits:
Ambient Jazz by AurbanniAudio - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:26 | Sponsor message** Copic medical liability insurance.
0:26 – 0:42 | Cold open Dr. Jerkins previews the episode's core tension: being a doctor is still the coolest job you can have — but there will be a financial point where people reconsider.
0:42 – 1:57 | Introduction Austin Littrell introduces the episode and the guests and previews the key findings from Panacea's 2026 survey, "The Financial Lives of Doctors."
1:57 – 3:41 | Meet the guests Dr. Jerkins describes his path from financially struggling MedPeds physician to co-founding Panacea Financial. Vestal explains her background in health system contract work and what drew her to Panacea Legal.
3:41 – 6:08 | Would doctors choose medicine again? 53% of survey respondents said they wouldn't choose medicine, or weren't sure, if student loans were capped at $200,000. Dr. Jerkins puts the number in context: record medical school enrollment suggests demand remains strong, but the cap could quietly shift who enters the profession and where they end up practicing.
6:08 – 11:39 | The contract knowledge gap 49% of respondents said understanding their own compensation is a top challenge — but Vestal argues the real number is higher, because many physicians don't know what they don't know. Two contracts with identical salary numbers can look very different once call obligations, productivity incentives and bonus structures are factored in.
11:39 – 12:50 | Why earning more doesn't mean feeling more confident Financial confidence barely moves from training to practice — not because doctors are irresponsible, but because clinical and administrative demands leave little bandwidth for learning to navigate tax strategy, long-term planning and retirement savings.
12:50 – 17:22 | Student debt and contract negotiations 46% of doctors don't fully understand their repayment, forgiveness or refinancing options — and that knowledge gap follows them into employment negotiations. Vestal walks through how signing bonuses structured as loans, student loan assistance clauses and termination language can each carry significant financial consequences that most physicians never see coming.
17:22 – 18:21 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
18:21 – 21:24 | Balancing loans with life goals 70% of respondents struggle to balance loan repayment with other financial goals, including 37% already in practice. Dr. Jerkins explains why the period right after training is when physicians are most at risk of financial mistakes — and why a student loan strategy needs to come before the nice house.
21:24 – 25:23 | The tax complexity problem Tax complexity was the most cited career challenge at 67%, split nearly evenly between trainees and practicing physicians. Vestal breaks down how signing bonuses structured as loans, relocation reimbursements and state-to-state tax bracket shifts create unexpected W-2 surprises in a physician's first year of practice. Dr. Jerkins adds the growing 1099 locums trap.
25:23 – 28:31 | What the financial services industry gets wrong about doctors Physicians aren't careless — they're busy and uninformed. Dr. Jerkins argues the industry misreads physician risk, ignores their schedules and fails to account for the income gaps that happen between training and practice.
28:31 – 32:27 | The single most important thing to do right now Educate yourself, don't trust appearances and find a fiduciary advisor with physician-specific experience. Vestal adds: even if you've already signed your contract and have no plans to leave, get it reviewed — one doctor recovered $40,000 she never knew she was owed.
32:27 – 33:20 | Closing thoughts and outro Littrell thanks the guests, directs listeners to Panacea's 2026 survey in the show notes and wraps the episode.
For the first time, CMS isn't asking whether physician-owned hospitals should be part of Medicare's care delivery models — it's asking how.
Carlos Cardenas, M.D., a practicing gastroenterologist, founder and chairman of DHR Health in Texas' Rio Grande Valley, and president of Physician-Led Healthcare for America, joins Medical Economics Senior Editor Richard Payerchin to explain why that distinction matters. They cover how Section 6001 of the ACA froze competition in hospital markets, what the data actually shows about cost and quality at physician-led facilities, how to address the overutilization criticism, the patchwork of state and federal rules governing physician ownership, and what it will take to move the needle in Congress.
CMS has published its proposed 2027 Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS), including a request for information about participation of physician-owned hospitals in Medicare’s new Transforming Episode Accountability Model (TEAM). Public comments on the CMS request for information are due June 9. The IPPS is a 576-page document, but the relevant section can be found by searching for: “Hospital with Physician Ownership Request for Information”.Music Credits:
Chasing the moment by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Sponsor message Copic medical liability insurance.
0:27 — Cold open: Dr. Cardenas on CMS's shift in framing physician-owned hospitals
0:52 — Intro: Austin Littrell previews the episode and the June 9 CMS public comment deadline
1:55 — Guest introduction: Dr. Cardenas and Physician-Led Healthcare for America
3:11 — The "landmark moment": What the CMS request for information actually signals
3:49 — How the ACA's Section 6001 restricted physician-owned hospitals and froze competition
4:31 — The economic environment for medical practice over the last 15 years
7:26 — Why CMS's request for information is a meaningful seat at the table
9:49 — P2 Management Minute: Keith Reynolds
10:37 — A 2023 study showing Medicare could have saved $1B+ if care had been delivered at physician-owned hospitals
12:34 — Addressing the overutilization criticism
13:34 — Cherry-picking patients: Is it real?
15:15 — Reconciling state corporate-practice-of-medicine laws with federal limits on physician hospital ownership
18:07 — What it will take to get Congress to act on physician ownership legislation
20:02 — If the Medicare inpatient rule produces no change, what comes next?
21:28 — A message to primary care physicians
22:22** — Outro and CMS public comment reminder
Happy Memorial Day, Off the Chart listeners!
In today's episode, Leon Moores, M.D., a pediatric neurosurgeon, experienced health care executive and author of "All Physicians Lead: Redefining Physician Leadership for Better Patient Outcomes," joins Medical Economics Associate Editor Austin Littrell to answer the question: What does it mean to lead when you don't have all the answers?
Moores argues that every physician is already exercising leadership every day, whether they recognize it or not, and that the clinical skills physicians already have are a better leadership template than most realize. He explains why projecting false confidence is more damaging than acknowledging what you don't know, how the COVID-19 pandemic's overconfident messaging left lasting scars on public trust, and what it actually looks like to be a stabilizing force rather than a cheerleader or a panic merchant. He also walks through the most common mistake physician leaders make under stress, dismissing the people around them while rushing to the next thing, and closes with one piece of advice any leader can act on this week: listen better.
Music Credits:
Her Name by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:24 | Sponsor message** Copic medical liability insurance.
0:24 – 0:42 | Cold open Dr. Moores previews the episode's core argument: by any fundamental definition of leadership, every physician is already doing it every day.
0:42 – 1:42 | Introduction Austin Littrell wishes listeners a happy Memorial Day and introduces the episode and Dr. Moores.
1:42 – 2:26 | Meet Dr. Leon Moores Dr. Moores introduces himself: nearly 37 years as a pediatric neurosurgeon, experience leading large health care organizations and a longtime student and teacher of leadership.
2:26 – 5:54 | How uncertainty affects medical teams Dr. Moores contextualizes today's uncertainty against the COVID-19 pandemic and argues that leaders need to recognize that personal pressures don't stay at the door when people come to work.
5:54 – 8:19 | What teams need from their leaders Be honest about what you don't know, say so upfront and tell your team that your recommendations may change as you learn more. Leaders are affected by uncertainty too, and self-awareness is the prerequisite for self-management.
8:19 – 10:59 | Every physician is already a leader By the basic definition of leadership, influencing behavior to achieve a desired result, every physician is leading every day. The clinical framework physicians already use maps almost exactly onto effective leadership practice.
10:59 – 13:33 | Calm vs. honest: finding the balance Using the Apollo 13 analogy, Dr. Moores explains the difference between being a credible stabilizing force and being either a robot or a cheerleader. Acknowledge the problem, don't panic and don't pretend everything is fine when it isn't.
13:33 – 14:22 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
14:22 – 16:43 | How to deliver difficult news without losing trust Show some humanity. Let your team know you're affected too. The Wizard of Oz leadership approach, telling everyone it's fine while standing behind the curtain, destroys credibility. Being honest builds the psychological safety that allows people to raise their hand when something is wrong.
16:43 – 18:51 | Seeing stress in team members who don't speak up Dr. Moores' advice: ask. Repeatedly. Create an environment where it's genuinely okay to say you're having a tough day, and people will eventually use it.
18:51 – 23:23 | Building trust before a crisis hits Trust is a bank account built over time through small, consistent actions: celebrating questions, welcoming challenges and pausing to actually listen. Dr. Moores describes an OR team with 123 combined years of experience and explains what you lose when even one of them doesn't feel safe to speak up.
23:23 – 26:06 | The most common leadership mistake under stress Dismissiveness, brushing off a question because you're moving too fast to stop. It's rarely intentional, but it persists. Stopping for 60 seconds to make eye contact and engage does more for team trust than most leaders realize.
26:06 – 28:32 | The one thing to do differently this week Listen better. Put the phone away, turn to face the person, sit down if they're sitting and don't mentally move on to the next thing while they're still talking.
28:32 – 30:30 | Closing thoughts and outro Dr. Moores closes with a reminder about acknowledging uncertainty honestly and the years it will take to rebuild societal trust in medicine. Littrell thanks listeners and wraps the episode.
Most practices feel defeated going into payer negotiations before they even start. In this episode of Off the Chart: A Business of Medicine Podcast, Doral Jacobsen, MBA, FACMPE, CEO of Prosper Beyond VBC, joins Physicians Practice Managing Editor Keith Reynolds to explain why, and what to do about it.
Jacobsen walks through the three things that undermine practices before a single word is spoken: no strategy, no clarity on how their contracts are actually performing and a poor track record that creates fear of rejection. She explains how to use price transparency data without getting trapped in a numbers debate, which contract terms beyond the headline rate move the needle most — including escalators, unilateral amendment protections and termination clauses — and what questions to ask payers early to find out how much leverage you actually have. The conversation also covers how negotiation strategy differs across primary care, specialty, behavioral health, ambulatory surgery and FQHC settings, and closes with a bottom line that Jacobsen says applies to every practice regardless of size: payers have nothing without a network, and you have more power than you think.
Music Credits:
RELAXED CHILL JAZZ LOUNGE (OVER THE RIVER) by Tasty Tunes - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:24 | Sponsor message** Copic medical liability insurance.
0:24 – 0:43 | Cold open Jacobsen previews the episode's core message: payers have nothing without a network, and practices win negotiations every day because payers do need them.
0:43 – 1:42 | Introduction Austin Littrell introduces the episode and previews the conversation with Jacobsen.
1:42 – 4:09 | Why practices feel defeated before they start Jacobsen traces practice anxiety in payer negotiations to three sources: a poor track record that creates assumptions about how talks will go, no short- or long-term strategy, and a lack of clarity about how their own contracts are actually performing. She uses a Florida client example to show how not knowing your own contract landscape can lead you to nearly terminate your second-best deal.
4:09 – 7:13 | How to use price transparency data without getting trapped Jacobsen argues transparency data is limited — it captures a rate in time but misses edits, administrative burden, payment policy erosion and value-based revenue. The real question to ask isn't how you compare to competitors, but what it would cost a payer to acquire your practice instead.
7:13 – 8:53 | The contract terms that move the needle beyond the headline rate Jacobsen's top undervalued terms: multi-year deals with escalators to keep pace with inflation, administrative burden relief written into proposals, unilateral amendment protections so payers can't change rates without consent, and a 90-day without-cause termination clause.
8:53 – 10:20 | The questions worth asking payers early Three questions Jacobsen recommends: what would happen to total cost of care if this practice were acquired by a health system; what can we do together to protect against contract termination; and would there be a network adequacy issue if we were no longer in network.
10:20 – 13:40 | How to sequence your asks and set the right cadence Jacobsen's framework: do a full contract audit first, establish short- and long-term goals, lead with your value proposition before your proposal, and plan for negotiations to take longer than expected — sometimes 14 months. Best-performing clients are always negotiating because costs are always rising.
13:40 – 14:43 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
14:43 – 18:20 | What a strong case actually looks like in the room Jacobsen's dream scenario: competitive rates with other payers being actively fixed, a strong market position the payer can't afford to lose, good quality ratings, a clear value proposition and an engaged clinician who can tell the story. A quarterly relationship with the payer that has nothing to do with rates is also a significant advantage.
18:20 – 21:21 | How strategy differs by practice type Primary care's power is the referral. Nephrology's is HCC coding. Rural specialists have access leverage. Ambulatory surgery centers save money every time they avoid an inpatient admission. FQHCs lead with adequacy and prevention. Behavioral health needs to watch rate multipliers by credential level. The pitfalls are largely the same across all of them.
21:21 – 23:54 | Repeatable moves that work across markets Jacobsen's framework: a one-page visual value proposition, a complete contract language review, proactive strategy before any payer "love letter" arrives and a tenacious follow-up cadence that assumes everything will take longer than it should.
23:54 – 24:46 | One tip to implement this week and outro Jacobsen's closing advice: start now. Pick one contract and work on it. You miss 100% of the swings you don't take. Littrell thanks listeners and wraps the episode.
Primary care is facing a collision of two trends: a growing patient population with more chronic disease, and a workforce that will be short 85,000 to 90,000 physicians within a decade.
In this episode, David Carmouche, M.D., executive vice president and chief medical and commercial officer at Lumeris — and a newly appointed member of the HHS Healthcare Advisory Committee — joins Medical Economics Senior Editor Richard Payerchin to discuss what AI can realistically do about that.
Music Credits:Higher Self by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:25 | Sponsor message** Copic medical liability insurance.
0:25 – 0:42 | Cold open Dr. Carmouche previews the episode's closing message: as physicians, we're meant to be lifelong learners — and this is an exciting time to shape how AI gets deployed in health care.
0:42 – 1:49 | Introduction Austin Littrell introduces the episode and previews the conversation with Dr. Carmouche.
1:49 – 5:16 | Dr. Carmouche's background Richard Payerchin invites Dr. Carmouche to introduce himself. He traces a career that moved from independent primary care practice to Blue Cross Blue Shield of Louisiana, Ochsner Health, Walmart Health and now Lumeris — 30 years of experience across payer, provider and retail health settings.
5:16 – 8:16 | The tipping point — and what AI is actually for Dr. Carmouche describes the collision driving the primary care crisis: unprecedented patient need meeting a shrinking workforce. He argues AI's role is to extend the human workforce and reduce cognitive load — summarized in his core design principle: make the right thing the easy thing.
8:16 – 11:29 | Value-based care's promise and execution failures Dr. Carmouche explains Medicare's two main value-based care models — ACOs and Medicare Advantage — and why the concept is right but the execution has consistently missed the mark. Most physicians feel managed to the wrong things: care gaps, AWVs and risk codes rather than keeping patients healthy.
11:29 – 15:10 | What AI-enabled continuous care could look like Dr. Carmouche lays out a vision of AI as a continuous presence between office visits — monitoring patients using EHR, pharmacy, HIE and consumer data, alerting physicians when someone is going off track and adjusting visit frequency based on real-time patient status rather than arbitrary scheduling.
15:10 – 15:56 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
15:56 – 21:42 | Repatriating specialty care back to primary care Richard raises the growing burden of chronic disease management falling to primary care. Dr. Carmouche addresses the specialty referral problem directly — including a health system where 30% of cardiology appointments are filled with hypertension patients — and describes how AI-enabled clinical decision support could help primary care physicians manage more complex conditions and reduce unnecessary specialist referrals.
21:42 – 23:53 | The Wolters Kluwer partnership and automated clinical decision support Dr. Carmouche describes a partnership with Wolters Kluwer and UpToDate to automate the connection between patient data and evidence-based guidance — presenting clinicians with personalized, guideline-directed treatment recommendations at the point of care without requiring them to manually query the tool.
23:53 – 28:05 | Who pays for the technology — and can everyone access it? Dr. Carmouche addresses the cost and access challenges around remote monitoring devices, distinguishing between high-tech connected options and low-tech alternatives like a $39 Omron blood pressure cuff paired with AI text communication. The key challenge isn't the device — it's closing the loop back to a prescribing clinician.
28:05 – 31:02 | Advice for physicians still on the sidelines Dr. Carmouche says skepticism is okay — but burying your head in the sand is not. He encourages even the most reluctant physicians to read about AI, explore free online primers and stay curious, while also urging caution about placing AI directly between physician and patient without requiring proof points first.
31:02 – 32:22 | Closing remarks and outro Payerchin wraps the interview. Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.
If you haven't given your staff a sanctioned artificial intelligence (AI) tool, chances are they've already found one on their own. In this episode, Asha Palmer, senior vice president of compliance solutions at Skillsoft, joins Medical Economics Associate Editor Austin Littrell to break down the real risks of shadow AI in clinical settings — not just the data privacy concerns most practices already know about, but the harder-to-catch problem of inaccurate outputs that no one is monitoring.
Palmer explains why banning AI entirely isn't a sustainable strategy, walks through what a simple, practical governance plan looks like for a smaller practice, and makes the case that the conversation with clinicians has to come before the policy does. She also covers what to ask vendors before any AI tool goes live, what to do when you discover staff are already using tools you didn't approve and why visibility — not prohibition — is the most important thing practice leaders can give themselves right now.
Music Credits:Ocean Calm by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:27 | Sponsor message** Copic medical liability insurance.
0:27 – 0:50 | Cold open Palmer previews the episode's central argument: banning AI is not a sustainable strategy — staff will use it on their phones whether you sanction it or not.
0:50 – 1:42 | Introduction Austin Littrell introduces the episode and previews the conversation with Palmer.
1:42 – 3:03 | Meet Asha Palmer and Skillsoft Palmer introduces herself — a lawyer turned compliance professional now in tech — and describes Skillsoft as a learning company focused on defensible, scalable compliance programs.
3:03 – 5:03 | What is shadow AI and why does it matter Palmer reframes the conversation by starting with the opportunity AI creates for clinicians — efficiency, cognitive support, a thought partner — before explaining why unmonitored use creates serious data input and output risks that organizations can't see or control.
5:03 – 6:20 | Why clinicians keep reaching for unsanctioned tools The number one reason: the organization hasn't sanctioned anything. When there's no approved path, people create their own — and banning AI entirely makes shadow use more likely, not less.
6:20 – 9:16 | What a governance plan actually looks like for a small practice Palmer's practical framework: establish use cases in three buckets — how people are already using AI, how they want to use it and how the organization wants them to. Then map risks to those cases, identify controls and build in ongoing testing and monitoring.
9:16 – 11:00 | The risks practices are underestimating It's not patient data exposure — most clinicians understand that risk. The bigger concern is inaccurate or inconsistent outputs: hallucinations, wrong conclusions drawn from real data, recommendations that don't align with the organization's care model.
11:00 – 11:56 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
11:56 – 13:59 | AI is not just an IT problem Palmer argues that AI has to be viewed as a multidisciplinary issue — IT procures and monitors, compliance ensures safe use, and practice leaders need to see AI through the lens of business opportunity and growth, not just risk management.
13:59 – 16:09 | What compliance infrastructure needs to be in place before any AI goes live Palmer's core recommendation: rigorous third-party due diligence. Ask vendors tough questions about where your data goes, how models are trained, whether they test for bias and accuracy, and what their own governance structure looks like.
16:09 – 18:38 | What to do when you discover shadow AI use Palmer's answer isn't to fire anyone — it's to ask why. What are clinicians not getting that they feel they need? Shadow use is a signal, not just a violation. She also makes the case for a clear, readable acceptable use policy as a foundational step before any AI goes live.
18:38 – 20:30 | Closing advice for practice leaders Palmer closes with a direct message: visibility is everything. Sanctioning a tool gives you the data, the use cases and the control you need. Letting staff use AI in the shadows means losing control of your data, your people and eventually your practice.
20:30 – 21:39 | Outro Littrell thanks Palmer and wraps the episode.
Vaccine confidence in the United States has declined sharply, and the reasons are complicated — organizational upheaval at the CDC, conflicting guidance from different authorities, COVID-19 messaging failures and a flood of social media misinformation.
In this episode, David Dodd, president and CEO of vaccine developer GeoVax, joins Medical Economics Managing Editor Todd Shryock to share his perspective as an industry insider who is neither dismissive of the concerns driving hesitancy nor willing to accept that the system is beyond repair.
Music Credits:Empty Spaces by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:24 | Sponsor message** Copic medical liability insurance.
0:24 – 0:50 | Cold open Dodd previews the episode's central concern: an unprecedented decline in public trust in the institutions that have historically guided vaccine decisions.
0:50 – 1:47 | Introduction Austin Littrell introduces the episode and previews the conversation with Dodd.
1:47 – 5:00 | The Vaccine Integrity Project Dodd explains why the AMA's independent vaccine review initiative matters — not because the CDC has collapsed, but because the current process lacks definition, and uncertainty is directly affecting development timelines and public confidence.
5:00 – 6:36 | Can independent review and federal oversight coexist? Dodd predicts convergence between the AMA's process and the federal government's, drawing on historical precedent for multiple parallel pathways eventually integrating into something new.
6:36 – 10:45 | The most damaging misinformation — and why Dodd pushes back Dodd names the blanket claim that Secretary Kennedy is entirely anti-vaccine as the most damaging narrative in circulation, and explains why his own company's experience — including losing a $400 million DOGE-cut program — makes him neither a hard-line supporter nor a dismisser. He also addresses the mRNA vs. multi-antigen platform debate and why preferring one over the other is a legitimate scientific conversation, not a conspiracy.
10:45 – 13:15 | Red states, blue states and fragmented guidelines Dodd says he doesn't believe the U.S. will end up with politically divided vaccine guidelines — but acknowledges the current vacuum is real and that medical organizations stepping in to fill it, while sometimes viewed as overreach, is a necessary response.
13:15 – 14:07 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
14:07 – 20:22 | How COVID-19 messaging failures bred lasting skepticism Dodd traces the roots of current vaccine hesitancy to the 2020 messaging around COVID-19 vaccines — overstated efficacy claims, promises of sterilizing immunity that didn't hold up, mandatory language that alienated the public. He argues the lesson is transparency about what vaccines actually do: reduce hospitalization and death, not prevent infection entirely. He also makes the case that measles, flu and COVID-19 vaccines require very different public conversations.
20:22 – 24:04 | Advice for primary care physicians Dodd's core message to physicians: listening is the most important clinical skill you have in this environment. He shares a personal story of switching physicians after feeling dismissed, and makes the case that patients who don't trust their doctor should be told to find another one — because the relationship only works if the communication is genuinely bidirectional.
24:04 – 25:01 | Closing remarks and outro Shryock wraps the interview. Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.
What's really driving the dysfunction in American health care?
Longtime Medical Economics editorial advisor and family physician Melissa Lucarelli, M.D., FAAFP, sits down with Erica Rowe Urquhart, M.D., Ph.D., MBA, an orthopedic surgeon, 20-year independent practice owner and author of "The Invisible Hand Wielding the Scalpel: The Hidden Cause of America's Healthcare Crisis." The two physicians discuss why independent practitioners may be a dying breed, how insurance middlemen quietly slash physician reimbursements and why Medicare Advantage brokers are steering patients away from their own doctors with incentives patients never see. They also get into the prior authorization maze — including the frustration of reverse-engineering insurer rules that change every January, and why AI may be one of the most promising tools for cutting through administrative waste.
What stood out to Lucarelli most about their conversation?"It was somehow reassuring to discover that across disparate geographic areas and medical specialties, physician frustration with the health care industry seems to be universal," she told Medical Economics Senior Editor Richard Payerchin. "I believe all physicians face an arduous career journey which includes lifelong learning. Dr. Urquhart's story was fascinating... in the context of serious personal health problems, she not only continued to practice medicine, but also decided to pursue financial and spiritual enrichment though an MBA program and seminary school."
On what listeners can take away from this conversation“Our conversation started with data and actionable information about how to navigate prior authorizations and managing an entrepreneurial independent medical practice, and we ended up delving into the application of artificial intelligence to our work and specific tips about how other doctors can get started developing their own podcast or publishing their own book.”
Urquhart is also the creator of the podcast "UpMed: The Journal of Healthcare's Race To The Bottom," available where you get your podcasts.
Music Credits:
Distant Memories by Buurd - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:24 | Sponsor message** Copic medical liability insurance.
0:24 – 0:42 | Cold open Dr. Urquhart previews the episode's central argument: the 21st century's undivided focus on profit does not benefit society as a whole.
0:42 – 1:27 | Introduction Austin Littrell introduces the episode and hands it off to Dr. Lucarelli.
1:27 – 5:38 | The invisible hand and the race to the bottom Dr. Lucarelli introduces Dr. Urquhart and opens with her book's title metaphors. Dr. Urquhart explains how she's reinterpreting Adam Smith's "invisible hand" as a force now driving health care in the wrong direction.
5:38 – 10:43 | Why independent practice in an underserved community Dr. Urquhart traces her mission to volunteering in a Boston NICU during the AIDS crisis and her commitment to care that's cutting edge, timely and accessible to anyone. The conversation turns to data on physician office density by state and her belief that independent practitioners may be a dying breed worth documenting for future generations.
10:43 – 15:21 | Independent vs. employed: the real trade-offs Dr. Urquhart lays out the honest pros and cons of each path. Dr. Lucarelli adds data on independent physicians' long-term compensation and lower burnout rates.
15:21 – 18:27 | The agility advantage Both physicians share how their independent practices pivoted quickly during COVID-19 — and why large health systems couldn't move nearly as fast.
18:27 – 20:47 | The podcast cliffhanger — and AI as the solution Dr. Lucarelli references the cliffhanger ending of Season 2 of Dr. Urquhart's UpMed podcast. Dr. Urquhart teases that the solutions season will focus heavily on AI and large language models.
20:47 – 26:47 | Advice for physicians who want a bigger platform Dr. Urquhart walks through practical steps for starting a podcast and why she chose hybrid publishing over traditional publishing for her book.
26:47 – 32:17 | The coffee analogy: why health care pricing makes no sense Dr. Urquhart uses the caramel macchiato analogy from her book to illustrate why the same service, the same code, can yield wildly different reimbursements. Both physicians agree the system seems designed for no one to understand.
32:17 – 35:13 | The middleman problem Dr. Urquhart explains the repricing middleman model — where insurers route claims through a second company they may partially own to cut physician payment and pocket a percentage of the reduction.
35:13 – 39:29 | Medicare Advantage brokers and continuity of care Dr. Lucarelli raises Wisconsin's $626-per-patient broker switching bonus and how patients are misled about network access. Both physicians describe winning continuity-of-care approvals only to have insurers refuse to pay the bill.
39:29 – 44:47 | Playing a game without the rule book Both physicians discuss the secret, ever-changing prior authorization criteria that force physicians to reverse-engineer insurer rules every January — and the waste it creates for both doctors and patients.
44:47 – 49:55 | Personal health crisis, MBA and seminary Dr. Urquhart opens up about a health crisis that led her to pursue a theology degree and an executive MBA — and what both taught her about leadership, recovery and running a practice.
49:55 – 55:00 | Personal reflections and the next generation Dr. Urquhart reflects on her mother's influence, her children and whether she would recommend medicine as a career today.
55:00 – 57:05 | Closing remarks and outro Dr. Lucarelli wraps the conversation. Austin Littrell thanks both physicians and wraps the episode.
Getting paid for services already rendered shouldn't be this hard. But for most physician practices, navigating insurance payments has become one of the most frustrating and resource-intensive parts of running a business.
In this episode, Roshan Patel, founder and CEO of Arrow, joins Medical Economics Managing Editor Todd Shryock to break down why health care payment friction keeps getting worse — more prior auth requirements, more denials, more fragmented systems and a chronic shortage of trained billing staff to manage it all. Patel walks through the three routes practices typically take when payment processing gets out of hand, explains where AI is genuinely helping in revenue cycle management versus where it's still more hype than substance, and argues that denials management is the single highest-impact area for technology right now.
Music Credits:MUCHOS BESOS by Bopper Beats - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:28 | Sponsor message** Copic medical liability insurance.
0:28 – 0:54 | Cold open Patel previews the episode's central tension: in health care payments, one side wants to get paid and one side doesn't want to pay — making it almost a zero sum game by design.
0:54 – 1:48 | Introduction Austin Littrell introduces the episode and previews the conversation with Patel.
1:48 – 2:42 | The biggest pain points in medical payment processing Patel describes the current state: constantly changing payer rules, more prior auth requirements, rising denial rates and increasingly fragmented systems — all adding up to mass frustration across the industry.
2:42 – 4:14 | Why hasn't this been fixed? Patel explains the structural problem — misaligned incentives, fragmented payer systems, information that's nearly impossible to access without calling the insurer directly, and a staffing pipeline that keeps burning out the specialized people needed to manage it all.
4:14 – 5:28 | Three routes practices take Patel lays out the options: hire more in-house staff, outsource to a medical billing company or adopt technology. Each has tradeoffs, and knowing which fits your practice depends heavily on size and growth stage.
5:28 – 8:34 | How AI actually fits into revenue cycle management Patel distinguishes between two AI models — full automation for lower-stakes tasks like scribing, and a co-pilot approach for higher-stakes work like billing where a human needs to stay in the loop. He walks through specific use cases, including clean claims checks and AI-assisted appeal letter writing, where tasks that took hours now take minutes.
8:34 – 9:26 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
9:26 – 10:45 | Patient payments and the system-of-record problem Patel addresses the gap between insurance and patient payment systems, explaining why most practices can't answer basic questions about their own collection rates — because there is no single source of truth, and the EMR was never really built to be one.
10:45 – 12:10 | How to modernize your payment systems Patel's advice: skip the Google search and ask peers what's actually working. Smaller practices should look for one or two tools that do most of the work; larger practices can afford point solutions. Conferences are an underrated place to vet vendors in person.
12:10 – 13:15 | What metrics to demand from vendors Patel says practices should know their own collection rate and average time to payment before approaching any vendor — and then hold that vendor accountable to moving those specific numbers, not just general promises.
13:15 – 14:24 | Where technology makes the biggest difference Denials management. It's the most labor-intensive part of revenue cycle — vague denial reasons, phone calls to insurers, appeal letters, follow-up — and the area where Patel sees the clearest case for technology.
14:24 – 15:51 | The five-to-ten year outlook Patel pushes back on the idea that AI will replace medical billers, arguing that the specialized institutional knowledge experienced billers carry is something AI can't replicate. His prediction: billers stick around but become significantly more productive — and health care payments never fully loses its friction.
15:51 – 17:10 | Outro Shryock closes the interview. Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.
Earlier this year, the Milbank Memorial Fund, the Physicians Foundation and the Robert Graham Center jointly released "Investing in Primary Care: The Missing Strategy in America's Fight Against Chronic Disease" — a detailed, data-driven report making the case that primary care is both the most effective and most underfunded tool the United States has in its fight against chronic disease.
In this special episode of Off the Chart, Medical Economics Senior Editor Richard Payerchin speaks with four of the people closest to the work: Morgan McDonald, M.D., national director for population health at the Milbank Memorial Fund; Debra Lubar, Ph.D., president of the Milbank Memorial Fund; Ripley Hollister, M.D., a family physician and board member of the Physicians Foundation; and Yalda Jabbarpour, M.D., a family physician, lead author of the report and vice president and director of the Robert Graham Center.
Together, they walk through the report's most striking findings, explain why less than 5% of U.S. health care spending goes to primary care, and make the case for what needs to change.
Read the full report: https://www.milbank.org/publications/investing-in-primary-care-the-missing-strategy-in-americas-fight-against-chronic-disease/
Music Credits:Crystal Grind by NISO - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:28 | Sponsor message** Copic medical liability insurance.
0:28 – 0:41 | Cold open A preview of the episode's central framing: America's health care system isn't broken — it's just off balance.
0:41 – 1:54 | Introduction Austin Littrell introduces the episode, the report and all four guests.
1:54 – 2:18 | Guest introductions Richard Payerchin introduces each guest by name.
2:18 – 3:50 | The state of primary care today Richard asks each guest the same opening question. The answers converge on the same theme: primary care is overburdened, underreimbursed and increasingly unable to attract new clinicians.
3:50 – 6:04 | Why primary care is best positioned to lead on chronic disease Richard asks why primary care is the specialty best suited to lead the Make America Healthy Again agenda's shift toward prevention. The guests explain why prevention has always been primary care's core mission — and why the patient-physician relationship is the mechanism that makes it work.
6:04 – 8:00 | What the data shows: prevention and the trust finding The report's prevention findings — blood pressure checks, cholesterol screening, mammograms — are contextualized, with particular focus on why patients with a primary care physician are more likely to complete cancer screenings that don't even happen in the primary care office.
8:00 – 9:56 | The pediatric findings Children with a usual source of primary care cut their odds of an avoidable ED visit or hospitalization by nearly 50%. The guests discuss why the pediatric findings may be the most important in the entire report.
9:56 – 12:36 | The cost finding Richard asks each guest what finding surprised them most. The answer is consistent across all four: adults with chronic disease who have a usual source of primary care have nearly 54% lower total health care expenditures.
12:36 – 15:14 | Where the money goes — and doesn't Primary care is preventing disease and cutting costs but receives less than 5% of U.S. health care expenditure. The guests discuss whether that number has changed, why it hasn't and what doubling it by 2030 would actually require — including a fundamental shift away from fee-for-service.
15:14 – 16:37 | The APCM code opportunity Medicare's Advanced Primary Care Management codes are flagged as a concrete policy mechanism worth watching. The guests discuss how treating primary care services as preventive — the way Medicare treats colonoscopies — could change the financial picture for struggling practices.
16:37 – 17:27 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
17:27 – 20:59 | The workforce problem and the employer opportunity The spending gap is fueling a workforce crisis. The guests describe what the staffing math looks like in independent practice, why where physicians train determines what specialty they choose, and what role large employers can play in purchasing health plans that prioritize primary care access.
20:59 – 23:46 | The one recommendation Richard asks each guest which of the report's seven recommendations they would implement first. All four point to the same broad answer: change how much — and how — primary care is paid.
23:46 – 24:58 | A message to primary care physicians The guests close with a direct message to the physicians listening: the data makes the case, the policy levers exist and the work being done on their behalf is real.
24:58 – 26:20 | Outro Austin thanks all four guests, points listeners to the full report at milbank.org and wraps the episode.
Most practices manage their revenue cycle reactively — putting out fires instead of preventing them. In this episode, Kem Tolliver, FACMPE, CPC, CMOM, CEO of Medical Revenue Cycle Specialists, joins Physicians Practice Managing Editor Keith A. Reynolds to explain what a truly strategic revenue cycle work plan looks like and how to build one that aligns with your overall business goals.
Sign up for the April 29 webinar for FREE:
https://globalmeet.webcasts.com/starthere.jsp?ei=1757445&tp_key=0e7f653cd1
Music Credits:Groovy 90s Hip Hop Acid Jazz by Musinova - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:24 | Sponsor message** Copic medical liability insurance.
0:24 – 0:42 | Cold open Tolliver previews the episode's central warning: revenue leakage is a serious threat to financial stability — and it becomes more dangerous the more common it gets.
0:42 – 1:59 | Introduction Austin Littrell introduces the episode, plugs the April 29 AI webinar sponsored by Heidi Health and previews the conversation with Tolliver.
1:59 – 4:42 | What a strategic revenue cycle work plan actually looks like Tolliver explains how a strategic work plan aligns revenue cycle priorities with the overall business plan — broken down by quarter — and why most practices are still running off a business plan that hasn't been updated in years.
4:42 – 7:32 | Three moves to make in 30 days when payer friction is out of control Tolliver's framework: understand your denial drivers by volume, dollars and complexity; find where your cash is getting stuck in the AR aging buckets; and build real payer escalation relationships before you need them.
7:32 – 9:36 | The biggest mistake practices make when engaging payers Tolliver says it's showing up frustrated instead of prepared. Data, examples, trends and documented reference numbers beat complaints every time — because payers respond to evidence, not emotion.
9:36 – 12:08 | How to find the root cause when denials are spiking Tolliver's four-quadrant revenue cycle framework — front end, mid-cycle, payer communications and data — and how to use denial reason codes to trace a spike back to its source before it becomes a pattern.
12:08 – 14:02 | The denial type practices keep getting that a workflow fix could prevent Tolliver points to CPT coding as the most persistent offender — specifically the gap between correct coding initiatives and individual payer reimbursement guidelines — and explains why a payer-specific workflow is the fix.
14:02 – 18:00 | What a strong payer-specific action plan looks like — and who owns it Tolliver argues the billing team isn't the only one responsible. Providers, front desk staff and medical assistants all have a role — from closing notes on time to verifying benefits the EHR can't fully capture for certain specialties.
18:00 – 19:10 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
19:10 – 23:14 | Which metrics predict cash flow — and which create a false sense of security Tolliver's real cash flow predictors: aging AR, time-of-service collections, clean claims rate and denial rates by dollar amount. Her false sense of security warnings: gross collection rate and total charges, both of which can mask serious AR problems.
23:14 – 26:46 | When to automate, when to outsource and when to hire Tolliver's rule of thumb: automate anything repetitive, high-volume or rule-based; outsource when you need expertise you don't have in-house — like working down old AR during an EHR transition; and don't add staff until you've done a staffing ratio analysis.
26:46 – 28:42 | One tip to implement next week Tolliver's closing advice: look for revenue leakage. Under-coding, writing off collectible balances, accepting virtual credit card payments without negotiating rates and not pushing back on fee schedules are all quiet drains that practices normalize — and shouldn't.
28:42 – 30:40 | Outro Littrell thanks listeners, reminds the audience about the April 29 AI webinar and wraps the episode.
Ambient artificial intelligence (AI) scribes have become the fastest-adopted physician technology in recent memory. At UCSF, 70% of physicians now use one daily. At Kaiser Permanente, more than 7,000 physicians used them across 2.5 million patient encounters in just over a year. But what does the evidence actually show, and what are practices getting wrong?
In this feature episode of Off the Chart, Medical Economics Associate Editor Austin Littrell goes deeper on the AI scribe era, alongside Medical Economics' March-April 2026 cover story: Take note: The AI scribe era is here.
Robert Wachter, M.D., chair of the Department of Medicine at UCSF and author of "A Giant Leap: How AI Is Transforming Healthcare and What That Means for Our Future," is our main guide — explaining why documentation was the right entry point for AI in medicine, why the efficiency gains have been overstated, and why he's worried about what happens at note number 50.
We also hear from Shannon Sims, M.D., Ph.D., FAMIA, of Vizient on the case for thinking beyond the 12-month P&L, Marc Succi, M.D., of Mass General Brigham on where AI clinical reasoning actually stands today, and health care attorney Dan Silverboard, J.D., of Holland & Knight on the legal risks practices can't afford to ignore.
Music Credits:Silent Tension by AudioAmbi - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:24 | Sponsor message** Copic medical liability insurance.
0:24 – 1:55 | Cold open and introduction Austin Littrell opens with the story of pajama time, introduces Dr. Robert Wachter and previews the episode.
1:55 – 5:00 | How we got here — and why documentation won Wachter explains what the EHR did to the clinical note, how generative AI scribes are different from older voice-to-text tools, and why documentation — not diagnosis — was the right entry point for AI in medicine. The driverless car analogy.
5:00 – 8:20 | What the research actually shows Adoption numbers at UCSF. Findings from the UCLA randomized trial in NEJM AI and the Mass General Brigham/Emory burnout study. Wachter on why time savings have been overstated — and why the real ROI is in retention, recruitment and joy in practice. Dr. Shannon Sims on thinking beyond the 12-month P&L.
8:20 – 9:19 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
9:19 – 11:30 | Where the tools fall short The 70% error rate finding. Wachter on the 50th note problem and the cognitive trade-off of no longer writing your own notes. Dr. Marc Succi on where AI belongs right now — and where it doesn't.
11:30 – 15:45 | The legal picture Dan Silverboard on physician liability, the three questions to ask before signing any vendor contract, HIPAA complications around AI training on patient data, and why 85% of health care AI investment going to startups should give practices pause.
15:45 – 17:47 | What to do right now — and what comes next Practical steps: know your tool, talk to your patients, review your notes, get your governance in order. Wachter on why AI scribes are singles — and what the home run looks like.
17:47 – 18:55 | Outro Littrell thanks the experts, points listeners to the cover story at MedicalEconomics.com and wraps the episode.
A new Medical Group Management Association (MGMA) report found that 95% of practices say administrative and regulatory burden has increased over the past several years. Anders Gilberg, MGMA's senior vice president of government affairs, says the data tells a clear story about why.
In this episode, Gilberg joins Physicians Practice Managing Editor Keith Reynolds, to walk through the biggest drivers, from the explosive growth of Medicare Advantage and its abusive prior authorization tactics to the persistent failure of the MIPS-to-APM transition that was supposed to have happened a decade ago. He explains why practices are now staffing three or more full-time administrative employees per physician just to manage payer requirements, and why a full quarter of all U.S. health care spending goes toward administrative burden, higher than anywhere else in the free world.
Music Credits:Healing breeze by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:22 | Sponsor message** Copic medical liability insurance.
0:22 – 0:44 | Cold open Gilberg previews the episode's central stat: a full quarter of all U.S. health care spending goes toward administrative burden — higher than anywhere else in the free world.
0:44 – 1:40 | Introduction Austin Littrell introduces the episode and previews the conversation with Gilberg.
1:40 – 3:01 | Setting the stage: 95% Gilberg explains the MGMA regulatory burden report and confirms the headline finding: 95% of member practices say administrative and regulatory burden has increased in recent years.
3:01 – 5:07 | What's driving the surge Gilberg traces the growth of Medicare Advantage — now covering over half of all Medicare beneficiaries — as the primary culprit, bringing commercial insurer frustrations into what used to be a simpler government program. He also flags the 90% of practices reporting increased prior authorization burden and the two-thirds still stuck in MIPS with no viable alternative.
5:07 – 7:07 | Is Medicare Advantage broken? Gilberg draws a distinction between Medicare Advantage as a model — which can enable innovative, patient-friendly care — and the commercial administration of Medicare Advantage, which has brought take-it-or-leave-it contracting, utilization review abuse, denials and audits to the top of MGMA's burden survey.
7:07 – 9:13 | What prior authorization actually looks like day to day Gilberg describes the real-world experience: delayed authorizations, denials, phone calls with clinicians who don't match the requesting specialty, and a patchwork of dozens of separate insurer portals — each with its own workflow — that practices must navigate simultaneously. He notes CMS is moving toward standardization, but the problem is nowhere near resolved.
9:13 – 11:00 | The cost in dollars and staff Gilberg puts a number on the problem: upward of three full-time administrative staff per physician, devoted entirely to prior authorization, audits and billing — while a full quarter of all U.S. health care spending goes to administrative overhead, the highest of any country in the free world.
11:00 – 12:20 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
12:20 – 13:56 | The WISeR model: a foot in the door Gilberg explains why the WISeR model — which introduces prior authorization into traditional Medicare across six states and 17 services — is alarming even for practices not yet affected. He notes the irony that CMS is simultaneously pushing for prior authorization standardization while rolling out WISeR on a separate, non-standardized portal. The concern: a slippery slope toward broader expansion.
13:56 – 15:54 | Why practices are still stuck in MIPS Gilberg explains the original promise of MIPS — a bridge to alternative payment models — and why it failed. Over a decade later, not a single APM has been produced by the Physician Technical Advisory Committee, leaving the vast majority of practices trapped in a reporting exercise that doesn't function as a meaningful quality improvement program.
15:54 – 17:33 | Burnout, access and the human cost 77% of MGMA members link regulatory burden directly to burnout. Gilberg explains what that means in practice: physicians retiring early, leaving rural communities, or moving into employed roles to escape the paperwork — leaving patients without access to care that can't easily be replaced.
17:33 – 19:19 | If Congress could do one thing Gilberg's answer: physician payment reform. Specifically, eliminating the tournament model from MIPS — which requires some physicians to be cut in order to fund quality bonuses for others — and aligning Medicare payment with inflation. He calls it an oldie but goodie that the system can no longer afford to delay.
19:19 – 20:50 | Closing remarks and outro Gilberg closes with a note of cautious optimism — hoping for progress on prior authorization and payment reform by year's end. Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.
Artificial intelligence (AI) tools are proliferating fast in health care, but the legal framework around them is still catching up.
In this episode, Dan Silverboard, J.D., a health care attorney at Holland & Knight, joins Medical Economics Managing Editor Todd Shryock to explain how AI is currently being regulated — by states primarily, and by the FDA only indirectly — and where the biggest liability gaps exist for physicians and practices. He walks through what happens legally when an AI-generated recommendation contributes to patient harm, why the responsibility almost always lands on the provider, and why there is no get-out-of-jail-free card when an AI tool generates a higher billing code than what was actually performed.
Music Credits:Sky Drifter by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:25 | Sponsor message** Copic medical liability insurance.
0:25 – 0:51 | Cold open Silverboard delivers the episode's central warning: periodic auditing of AI-generated billing documentation is non-negotiable, and there is no get-out-of-jail-free card when an AI tool recommends a higher code than what was performed.
0:51 – 1:53 | Introduction Austin Littrell introduces the episode and previews the conversation with Silverboard.
1:53 – 3:09 | How AI in health care is currently being regulated Silverboard explains that states are the primary regulators, treating AI as a technology that supports clinical decision-making rather than a medical device. The FDA regulates AI only indirectly, based on whether it's incorporated into a regulated medical device.
3:09 – 4:57 | The two biggest liability risks for physicians using AI Silverboard identifies the core risks: 85% of health care AI investment is going to startups without proven compliance track records, and providers who blindly sign off on AI recommendations — clinical or documentation-based — without verifying accuracy are taking on serious legal exposure.
4:57 – 6:45 | Who is liable when AI contributes to patient harm Silverboard explains that legally, the provider must sign off on any AI recommendation, making them the primary responsible party. Technology vendors can face liability if their product is found to be wholly deficient — trained on biased or false data, for example — but broad liability disclaimers in vendor contracts make that a high bar.
6:45 – 7:28 | Should physicians document AI use in the medical record Silverboard says yes — physicians should document whether AI was used, whether they followed its recommendations and, if they deviated from them, why. Several states, including North Carolina, have already passed legislation or board guidance requiring exactly this.
7:28 – 8:37 | Compliance and billing risks from administrative AI tools Silverboard is direct: providers attest to the accuracy of their claims, and that responsibility doesn't transfer to an AI tool. Up-coding, down-coding and unbundling errors generated by AI are still the provider's problem. Periodic auditing and monitoring of all billing documentation — AI-generated or not — is essential.
8:37 – 9:27 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
9:27 – 10:36 | What to demand in an AI vendor contract Silverboard outlines the must-haves: robust HIPAA compliance representations and warranties, ongoing validation and bias testing with reporting obligations, and a data governance plan confirming the AI system and its training data are free from bias or untrustworthy sources.
10:36 – 12:30 | Privacy complications when AI learns from patient data Silverboard explains a key HIPAA limitation: vendors can only train on protected health information for the benefit of the contracting provider — not to improve their own product. De-identified data is simpler, but practices still need contract provisions prohibiting re-identification, which is an increasingly realistic risk as AI becomes more powerful.
12:30 – 13:24 | Legal concerns around ambient AI and automated note generation Silverboard says the core risk is providers relying too heavily on ambient AI without verifying that the record accurately reflects the encounter. Texas has already codified this as a statutory requirement for all providers using AI to record patient encounters.
13:24 – 15:13 | Three questions practices should ask before deploying AI Silverboard's framework: first, vet the vendor thoroughly for HIPAA compliance and a proven track record; second, understand your patient population's comfort level with AI, which should shape how and where you deploy it; and third, decide how you will disclose AI use to patients — regardless of whether your state requires it.
15:13 – 16:16 | Where AI-related litigation is heading Silverboard says if HHS projections hold, AI could actually reduce adverse events and litigation over time. But one area he expects to keep growing: lawsuits challenging health insurers' use of AI to deny or down-code claims and prior authorization requests.
16:16 – 17:15 | Closing thoughts and outro Silverboard closes with a note of optimism — AI holds great promise — paired with a practical bottom line: vet your vendors, monitor your billing, and build compliance checks into your program now. Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.
Medicare's Wasteful and Inappropriate Service Reduction (WISeR) Model launched January 1, 2026, in six states, immediately drawing fire from physicians, patient advocates and members of Congress.
In this episode, Rep. Greg Landsman (D-Ohio), a co-sponsor of the Ban AI Denials in Medicare Act, explains why he believes the pilot needs to be stopped. He argues the model is less about reducing waste and more about using artificial intelligence (AI) to deny claims faster, at the expense of seniors — he points out that the entire program operates as a black box, with no transparency about how it works, why the six states were selected or how the financial incentives are structured.
Music Credits:Rooftops by Buurd - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:28 | Sponsor message** Copic medical liability insurance.
0:28 – 1:02 | Cold open Landsman previews the episode's central argument: human beings denying claims is already a problem — handing that job to a computer system that isn't learning, just denying faster, makes it worse.
1:02 – 1:59 | Introduction Austin Littrell introduces the episode and previews the conversation with Landsman.
1:59 – 3:29 | What the WISeR model actually does Landsman describes the model as the administration contracting with big tech to deny claims for seniors, starting with procedures they expect to be noncontroversial — specifically to normalize AI-driven claim denials.
3:29 – 5:05 | The Ban AI Denials in Medicare Act Landsman explains the bill would stop the pilot entirely, not just the prior authorization component. He argues it should attract bipartisan support — the target should be fraud, waste and abuse, not senior care.
5:05 – 6:06 | What physicians and patients are actually experiencing Landsman says the most common story he hears is a claim that got denied, then reversed on appeal because it was always medically necessary. His argument: that's where AI should be deployed — reducing wrongful denials, not speeding them up.
6:06 – 7:13 | The transparency problem Landsman says no provider he has spoken with understands how the model is being implemented or why these six states were selected. The financial incentives reward more denials, but the formula is unknown and the code is invisible — a black box with no accountability.
7:13 – 7:56 | Has any Medicare payment model ever been stopped by Congress retroactively? Landsman says he's not aware of one — and adds that the chaotic rollout of the WISeR model has compounded the underlying policy concerns.
7:56 – 8:44 | What prior authorization reform should actually look like Landsman calls for full transparency and a measurable reduction in wrongfully denied claims as the baseline expectation for any entity receiving public money.
8:44 – 9:36 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
9:36 – 11:35 | The fate of ACA premium tax credits Landsman says 22 million Americans rely on the ACA, and 32,000 of his own constituents needed the extension to pass. He calls on the Senate to act, warning that failure to extend the credits will cause real harm — and that people will die. He frames it as a political loser for Republicans who try to block it.
11:35 – 12:42 | Common ground 2025: key provisions Landsman highlights the ACA subsidy extension and PBM reform as the plan's most important pieces, arguing that pharmacy benefit managers are charging enormous markups and those savings need to reach patients.
12:42 – 13:22 | Medicare physician fee schedule Landsman acknowledges he wasn't focused on that specific piece of the plan, but says the broader point is clear: physicians aren't getting paid what they need to be paid, and it's causing serious problems across the health care system.
13:22 – 14:24 | A message to primary care physicians Landsman closes with a direct message to physicians: he's a huge supporter, he recognizes they're being asked to do more under greater pressure for less pay, and he wants them to know they have allies in Congress.
14:24 – 15:30 | Outro Payerchin closes the interview. Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.
CMS's latest antifraud actions — withholding Medicaid funds from Minnesota, freezing enrollment for certain durable medical equipment suppliers and launching the CRUSH initiative — signal a broader shift in how the federal government plans to police health care fraud. In this episode, Pat Naples, J.D., senior associate at ArentFox Schiff, walks through the legal authority behind each of those actions and explains what the move from "pay and chase" to AI-driven real-time fraud detection means for physician practices.
Naples covers what rights physicians actually have when payments are flagged or withheld, why CMS has near-total immunity even if an AI system makes a mistake, and why the Minnesota action is a warning shot for state-level enforcement everywhere. He also lays out a practical compliance roadmap for small practices without dedicated staff.
Music Credits:
Midnight Serenade by MORRIX Holyhold - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:25 | Sponsor message** Copic Medical Liability Insurance.
0:25 – 0:46 | Cold open Naples previews the episode's bottom line: health care fraud enforcement is not going away, and providers need to be vigilant on the front end.
0:46 – 1:42 | Introduction Austin Littrell introduces the episode and previews the conversation with Naples.
1:42 – 2:43 | Meet Pat Naples and ArentFox Schiff Naples describes his practice — health care fraud enforcement, compliance and managed care litigation — and ArentFox Schiff's national footprint.
2:43 – 5:52 | The legal basis behind CMS's three-part crackdown Naples walks through the distinct legal authority behind each action: the Social Security Act for the Minnesota funding withholding, the Affordable Care Act for the DME enrollment moratorium, and broad government rulemaking authority for the CRUSH request for information. He explains how the moratorium and CRUSH initiative work in tandem — one freezing new enrollment, the other seeking longer-term solutions.
5:52 – 7:17 | Legal guardrails on AI-driven fraud detection Naples identifies the two primary guardrails on the "detect and deploy" approach: a credible allegation of fraud must exist before funds are withheld, and CMS must follow procedural notice requirements. He notes that both are largely within the agency's own discretion in practice.
7:17 – 9:00 | Can an AI flag alone justify withholding payment? Naples explains that claims data mining has been part of federal health care regulations since 2011 — this isn't new. He says regulators typically look for large outliers across the data set, not single anomalous claims, though circumstances and provider profile both factor in.
9:00 – 12:13 | What physicians can do when payments are withheld Naples walks through the appeals path: a written rebuttal statement, then administrative review, then judicial review — a process he acknowledges can be slow. He stresses that providers should be monitoring their own claims data proactively, and that voluntary self-disclosure under the new policy can reduce penalties significantly if issues are caught early.
12:13 – 13:02 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
13:02 – 14:48 | What the Minnesota action signals for other states Naples says the federal government's message is clear: states that aren't sufficiently vigilant about fraud will face intervention. He expects a meaningful uptick in state-level enforcement activity, pointing to Texas Attorney General Ken Paxton's aggressive pursuit of pharmaceutical companies as an early indicator.
14:48 – 17:35 | What the DME moratorium means for referring physicians Naples advises practices that refer patients to DME suppliers to scrutinize those relationships now — ensuring referral agreements fall within CMS safe harbors. Even practices that aren't targets of an investigation can be pulled in as witnesses, which requires responding to subpoenas, producing documents and making staff available for interviews.
17:35 – 18:39 | Other enforcement developments to watch Naples flags three: DOJ's new uniform corporate enforcement policy, a new joint HHS-OIG-DOJ task force, and the creation of a National Fraud Enforcement Division — all signals of increased focus and resources devoted to fraud, waste and abuse.
18:39 – 22:17 | Compliance risks that keep coming up at small practices Naples identifies the three most common compliance vulnerabilities: referral relationships and Anti-Kickback Statute exposure, documentation gaps around medical necessity, and inadequate cybersecurity resources. He notes HIPAA compliance has grown more complicated as cyber threats have multiplied.
22:17 – 23:48 | A compliance roadmap for practices without dedicated staff Naples outlines four practical steps: identify your high-risk areas first; implement proper training, including onboarding and annual compliance education; conduct basic monitoring of referral relationships and billing; and build a relationship with outside counsel or compliance consultants before an enforcement action forces the issue.
23:48 – 25:40 | Telehealth scrutiny and the big picture Naples closes with a warning about rising telehealth enforcement activity stemming from pandemic-era proliferation. He also pushes back on the idea that this is something new — health care fraud enforcement has been escalating consistently across administrations, and that trend is not going to change.
25:40 – 26:40 | Outro Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.
When tariffs on medical devices and components were first announced, the initial figures were, as Casey Hite puts it, mind-blowing — potentially forcing Aeroflow Health to exit entire business lines. In this episode, Hite joins Medical Economics Managing Editor Todd Shryock to discuss how the medical device supply chain has been reshaped by tariffs, why physician practices are already feeling the squeeze on items like syringes and PPE, and how Aeroflow responded not by lobbying for relief, but by accelerating AI adoption across the organization.
Hite walks through specific examples, from artificial intelligence (AI)-powered medical record interpretation to automated customer inquiry agents, and explains why implementing these tools wrong can be just as damaging as not implementing them at all. He also addresses how supply chain costs have risen 15% year over year, why diversifying away from single-country sourcing is now essential, and why he believes health care's default tendency to protect the status quo is its biggest obstacle in a tariff-driven world.
Music Credits:
Trusted by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:25 | Sponsor message** Copic Insurance.
0:25 – 0:42 | Cold open Hite previews the episode's central tension: the initial tariff figures were so large they would have made entire business lines unsustainable.
0:42 – 1:31 | Introduction Austin Littrell introduces the episode and previews the conversation with Hite.
1:31 – 2:34 | Initial fears when tariffs were announced Hite says Aeroflow's primary concern was access to care — specifically, whether they could absorb the margin hit without passing costs to patients, given that more than 90% of revenue flows through third-party payers at rates locked in years in advance.
2:34 – 3:13 | Which segments were hit hardest Hite identifies soft goods — breastfeeding supplies, PPE, syringes — and device components assembled in the U.S. from overseas parts as the most vulnerable categories.
3:13 – 3:58 | How fears compared to reality Hite notes that announced tariff sizes rarely match what actually goes into effect, and that the figures initially quoted would have been existential for some of Aeroflow's business lines. The final numbers came in lower — but still significant.
3:58 – 5:33 | Real-world effects on physician practices and the industry Hite describes the squeeze on practices already operating on thin margins — higher costs for basic supplies, pressure to find savings elsewhere. He explains how Aeroflow chose to treat the crisis as a forcing function for innovation rather than simply lobbying for tariff relief.
5:33 – 7:07 | How the industry is responding — and how Aeroflow is different Most companies are focused on pushing back on tariffs directly. Aeroflow looked the other way: how can AI and technology make up the lost margins? Hite frames AI as a force multiplier — one of the rare tools that simultaneously reduces cost and improves service.
7:07 – 12:35 | AI in action at Aeroflow Hite walks through specific deployments: replacing fax-based communication with EMR data pipelines via Particle Health and Redox; using AI to extract relevant data from patient charts that can run hundreds of pages; deploying AI agents to handle email, chat and soon phone inquiries; and putting AI coding tools in developers' hands to cut workload by 20–30%. He stresses that real-time sentiment monitoring is essential to prevent AI agents from trapping customers in loops.
12:35 – 13:27 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
13:27 – 15:00 | Why most companies aren't seeing the AI gains they expected Hite says the problem isn't the tools — it's implementation. Large committee-driven rollouts move too slowly. He also shares a candid moment: the first time he used AI coding tools, it hit his ego.
15:00 – 16:50 | Tariffs as an unexpected accelerant for innovation Hite argues the counterintuitive effect of tariffs is that they've urgently accelerated AI adoption. He also warns that this same dynamic will eventually depress hiring, and that companies will need to invest in retraining their people.
16:50 – 18:02 | Who's absorbing the cost — and by how much Hite confirms that Aeroflow's cost of goods rose 15% from 2024 to 2025 — and that savings elsewhere have not come close to offsetting that increase. Manufacturers are shouldering some of the burden, but not all.
18:02 – 18:46 | Lessons learned: diversify the supply chain Hite's key takeaway for the industry: stop concentrating supply chains in a single country. Aeroflow has prioritized sourcing from multiple countries to reduce exposure to any single tariff spike.
18:46 – 21:27 | Advice for physicians and health care leaders Hite pushes back on health care's doom-and-gloom culture and its tendency to protect the status quo — citing fee-for-service as the prime example. He draws a parallel to COVID-19, arguing that tariffs, like the pandemic, have simply accelerated adoption of technology that was already available. His message: accept the new reality, rally your team and look for the opportunity.
21:27 – 22:15 | Outro Shryock closes the interview. Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.
Artificial intelligence (AI) is already driving workforce decisions at major companies, and health care practices, large and small, are not immune.
In this episode, Christopher Mayer, J.D., a specialist in employment law with the firm Frier Levitt, explains how generative AI is being used to guide layoff decisions, why practice leaders can never simply accept what an AI tool recommends, and what the legal exposure looks like when AI-influenced reductions in force create disparate impact across protected categories. Mayer also addresses the near-total absence of federal AI regulation in the employment space, why the first jury trials over AI-driven layoffs could be damaging for employers, and where litigation is likely to land next. The conversation then turns to physician non-compete agreements.
Music Credits:
Warm Hands by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:33 | Sponsor message** Copic Insurance.
0:33 – 0:52 | Cold open Mayer delivers the episode's central warning: you can't blindly accept what an AI tool tells you to do — you have to protect yourself from liability.
0:52 – 1:37 | Introduction Austin Littrell introduces the episode and previews the conversation with Mayer.
1:37 – 5:07 | How AI is reshaping workforce decisions Mayer describes two converging forces: employers using generative AI to drive layoff decisions, and AI disrupting entire job categories across industries. He notes that health care is relatively protected from AI job displacement given its patient-facing nature — but not entirely immune, citing Verizon and Amazon as examples of AI-driven workforce reductions.
5:07 – 7:19 | AI-related layoffs in health care so far Mayer says major AI-driven health care layoffs have been limited, pointing to Revere Health in Utah — which eliminated nearly 200 jobs, roughly 7% of its workforce, largely targeting medical coders. He explains why small practices are unlikely to trigger WARN Act requirements and why their layoffs tend to stay out of the headlines.
7:19 – 9:14 | How small practices are already using AI Mayer observes that small practice owners are often early AI adopters, using it for administrative and research tasks — not as a replacement for clinical judgment, but as a practical tool for running a lean operation.
9:14 – 14:01 | The HR and employment law intersection with AI Mayer explains the core compliance risk when AI influences a reduction in force: disparate impact across protected categories. He walks through the Age Discrimination in Employment Act requirements for group layoffs, why employers must build an employee census before proceeding, and why you can never simply accept what an AI tool tells you to do.
14:01 – 16:30 | Age, discrimination and the employee census Mayer clarifies how employers can know employee ages for compliance purposes, explains what an employee census looks like in practice and describes how small practices can conduct their own disparate impact analysis before proceeding with a reduction.
16:30 – 18:25 | Federal AI regulation: largely absent Mayer says meaningful federal AI regulation in the employment space doesn't yet exist. The current administration is broadly pro-AI and not focused on regulating it. California has moved at the state level, but the federal picture remains thin.
18:25 – 22:14 | Predicting the first AI employment lawsuits Mayer forecasts that challenges to AI-driven layoffs are inevitable — and that juries will likely be unsympathetic to employers who appear to have used AI as cover for discriminatory intent. He flags AI bias in tools like Grok as an early warning sign of what's coming.
22:14 – 23:04 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
23:04 – 28:08 | The non-compete landscape for physicians Mayer traces the FTC's failed attempt at a federal non-compete ban, explains why state law now governs entirely, and walks through the spectrum: California's outright ban, Pennsylvania's new one-year cap and termination carve-out for physicians, and states like New Jersey and New York where enforceability depends heavily on geographic scope, duration and the judge.
28:08 – 31:06 | What physicians should do when presented with a non-compete Mayer's advice: don't sign without consulting an attorney. He also raises a nuance most physicians overlook — that a new employer's legal team can review an existing non-compete and potentially provide indemnification if the physician is sued by a former employer.
31:06 – 31:51 | The one thing physicians must never do Mayer warns that deceiving either a former or new employer about a non-compete — or hiding its existence — is the fastest way to create serious legal exposure.
31:51 – 32:49 | A message to primary care physicians Mayer closes with a note of optimism: don't be fearful of AI. For physicians in particular, he expects it will supplement care rather than replace it — and that over time it will be viewed as more positive than the current fear suggests.
32:49 – 34:10 | Outro Payerchin closes the interview. Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.
Health care fraud enforcement recovered more than $6 billion last year. Shannon Sumner, CPA, CHC, expects this year to be even larger.
In this episode, Sumner, managing principal of PYA's Nashville office and the firm's chief compliance officer, explains how enforcement has shifted from targeting large health systems to going after individual physicians and practice leaders. She walks through the highest-risk areas regulators are focused on in 2026, including billing and coding integrity, value-based care arrangements, telehealth documentation and artificial intelligence (AI)-assisted tools, and what practices of every size can do right now to get ahead of it.
Sumner also breaks down what a realistic compliance program looks like for a smaller practice — separating the true must-haves from the nice-to-haves — and explains exactly what to do if an internal audit turns up a potential problem, including when self-disclosure is necessary and when a corrective action plan is enough.
Music Credits:
Soft Morning by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:22 | Cold open Sumner previews the episode's central warning: health care fraud recoveries hit a record last year, and 2026 is on track to surpass it.
0:22 – 1:11 | Introduction Austin Littrell introduces the episode and previews the conversation with Sumner.
1:11 – 2:38 | Meet Shannon Sumner and PYA Sumner introduces herself and PYA, a top-100 national health care consulting and accounting firm, and describes her background spanning traditional accounting, internal auditing and regulatory compliance.
2:38 – 5:43 | How the enforcement environment is changing in 2026 Sumner explains that enforcement is now analytics-driven — practices get flagged because their data doesn't look like their peers. She walks through the top risk areas: billing and coding integrity, quality reporting and value-based payment errors, Medicare Advantage and risk adjustment, and data privacy and cybersecurity.
5:43 – 7:40 | Where value-based care arrangements create fraud and abuse risk Sumner identifies the biggest compliance risks in VBC deals — risk adjustment, quality reporting, patient attribution and incentive payments — and urges practices to demand clear contractual definitions, independent access to performance data and thorough legal vetting before signing or renewing any arrangement.
7:40 – 9:42 | Red flags in VBC negotiations — and fixes that don't blow up the deal Sumner says most deals don't need to be scrapped, just properly vetted. Key fixes include clarifying definitions, adding payment guardrails, requiring data transparency and building in ongoing monitoring. She flags False Claims Act exposure for knowingly inaccurate data submissions and warns that Stark law remains strict liability.
9:42 – 12:36 | Telehealth fraud patterns drawing regulatory attention Sumner outlines the concerning patterns the OIG is flagging: brief or scripted encounters, improbable utilization, incorrect place-of-service coding and remote prescribing violations. She also stresses HIPAA risks including platforms without business associate agreements and recording sessions without patient authorization.
12:36 – 14:22 | How analytics have changed compliance and what practices should do Sumner explains that regulators now analyze the full population of claims, not just samples — and practices should be doing the same internally. She recommends building dashboards to track outlier metrics, conducting targeted audits and focusing on the 20% of activity generating 80% of risk.
14:22 – 15:14 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
15:14 – 20:44 | Must-haves vs. nice-to-haves for a compliance program in 2026 Drawing on the OIG's updated General Compliance Program Guidance, Sumner outlines the must-haves for small practices: a designated compliance lead who isn't involved in coding and billing, written policies that match actual workflows, role-specific training, a mechanism to report concerns without retaliation, basic auditing and monitoring, and a corrective action roadmap. Nice-to-haves include third-party compliance assessments every three to five years and advanced analytic tools — though she says the latter is quickly becoming a must-have.
20:44 – 22:29 | What to do when an internal audit finds a problem Sumner's plan of action: contain the issue immediately, pause billing, locate documentation and seek counsel versed in fraud, waste and abuse before doing anything else. She walks through how to determine whether self-disclosure or an internal corrective action plan is the appropriate response.
22:29 – 24:16 | Where the next wave of enforcement is heading Sumner points to AI-enabled documentation and coding tools as the next major enforcement frontier and recommends practices form an AI governance committee — even a small one — to inventory tools and assess risk. Third-party vendor risk is another growing area, with business associate agreements and security assessments taking on new importance.
24:16 – 26:38 | The CRUSH initiative and what it means for individual physicians Sumner explains that enforcement has shifted from large health systems to individual providers, notes that CMS held a "chili cook-off" contest to solicit better fraud-detection analytics, and warns that the government has now put practices on notice: the absence of an effective compliance program is an aggravating factor in enforcement actions.
26:38 – 27:22 | Closing thoughts Sumner's bottom line: the best compliance programs are operational partners, not paper programs. Practices need to move from reactive to proactive compliance — because prevention is the best medicine.
27:22 – 28:15 | Outro Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.
Nearly half of all physicians are now employed by or affiliated with a hospital system, and the forces behind that consolidation aren't slowing down.
John Pack, vice president of health care finance at Mitsubishi HC Capital America, explains to Physicians Practice Managing Editor Keith A. Reynolds what's driving independent practices toward consolidation, and why mid-size practices in particular get stuck in a lending no man's land.
He walks through what lenders are actually looking at when they evaluate a practice, including EBITDA — that's earnings before interest, taxes, depreciation and amortization — margins, accounts receivable aging and payer mix, and what the cleanest path to funding growth looks like without surrendering equity or clinical control.
Music Credits:
Cozy Evening Coffee Time by BJBeats - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:22 | Cold open** Pack previews the episode's bottom line: small operational fixes often have a bigger financial impact than simply adding new patient volume.
0:22 – 1:17 | Introduction Austin Littrell introduces the episode and previews the conversation with Pack.
1:17 – 4:09 | What's driving practice consolidation Pack outlines the four main forces squeezing independent practices: rising operating costs, stagnant or declining reimbursements, aggressive acquisition by hospitals and private equity, and the lingering financial aftershocks of COVID-19. He notes that nearly 50% of physicians are now employed by or affiliated with hospital systems, up from under 30% a decade ago.
4:09 – 5:53 | Why mid-size practices hit a ceiling with traditional bank financing Pack defines mid-size practices as those between $10–15 million and $120 million in revenue and explains why they fall into a lending no man's land — too large for local banks, too small for large ones — and why health care's cash flow profile makes traditional bank underwriting a poor fit.
5:53 – 8:03 | What lenders are actually looking at Pack walks through the key metrics lenders use to size up a practice: EBITDA margins (typically 10–20% for outpatient specialties), accounts receivable aging (under 45 days is strong, 90-plus days is a red flag), and payer mix across Medicare, Medicaid, commercial insurance and self-pay.
8:03 – 9:01 | Funding growth without giving up control Pack identifies cash flow-based debt — traditional or private credit — as the cleanest path to growth, with no equity issued, no board seats surrendered and no covenants tied to clinical decision-making. Asset-backed credit lines are a secondary option.
9:01 – 10:02 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
10:02 – 11:37 | What makes an acquisition deal financeable — and what raises red flags Pack says verifiable EBITDA is the first thing credit analysts look for, followed by a diversified provider base with no key-person dependency, consistent revenue growth, strong payer mix and clean accounts receivable under 45 days.
11:37 – 13:07 | Cash flow fixes that unlock better financing terms Pack's top two levers: normalizing physician compensation so retained earnings stay in the practice, and tightening accounts receivable management — which he calls the fastest and most common cash flow win lenders cite.
13:07 – 14:22 | How to stress-test your debt Pack advises practice owners to model downside scenarios — not just base cases — asking whether the practice can still service its debt if reimbursements drop, labor costs rise or a key provider leaves.
14:22 – 16:08 | Three steps before expanding your practice Pack's pre-expansion checklist: get a clear picture of your true cash flow stripped of one-time expenses, assess operational readiness and leadership depth, and engage financial partners early — a step he says probably belongs at the top of the list.
16:08 – 17:16 | One tip to improve practice finances today Pack's closing advice: start managing the practice like a business, not just a clinic. Review cash flow regularly, understand where money is leaking and recognize that small operational fixes often outperform chasing new volume.
17:16 – 18:00 | Outro Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.
Virtual care has reshaped medicine since COVID-19, but the shift to the screen comes with real trade-offs.
In this episode, Sarah Matt, M.D., MBA — practicing physician, health technology strategist, author of "The Borderless Healthcare Revolution" and a recent addition to the Medical Economics editorial advisory board — joins Managing Editor Todd Shryock to explore what's actually at stake when care moves online. She explains what gets lost in a virtual encounter, why certain patient populations actually do better with telehealth than in person, and why reliable internet access has become a social determinant of health.
Matt also pushes back on the idea that individual physicians are responsible for bridging the digital divide, arguing that health systems need to own that problem, and that technology vendors need to start designing with patients at the table rather than on their behalf.
Her closing advice for any practice navigating the virtual care landscape: be flexible, because one size fits nobody.
Music Credits:
Sleepy Sunday by Buurd - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:22 | Cold open** Matt opens with a provocation: reliable internet access has become a social determinant of health and should be treated as a utility.
0:22 – 1:17 | Introduction Austin Littrell introduces the episode and previews the conversation with Matt.
1:17 – 2:24 | How virtual care has changed clinical practice Matt describes the spectrum of virtual care since COVID-19 — from fully remote telehealth-only practices in primary care and women's health to hybrid models that blend in-person and virtual visits.
2:24 – 3:22 | What's at risk in a remote encounter Matt explains what physicians lose when care moves to a screen — the contextual cues of a full in-person visit — and notes that patients lose the ability to read their provider too.
3:22 – 4:12 | Building trust and rapport virtually Matt argues that digital empathy and in-person empathy require the same skills: small talk, active listening and genuine relationship-building matter whether you're in a clinic or on a video call.
4:12 – 5:21 | The role of preparation in virtual visits Matt is candid about the reality most physicians face: limited prep time, limited environmental control and a chart review that often happens seconds before the visit. She says preparation is a shared responsibility between provider and patient.
5:21 – 6:47 | When virtual care actually works better Matt points to older adults using iPads for virtual discharge as one example where virtual care improved communication — noting features like volume control, lip reading and transcription. She also highlights reduced commute stress and the ability to reference notes as patient-side advantages.
6:47 – 9:06 | Virtual care, equity and the infrastructure gap Matt is hopeful that virtual care can raise the floor for access but flags a hard reality: for patients without reliable internet — whether urban poor or deeply rural — the infrastructure gap is its own barrier. She uses a snowstorm analogy to make the point that technology can't fix an unplowed road.
9:06 – 9:57 | What individual physicians can do Matt says systemic problems require systemic solutions, but urges physicians to stay open across all communication channels — while also protecting their own well-being, because a burned-out physician helps no one.
9:57 – 10:47 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
10:47 – 12:32 | Digital literacy on both sides of the screen Matt describes a generational knowledge gap affecting both patients and providers, and calls for communities and health care organizations to draw on expertise from all levels — from medical students to senior clinicians — rather than deferring only to leadership.
12:32 – 13:32 | Physician responsibility vs. system responsibility Matt pushes back on placing the burden of technology adaptation solely on individual physicians, arguing that health systems need to own the responsibility of enabling providers with tools that don't get in the way of care.
13:32 – 14:51 | Designing virtual care for the people who actually use it Matt's core design principle: stop assuming you know what patients need and start including them in the process. Whether the population is rural farmers, non-English speakers or urban transit riders, solutions built without them will miss the mark.
14:51 – 15:25 | One guiding principle for virtual care Matt's closing advice: be flexible. Virtual care is not one-size-fits-all for patients or for physicians, and recognizing where it works — and where it doesn't — is the starting point.
15:25 – 15:57 | Book plug and closing remarks Matt points listeners to her national bestseller "The Borderless Healthcare Revolution" as a roadmap for improving health care access, and encourages everyone to identify one thing they can do to improve access today.
15:57 – 17:05 | Outro Shryock closes the interview. Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.
The Merit-based Incentive Payment System (MIPS) has been around since 2017, but that doesn't mean the program has gotten easier to navigate.
Holly Black, project manager for regulatory affairs and compliance at Sightview Software — and often referred to as a "MIPS Geek Guru" — walks through the most consequential changes for 2026, including the removal of the three-point scoring floor for large practices and new documentation requirements for security risk assessments.
She explains why MIPS performance is never really one person's job, what practices should be doing quarterly to avoid a scramble at year-end, and how electronic health record (EHR) documentation habits show up directly in performance scores. Black also covers the shift toward MIPS value pathways (MVPs), what the transition means for specialists and sub-specialists, and how time-strapped practices can focus their limited hours on the changes that will have the biggest impact on their score.
Music Credits:
Swinging Lounge Bar by NC MUSIC - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:18 | Cold open** Black previews the episode's central theme: MIPS is a team sport, not a one-person job.
0:18 – 0:59 | Introduction Austin Littrell introduces the episode and previews the conversation with Black.
0:59 – 3:40 | What's changed in MIPS for 2026 Black breaks down the biggest updates by category: the removal of the three-point scoring floor for large practices, new documentation requirements for security risk assessments under the promoting interoperability category, and the updated 2025 SAFER guide that practices need to be using.
3:40 – 5:58 | What practices can still do right now Black's top recommendations for mid-year course correction: build a MIPS team, run reports at least quarterly, and know your key deadlines — including the September 30 registry mapping deadline and the March 31 MIPS attestation window for 2025.
5:58 – 8:36 | MIPS value pathways: what they mean for specialists Black explains how MVPs work in 2026, why practices can opt in now and let CMS take the higher of the two scores, and what the shift to four quality measures instead of six means for specialty practices. She flags where sub-specialties may run into trouble finding applicable measures.
8:36 – 10:14 | Lessons from ophthalmology Drawing on Sightview's eye care client base, Black reports that practices opting into MVPs are scoring roughly the same as traditional MIPS — and says the takeaway for all specialties is to start looking at MVPs now and focus on measures specific to your patient demographics.
10:14 – 11:02 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
11:02 – 14:08 | Compliance mistakes that are still costing practices Black walks through the most common and avoidable errors: missed registry mapping deadlines, EHR switching mid-year without updating the registry, failing to validate data throughout the year, and leaving all MIPS responsibility on the practice administrator.
14:08 – 15:44 | How EHR documentation affects your MIPS score Since CMS eliminated manual data submissions last year, EHR use is now essential for meaningful MIPS reporting. Black explains why structured fields, automated workflows and patient portal engagement all feed directly into performance scores.
15:44 – 17:07 | Protecting Medicare revenue without adding administrative burden Black's practical advice for small and mid-size practices: use the EHR to its full capability, understand your category weights, and double-check registry data rather than assuming it's pulling correctly. Quality and cost categories each carry 30% of the total score.
17:07 – 19:00 | MIPS priorities for time-strapped practices For practices with only a few hours a month to dedicate to MIPS, Black says focus on tracking the right measures and reviewing workflows with the team — drawing on her own experience spending five hours a month as a MIPS coordinator at a medical practice.
19:00 – 20:38 | Final advice and outro Black closes with a reminder to check qpp.cms.gov regularly and never assume last year's approach still applies — especially for improvement activities, where documentation requirements can shift quietly from year to year. Littrell thanks listeners and wraps the episode.
Texas has long carried the highest uninsured rate in the country — but research by Texas 2036 found the reasons why are more complicated than most people assume. In this episode, Charles Miller, J.D., director of health and economic mobility policy for Texas 2036, unpacks what the organization learned when it went directly to uninsured Texans to ask why they hadn't enrolled in coverage many of them could get for free.
He also explains how a bipartisan Texas law called premium alignment has quietly made ACA bronze and gold plans more affordable, what physicians need to understand about how plan metal levels actually affect patient cost-sharing, and why market consolidation — driven by both large hospital systems and insurers — is the central threat to independent practice.
Miller closes with a direct message to independent physicians: if you want that model to survive, you need to make your voice heard on market reform, because the current rules of the game are working against you.
Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EDT: https://registration.physicianspractice.com
Music Credits:
Ocean Calm by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:31 | Cold open** Miller warns that without serious market reform, independent physicians are going to be squeezed out — and says the current rules of the game are what's driving that outcome.
0:31 – 1:59 | Introduction Austin Littrell introduces the episode, plugs the Practice Academy Practice Management track on March 19, and previews the conversation with Miller.
1:59 – 3:24 | Meet Charles Miller and Texas 2036 Payerchin introduces Miller, who explains the organization's two-track focus: expanding health insurance coverage and making the underlying prices of health care more affordable ahead of Texas's 2036 bicentennial.
3:24 – 4:24 | Why Texas made health care a priority Texas has long held the highest uninsured rate in the country — and Miller explains how that designation pushed the organization to look beyond coverage alone and into the broader affordability of the system.
4:24 – 9:01 | Who are the uninsured in Texas? Miller walks through a Texas 2036 research project that went directly to uninsured Texans to ask why they hadn't enrolled. The findings: many didn't know options existed outside employer coverage, and most wildly overestimated what plans would cost — with some eligible for free plans assuming they'd pay $300–$500 a month.
9:01 – 10:00 | Bringing it back to physicians Payerchin pivots to the physician audience, asking whether doctors were involved in shaping the policies that followed — and what the response has been from Texas's medical community.
10:00 – 12:52 | ACA metal levels and what they mean for your practice Miller explains how bronze, silver and gold plan tiers work in practice, why silver plans carry cost-sharing reductions for lower-income patients, and why there's no single filter physicians can use to predict patient cost share based on plan type alone.
12:52 – 14:28 | Premium alignment: the policy making plans more affordable Miller describes the Texas premium alignment policy — a bipartisan 2021 law that enforces the ACA's single risk pool requirement more stringently, effectively drawing in more federal subsidies for bronze and gold plans. Illinois and New Mexico are among the states watching closely.
14:28 – 15:59 | Health care access for undocumented residents Miller separates the question of health care access from government-subsidized coverage, noting that while there is no legal barrier to anyone seeking care, Texas does not extend Medicaid or ACA subsidies to those without legal status.
15:59 – 21:42 | Price transparency: what Texas has done and what's still missing Miller traces Texas's price transparency efforts from 2021 through the most recent legislative session, covering machine-readable files for hospitals and insurers, consumer self-service tools, itemized billing requirements and a new enforceable cost estimate provision for patients shopping for procedures.
21:42 – 22:37 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
22:37 – 29:12 | Market consolidation and the squeeze on independent practice Miller addresses hospital market concentration, vertical integration and the anti-competitive contracting practices — including anti-steering clauses, most-favored-nation clauses and gag clauses — that are limiting physician independence and patient choice. He outlines Texas House Bill 711 and ongoing efforts to preserve competitive markets.
29:12 – 31:01 | What this means for independent physicians Miller and Payerchin discuss the convergence of forces — large health systems and large insurers both exerting pressure — that is making independent practice increasingly difficult to sustain, and why the physician-patient relationship is at the center of the fight.
31:01 – 32:18 | A message to primary care physicians Miller closes with a direct call to action: if independent practice matters to you, get active, make your voice heard, and make sure the groups claiming to represent you actually are.
32:18 – 33:15 | Outro Littrell thanks listeners, plugs the March 19 Practice Academy event, and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.
A new Wolters Kluwer survey of physician assistants found that 96% feel confident walking into patient interactions on day one, but 87% say they still need more training on artificial intelligence (AI).
Kelly Villella, segment leader and director of product management at Wolters Kluwer Health, unpacks what those numbers mean for the practice managers responsible for hiring and onboarding PAs.
She explains why documentation keeps emerging as a friction point, what practices should be doing right now to get ahead of shadow AI risks and why a clear written policy on acceptable AI use isn't optional anymore.
Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EDT: https://registration.physicianspractice.com
Music Credits:
Coffee Shop Sketches by Buurd - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:35 | Cold open Villella previews the episode's central tension: physician assistants are one of the fastest-growing health care professions, and AI is transforming both at the same time.
0:35 – 1:54 | Introduction Austin Littrell introduces the episode, plugs the Practice Academy Practice Management track on March 19, and previews the conversation with Villella.
1:54 – 2:46 | Meet Kelly Villella Reynolds introduces Villella, who shares her background: nearly 27 years in higher education technology, overseeing digital products and textbooks for students training to become PAs, physicians, pharmacists and other clinicians at Wolters Kluwer Health.
2:46 – 4:17 | What the survey found Villella walks through the top-line results: 96% of PAs feel confident in patient interaction, but 87% say they need more AI training — and 20% feel underprepared on documentation.
4:17 – 5:43 | What's changed most for PAs The two biggest day-to-day changes PAs cited: dealing with insurance companies and navigating the rise of AI tools, particularly around documentation.
5:43 – 7:40 | Where new PAs feel strong — and where they need support PAs walk in confident on patient care but often struggle with documentation and unfamiliar systems. Villella says practice managers need clear onboarding policies and pre-approved tools ready from day one.
7:40 – 9:01 | Building the ideal onboarding plan Villella outlines her onboarding must-haves, including written policies on acceptable AI use and a frank conversation about shadow AI — the unapproved tools clinicians may already be using in their personal lives.
9:01 – 10:28 | The root cause of workflow friction Villella describes the core tension: PAs enter the field to focus on patients, but documentation pulls them away from that mission. She frames AI-assisted documentation as the most promising area to reduce that friction.
10:28 – 12:53 | Balancing productivity, quality and AI in onboarding Practice leaders need to identify trusted AI-integrated tools already in their workflow, train staff to use them — and be explicit that AI is an aid, not a replacement. Checks and balances matter.
12:53 – 14:21 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
14:21 – 16:06 | AI as a feature, not a solution Villella makes the case that AI shouldn't be thought of as a standalone tool but as a feature built into the trusted, evidence-based solutions practices are already using — pointing to radiology's second-read model as an example.
16:06 – 17:21 | One thing practice managers can do next week Villella's concrete takeaway: sit down as a team, document your current AI policy and communicate it clearly. Don't assume every incoming clinician has the same understanding of what's acceptable.
17:21 – 18:30 | A message for PA educators Villella closes with a note for PA programs: the mindset around AI use needs to start in the classroom, so that by the time new clinicians arrive at a practice, the groundwork is already laid.
18:30 – 19:45 | Outro Littrell thanks listeners, plugs the March 19 Practice Academy event, and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.
Osteopathic medicine has grown from a single school in the 1890s to 73 campuses across 36 states, now accounting for nearly 30% of all U.S. medical students.
In this episode, Robert Cain, D.O., FACOI, FAODME, president and CEO of the American Association of Colleges of Osteopathic Medicine (AACOM), walks through the association's inaugural workforce and economic impact report, which found that roughly half of D.O. graduates go into primary care — more than twice the rate of their M.D. counterparts.
He also discusses how placing a college of osteopathic medicine in an underserved community can transform its local economy, why the profession's prevention-focused philosophy aligns naturally with the national conversation around healthy living, and how D.O. colleges are approaching artificial intelligence (AI) integration in ways designed to keep the patient at the center of care.
Finally, Cain makes the case for why primary care physicians deserve better pay, better working conditions and stronger policy support.
Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EDT: https://registration.physicianspractice.com
Music Credits:
Saved by You by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:30 | Cold open Robert Cain, D.O. previews the episode's central argument: that osteopathic medicine is at a tipping point in its contribution to the U.S. health care system.
0:30 – 1:47 | Introduction Austin Littrell introduces the episode, plugs the Practice Academy Practice Management track on March 19, and previews the conversation with Cain.
1:47 – 3:27 | Growth by the numbers Payerchin and Cain open with the facts: from a single school in the 1890s to 73 campuses across 36 states, with nearly 30% of all U.S. medical students now earning the D.O. degree.
3:27 – 4:25 | The state of osteopathic medicine today Cain describes the profession as being at a genuine tipping point — with visibility, applications and influence all on the rise.
4:25 – 6:35 | What drew Robert Cain to osteopathic medicine — and what's drawing students today Cain traces his path from working as an EMT in western Pennsylvania to choosing osteopathic medicine for its philosophy and manual medicine approach. He describes today's students as drawn to its health-first, patient-centered identity.
6:35 – 7:53 | A self-propagating profession Discussion of how geographic expansion and growing visibility are creating a cycle: more schools attract more students, which leads to more physicians and even more visibility.
7:53 – 9:47 | The origins of the workforce and economic impact report Cain explains the thought experiment that sparked the report: if osteopathic medicine disappeared overnight, what would be missing — and who would care?
9:47 – 12:46 | Key findings: primary care, high-need specialties and rural placement Roughly 50% of D.O. graduates enter primary care — more than twice the rate of M.D. graduates. About 25% go into high-need specialties. More than half of colleges are in medically underserved areas, and rural placement numbers are strong.
12:46 – 15:03 | Why D.O.s go into primary care — and whether that will continue Cain traces the primary care pipeline to the profession's foundational principles, its community-based training model and its deliberate selection of students with a generalist mindset.
15:03 – 17:40 | Specialty care vs. the big picture Cain reflects on his own career as a pulmonologist — and how an osteopathic education shaped his ability to treat the whole patient, not just the lungs.
17:40 – 18:34 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
18:34 – 22:16 | Economic impact: jobs, communities and the Pikeville story Cain describes how opening a college of osteopathic medicine in a community generates jobs and economic activity — using Pikeville, Ky., as a vivid example of a rural coal town transformed.
22:16 – 25:22 | Policy priorities: the Community Teams Act and primary care reimbursement Cain calls for more funding for community-based teaching sites through the Community Teams Act, and advocates for leveling the compensation playing field for primary care physicians.
25:22 – 27:13 | Osteopathic medicine and the healthy living movement Cain explains why conversations around nutrition, sleep and exercise align naturally with osteopathic principles — and what the profession wants from those policy discussions.
27:13 – 29:43 | AI in osteopathic medical education Cain discusses how D.O. colleges are approaching AI integration — with a focus on using tools like ambient scribing to restore face-to-face patient interaction, not replace it.
29:43 – 30:33 | A message to primary care physicians Cain closes with a direct message to primary care physicians: osteopathic medicine sees them as partners and shares their commitment to improving the health care system.
30:33 – 31:40 | Outro Littrell thanks listeners, plugs the March 19 Practice Academy event, and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.
Workplace violence in health care settings isn't just a safety issue — it's a financial and operational one.
In this episode, Andrea Greco, SVP of healthcare safety at CENTEGIX, breaks down key findings from the company's 2026 Healthcare Trends Report, including why duress alerts now spike nearly 300% during morning hours, why hallways and exam rooms remain the most dangerous spaces in a practice, and what a realistic ROI looks like when evaluating safety technology. She also addresses staff resistance to real-time location tracking, how to build an effective internal response protocol, and the federal and state legislation that could soon raise the accountability stakes for practice leaders.
Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EDT: https://registration.physicianspractice.com
Music Credits:
Her Name by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 0:37 | Cold open** Andrea Greco previews the episode's core argument: that the cost of inaction on workplace violence is starting to outweigh the cost of hoping things improve.
0:37 – 1:58 | Introduction Austin Littrell introduces the episode, plugs the Practice Academy Practice Management track on March 19, and previews the conversation with Greco.
1:58 – 2:37 | Setting the stage Littrell introduces Greco.
2:37 – 3:45 | Violence as a business risk Greco explains why practice leaders need to see workplace violence as a financial and operational issue — not just a security one — and why a comprehensive, executable safety strategy beats siloed solutions.
3:45 – 4:33 | Shifting alert patterns across the week Greco reacts to a key finding: duress alerts, which previously spiked on certain days, have leveled out across all seven days — reinforcing that risk is present every day.
4:33 – 5:35 | The morning spike Discussion of the nearly 300% surge in duress alerts between 8:30 a.m. and 12:15 p.m., and the clinical workflows — morning rounds, discharge planning, shift changes — that drive it.
5:35 – 7:27 | Structuring an internal response Greco outlines what effective response looks like: immediate, discrete notification delivered to the right responders, customized to each organization's available resources.
7:27 – 8:34 | Where and how incidents escalate Greco describes where altercations most commonly occur — hallways and away from patient rooms — and notes a rise in staff-on-staff tensions since COVID-19.
8:34 – 9:25 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.
9:25 – 10:25 | Protecting high-risk areas Greco addresses whether practices can redesign vulnerable spaces, arguing that precise location data during an alert is often more practical than physical redesign.
10:25 – 12:00 | Privacy concerns and wearable adoption Greco discusses staff resistance to real-time location tracking, and how CENTEGIX's approach — only activating location when an alert is triggered — addresses those concerns and improves adoption.
12:00 – 14:43 | Building the ROI case Greco walks through CENTEGIX's new ROI calculator, covering incident costs, backup staffing, workers' compensation, nurse replacement costs (over $60,000 per nurse), and potential insurance savings.
14:43 – 17:22 | Three themes for 2026 Greco closes with three priorities for safety planning: a workforce-centric approach, a demand for measurable ROI, and greater accountability — including the federal SAVE Act and Illinois SB 1435.
17:22 – 17:41 | Closing remarks Littrell thanks Greco and wraps the interview.
17:41 – 19:00 | Outro Littrell thanks listeners, plugs the March 19 Practice Academy event, and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.
It's no secret that health care has a staffing problem. But are patients really resorting to artificial intelligence (AI) chatbots when they can't get in to see a physician?
Medical Economics Associate Editor Austin Littrell sat down with Rosemarie Aznavorian, D.N.P., RN, CENP, CCWP, CCRN, senior vice president of client services and chief clinical officer at MedPro Healthcare Staffing, to talk about the growing gap between patient demand and available clinical staff.
Aznavorian explains how lower nursing school enrollment, pandemic-driven retirements and rising patient acuity are stretching hospitals and outpatient settings thin. She outlines the downstream effects: longer emergency department waits, delayed surgeries, missed care and increased risk of medical errors.
And, on the emerging trend of patients turning to GenAI tools like ChatGPT Health to self-diagnose when they cannot access care, Aznavorian discusses the risks of misdiagnosis, over-the-counter self-treatment and delayed preventive care, while emphasizing the need for clinicians to approach these conversations without judgment.
Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EDT: https://registration.physicianspractice.com
Music Credits:
Retro Disco Lounge Groove by MotifLab Music - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Cold open**
Why clinicians should be concerned — and not judgmental — about patients using AI tools.
0:17 — Intro and Practice Academy note
1:42 — Meet Rosemarie Aznavorian
MedPro’s staffing model and international workforce strategy.
2:42 — How staffing shortages affect patient access
Lower enrollment, retirements and rising acuity.
4:53 — Are patients turning to ChatGPT Health?
AI self-diagnosis and its risks.
6:21 — Where this is happening most
Rural areas, hospital deserts and overwhelmed emergency departments.
7:26 — Is any specialty driving patients toward AI?
8:34 — Should clinicians be worried?
Balancing awareness with non-judgmental communication.
10:21 — 5% of ChatGPT messages are health care-related
Unmet needs, curiosity or frustration?
11:45 — Risks to practices
Misdiagnosis and over-the-counter self-treatment.
12:36 — Is staffing the answer?
How acuity changes nurse needs.
13:57 — The 80/10/10 staffing model explained
16:58 — Closing thoughts
17:15 — Outro
Payment processing has become more complex for medical practices — and more vulnerable to fraud.
Medical Economics Managing Editor Todd Shryock sat down with Stephanie O’Connor, director of merchant experience at Wind River Payments, to talk about the evolving risks tied to digital payment platforms in health care
O’Connor explains how practices can unintentionally expose themselves to card testing attacks, friendly fraud and costly chargebacks when they rush to adopt trending payment tools without proper safeguards. She breaks down common red flags front office staff should recognize, why refund scams are targeting health care and how artificial intelligence (AI) is now playing a critical role in fraud detection behind the scenes.
Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EDT: https://registration.physicianspractice.com
Music Credits:
Chasing the Moonlight by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Cold open**
Why practices shouldn’t have to compromise patient experience to prevent fraud.
0:18 — Intro and Practice Academy note
1:42 — Introducing Stephanie O’Connor
Payment modernization and revenue protection.
2:17 — Why practices need a payment strategy
Balancing cost control and fraud prevention.
3:21 — The biggest mistake practices make
Turning on new payment options without safeguards.
4:46 — Card testing attacks explained
How fraudsters use your website to validate stolen cards.
6:57 — Friendly fraud and chargebacks
When confusion turns into revenue loss.
7:55 — Who should practices call first?
Coordinating IT and payment processors.
8:18 — Patient portals and fraud risk
How AI works behind the scenes to protect transactions.
10:39 — Healthcare-specific chargebacks
Services not rendered and telemedicine disputes.
13:01 — P2 Management Minute
14:09 — Red flags for front office staff
Multiple declines, refund requests and rushed payments.
16:10 — Where fraud originates
Foreign BIN numbers and local “friendly” disputes.
17:16 — Are small practices more vulnerable?
Why size matters in fraud exposure.
18:06 — Can you protect revenue without hurting experience?
Why modern AI tools change the equation.
19:41 — Questions to ask your payment processor
What type of fraud are you actually protected against?
21:26 — Trends heading into 2026
Fraud stability, AI growth and proactive planning.
23:30 — Outro
In this episode, Keith Reynolds, managing editor of Physicians Practice, speaks with Katie Russell, J.D., partner at Brown Immigration Law in Cleveland, Ohio, about what recent shifts in immigration enforcement really mean for medical practices.
Russell explains why enforcement has moved toward employer-focused compliance audits, particularly I-9 documentation and visa adherence. She outlines what practices often misunderstand about their obligations, how to distinguish between judicial and administrative warrants and what staff should do if federal officers arrive unexpectedly.
Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EDT: https://registration.physicianspractice.com
Music Credits:
CALM CHILL RELAXED SMOOTH JAZZ (OWE YOU) by Tasty Tunes - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Cold open**
Healthcare is not insulated from employer compliance standards.
0:27 — Intro and Practice Academy note
1:56 — Reconnecting since October
What’s changed in immigration enforcement?
2:39 — The biggest shift in ICE enforcement
From dramatic raids to employer compliance audits.
3:33 — I-9 documentation and why it matters
Common gaps practices overlook.
6:11 — Is this really new?
Why compliance scrutiny has always been there.
9:17 — What practices misunderstand
Healthcare is subject to the same employer standards as any industry.
11:18 — Judicial vs. administrative warrants
What staff should know before granting access.
13:42 — What to do if officers show up
Verify, document and call counsel.
16:47 — P2 Management Minute
17:57 — First compliance step this quarter
Audit your I-9 process and training.
20:48 — Is this just paperwork?
The purpose behind employer verification.
22:34 — The new $100,000 H-1B visa fee explained
Who it affects and who pays.
28:31 — Employer responsibility for visa costs
30:12 — Alternatives to H-1B visas
Exploring other pathways.
32:30 — The most practical step for overwhelmed leaders
Preparation, perspective and reducing panic.
35:27 — Final thoughts
Why most compliant practices have little to worry about.
Rising patient acuity. Aging demographics. Tight margins. Artificial intelligence (AI) moving from buzzword to workflow tool.
Medical Economics sat down with Shannon Sims, M.D., Ph.D., FAMIA, chief product officer at Vizient, and Matthew Bates, M.P.H., managing director at Kaufman Hall, to talk about Vizient's 2026 State of the Industry Report and what it calls a "reset" moment for U.S. health care.
Sims and Bates explain how AI is already reducing documentation burdens through ambient listening and revenue cycle automation, why access has overtaken staffing as the defining operational challenge and how advanced practice providers (APPs) are reshaping team-based care as physician shortages persist.
Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EDT: https://registration.physicianspractice.com
Music Credits:
Cherry Blossom Memories by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Cold open**
Can AI help return the joy to medicine — and improve the economics of practice?
0:34 — Intro and Practice Academy note
2:01 — Introducing Vizient and Kaufman Hall
2:12 — What does a “reset” in 2026 really mean?
AI moving from hype to workflow, and the growing role of advanced practice providers.
3:59 — How AI is changing day-to-day physician work
Ambient listening, documentation and automation.
4:46 — Patients are sicker — but outcomes are improving
Quality gains despite rising case mix.
7:03 — The aging population and care coordination challenges
Who becomes the “quarterback” for complex patients?
8:50 — Rising costs per employed provider
Why physicians are working harder but margins remain thin.
10:36 — APPs now make up 40% of employed providers
What effective team models look like — and where they can go wrong.
13:01 — P2 Management Minute
13:52 — Labor, drug and supply cost pressures
What smaller practices can realistically do.
15:01 — Fewer big hospital mergers, more targeted partnerships
Governance, ownership and alignment risks.
16:28 — AI beyond the hype
Revenue cycle, clinical decision support and the need for a human in the loop.
18:27 — What should small practices be watching right now?
Access, patient experience and payer mix realities.
20:15 — One practical takeaway for physicians in 2026
Embrace digital tools and fix access bottlenecks.
22:00 — Final reflection
Can AI restore professional satisfaction and extend careers?
23:00 — Outro
Medicare often pays dramatically different rates for the exact same service depending on where it’s delivered. That difference has helped fuel hospital acquisition of physician practices and reshaped the structure of U.S. health care.
Medical Economics Senior Editor Richard Payerchin sat down with Christopher Whaley, Ph.D., associate professor in the Department of Health Services, Policy and Practice at the Brown University School of Public Health, to learn more.
Whaley breaks down site-neutral payment policy, why Medicare’s 2026 rule takes what he calls a "meaningful step forward" and whether reform could help level the playing field for independent physicians.
Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EDT: https://registration.physicianspractice.com
Music Credits:
Empty Spaces by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Cold open**
Is the genie out of the bottle for independent practice?
0:20 — Intro
1:46 — What the 2026 OPPS and ASC rule gets right
Why CMS is taking incremental but meaningful steps toward site-neutral payment.
2:03 — Why Medicare pays more for the same service in hospital settings
How site-of-care differentials incentivized consolidation.
4:46 — The inpatient-only list explained
How advances in surgical safety changed where procedures can be performed.
6:18 — Is 2026 a breakthrough year for site neutrality?
Whether CMS is signaling broader reform.
7:00 — Too little, too late for independent practice?
Can payment reform meaningfully reverse consolidation trends?
8:41 — Off-campus hospital outpatient departments
How billing classifications affect Medicare spending.
9:43 — Do hospitals deserve higher reimbursement?
Arguments for and against differential payment rates.
11:09 — P2 Management Minute
12:01 — Rural hospitals and payment fairness
Balancing access concerns with cost control.
15:12 — When “rural” isn’t rural
How geographic classifications can distort payment policy.
16:27 — If you could change one thing in U.S. healthcare
Whaley’s view on the most impactful reform lever.
17:03 — Reaction to the administration’s broader health policy agenda
Where site-neutral payment fits into the larger strategy.
18:05 — Why price transparency hasn’t worked as intended
Behavioral economics and the limits of consumer-driven reform.
19:28 — Could transparency help independent practices compete?
Where leveling the payment field intersects with pricing visibility.
20:40 — What happens next with site-neutral payment policy
Political feasibility and stakeholder resistance.
22:04 — Who stands to gain — and who loses — under site neutrality
Hospitals, physicians and Medicare beneficiaries.
23:17 — What primary care physicians should be watching now
Practical implications for referral patterns and reimbursement.
24:20 — Outro
The health care system is changing quickly, and the legal and regulatory systems that govern it are struggling to keep up.
Medical Economics Associate Editor Austin Littrell sat down with Richard Anderson, M.D., CEO of The Doctors Company and TDC Group, to talk about the organization’s annual predictions report, Healthcare on the Horizon: Predictions for U.S. Healthcare Through 2026.Anderson explains why artificial intelligence may soon become part of the standard of care — and why clinician trust, legal precedent and liability exposure will determine how quickly that happens. He outlines the paradox physicians face when deciding whether to follow AI recommendations, the growing impact of nuclear verdicts and social inflation in malpractice litigation and the widening access gaps as rural hospitals close and reimbursement pressures mount.
Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EDT: https://registration.physicianspractice.com
Music Credits:
Cloud Garden by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Cold open
A system being revolutionized and torn apart at the same time.
0:20 — Intro
Austin Littrell introduces the episode and Dr. Anderson.
1:39 — The most underappreciated risk in 2026
Rapid change, consolidation and burnout.
6:04 — AI integration and clinician trust
Why liability concerns may slow adoption.
12:06 — How physicians should use AI today
Ambient listening, EHR burden and practical realities.
14:46 — The $1 trillion digital migration
Unexpected legal and clinical risks.
17:46 — P2 Management Minute
18:38 — Measuring digital progress
Why courts lag behind technological change.
20:26 — Nuclear verdicts explained
Why awards over $50 million are reshaping expectations.
25:56 — Hospital closures and access gaps
Rural care under pressure.
27:57 — Tort reform priorities
Why caps on non-economic damages matter.
31:52 — Agentic AI and responsibility
Who gets sued when machines act independently?
36:12 — Outro
Artificial intelligence (AI) is moving closer to patients, often before they ever step into the exam room. Tools like ChatGPT Health and other health-focused AI platforms are shaping how patients interpret test results, prepare questions and form expectations about care.
Medical Economics Associate Editor Austin Littrell sat down with Amber Maraccini, Ph.D., M.A., vice president and head of health care and life sciences at Medallia, to talk about what that shift means for physicians.
Maraccini explains how AI tools differ from earlier “Dr. Google” searches, why natural-language explanations can lower anxiety before a visit and where the real risks emerge when technology is poorly designed or over-trusted. She also shares practical guidance for clinicians navigating visits where patients arrive with AI-generated conclusions, including how to keep conversations productive, preserve trust and re-center care on clinical context.
Music Credits:
Steady State of Mind by Yigit Atilla - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Cold open**
Why the future isn’t AI versus clinicians.
0:31 — Intro
Austin Littrell introduces the episode and the Practice Academy note.
1:54 — Interview begins
Amber Maraccini introduces her role and Medallia’s focus on trust and experience.
3:12 — What’s different about ChatGPT Health
Why these tools go beyond symptom checkers.
3:28 — AI as a narrator of health data
Natural language, interpretation and emotional impact.
5:13 — Preparing patients before a visit
How AI can reduce anxiety around test results.
7:50 — Moving beyond “Dr. Google”
Shifting from worst-case scenarios to meaningful questions.
8:22 — When patients arrive with AI conclusions
How physicians can keep visits productive.
10:14 — AI mistakes and safety concerns
Why errors are inevitable — and how to address them.
10:39 — Teaching patients how to use AI
Leaning in rather than avoiding the conversation.
11:54 — Red flags for displaced relationships
When AI feels easier than talking to a doctor.
13:36 — P2 Management Minute
Keith Reynolds shares practical guidance for practices.
14:27 — Where AI fits in the patient journey
Before visits, after visits and education moments.
16:09 — What success should look like
More prepared patients, not longer visits.
17:37 — Final reflections
Using AI to support trust, presence and human connection.
18:55 — Outro
Wrap-up, subscription reminder and Practice Academy note.
Government funding deadlines, expiring coverage subsidies and temporary policy fixes are creating real-world disruptions for physician practices — often with little warning.
Keith Reynolds, managing editor of Physicians Practice, sat down with Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association (MGMA), to talk about how recent federal policy decisions are landing inside medical groups.
Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EDT: https://registration.physicianspractice.com
Music Credits:
Retro Rhythm by BJBeats - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Cold open**
Why 2026 is shaping up to be another unpredictable year for health care policy.
0:22 — Intro
Austin Littrell introduces the episode, the Practice Academy note and the conversation with Anders Gilberg.
1:41 — Interview begins
Keith Reynolds welcomes Gilberg and sets the policy context.
1:44 — What breaks first during funding delays
How last-minute government decisions disrupt medical groups.
2:15 — Telehealth disruptions after shutdowns
What expired flexibilities meant for care continuity.
4:07 — Are repeated telehealth extensions real progress?
Why short-term fixes keep practices in limbo.
4:21 — A longer telehealth extension on the table
Why a 2027 extension would be a meaningful shift.
5:39 — If telehealth rules were permanent
What flexibilities matter most for patients and practices.
7:29 — The 1.0 work GPCI floor explained
Why rural physician payment protections matter.
7:46 — What happens if the floor expires
Billing chaos and reduced reimbursement in rural areas.
10:09 — PAMA lab payment cuts
What scheduled reductions would mean for in-office labs.
12:30 — The RESULTS Act
Why MGMA supports broader reform beyond delaying cuts.
12:44 — Value-based care math
Are practices backing away from Advanced APMs?
12:59 — Why incentives matter
How APM bonuses help practices transition from fee-for-service.
15:06 — P2 Management Minute
Keith Reynolds shares practical guidance for practice leaders.
15:58 — Expiring ACA subsidies
Early signs of coverage loss and financial strain.
16:20 — What practices are seeing so far
Payment plans, uncompensated care and patient access concerns.
19:13 — Direct primary care and concierge models
What policy signals may — and may not — mean.
21:27 — MGMA’s 2026 advocacy agenda
What the organization is watching closely.
21:39 — Cybersecurity and unfunded mandates
Concerns about new regulatory costs for practices.
22:55 — Final thoughts
Why policy volatility isn’t slowing down.
23:15 — Outro
Wrap-up, subscription reminder and Practice Academy note.
When patients talk about what they want from a visit with their physician, the answer is often simpler than the system makes it feel: they want to feel understood.
Melissa Lucarelli, M.D., FAAFP, a family physician, owner of Randolph Community Clinic and longtime editorial advisor for Medical Economics speaks with Ronald Epstein, M.D., FAAHPM, professor of family medicine and palliative care at the University of Rochester and author of "Attending: Medicine, Mindfulness and Humanity."
Their conversation explores how mindfulness shows up in everyday clinical practice — not as meditation or another box to check, but as attention, curiosity, presence and communication in the exam room. Epstein reflects on burnout, the limits of productivity-driven care and why small moments of awareness can improve patient relationships, teamwork and professional satisfaction.
They also discuss mindfulness beyond the individual clinician, including its role in teams, leadership and organizational culture, as well as where tools like artificial intelligence (AI) may support — but never replace — human connection in medicine.
Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EDT: https://registration.physicianspractice.com
Music Credits:
Crystal Grind by NISO - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Cold open**
What patients say they want most from a doctor visit.
0:23 — Intro
Austin Littrell introduces the episode and the Practice Academy note.
1:03 — Interview begins
Melissa Lucarelli introduces Ronald Epstein and frames the conversation.
1:53 — Burnout and dissatisfaction
Why physicians and patients are both struggling with the system.
2:30 — The four foundations of mindfulness
Attention, curiosity, beginner’s mind and presence.
3:45 — Relationships before prescriptions
Why feeling understood matters as much as treatment.
4:25 — Curiosity in long-term care
Staying engaged with patients over years and decades.
5:20 — Beginner’s mind and the clinical gaze
How expertise can both help and limit perception.
6:25 — Defining presence
A story from the emergency department.
7:58 — Learning from missed details
What early experiences taught Epstein about attention.
10:56 — Seeing the disease, missing the person
A lesson from inpatient rounds.
11:54 — A turning point with electronic health records
What a patient taught Epstein about listening.
13:07 — A simple practice that changed visits
Why delaying the computer improved care.
14:41 — Mindfulness and malpractice risk
Why insurers care about communication.
15:55 — “I don’t have time for mindfulness”
Small practices that take seconds, not hours.
17:54 — Finding beauty during COVID-19
Staying present in bleak moments.
19:24 — Mindfulness in teams
Shared purpose in high-risk environments.
20:14 — Applying mindfulness in daily practice
Lucarelli reflects on what’s worked for her.
21:12 — Meditation and other paths
Mindfulness beyond sitting on a cushion.
22:30 — Emotional regulation in difficult encounters
Responding instead of reacting.
23:01 — Organizational mindfulness
Why teams and culture matter.
25:10 — Artificial intelligence and presence
Where AI helps — and where it doesn’t.
29:13 — Communication training with avatars
Using technology to improve listening and clarity.
31:02 — Can mindfulness fix a broken system?
The role of leadership and organizational change.
37:35 — Productivity and value-based care
Why throughput isn’t the same as health.
39:32 — Medical education and survival skills
What training still misses.
42:27 — If Epstein were rewriting the book today
Leadership, community and collective intelligence.
46:38 — Burnout as a long-standing reality
What’s systemic and what’s intrinsic to medicine.
47:34 — Final reflections
Why mindfulness belongs in education, culture and leadership.
48:08 — Outro
Wrap-up, subscription reminder and Practice Academy note.
In 2026, physicians are facing a familiar mix of pressure — reimbursement uncertainty, rising labor and supply costs, staffing shortages and growing exposure to legal and cyber risk.
Medical Economics Managing Editor Todd Shryock caught up with Peter Reilly, North American health care practice leader at HUB International, to talk about what those risks look like in practice, and which ones physicians can no longer afford to ignore.
Reilly explains why reimbursement instability is unlikely to ease in the near term, why rural hospitals and critical access facilities remain especially vulnerable, and how burnout and disengagement continue to affect retention. He also breaks down what’s happening in the medical professional liability market, including the rise of “nuclear” and “thermonuclear” jury verdicts and what that means for rates moving into 2026.
He shares practical guidance on planning, mitigation and why proactive steps matter more than ever in an increasingly unpredictable health care environment.
Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EST: https://registration.physicianspractice.com
Music Credits:
Neon Rainfall by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Cold open
Why health care hasn’t fully emerged from its post-COVID hangover.
0:21 — Intro
Austin Littrell introduces the episode and previews the conversation with Peter Reilly.
1:31 — Interview begins
Todd Shryock welcomes Reilly and frames the challenges facing physicians.
1:35 — Why pressures aren’t easing in 2026
Reimbursement uncertainty, labor shortages and lingering instability.
3:34 — Rural hospitals under strain
Why critical access facilities remain especially vulnerable.
5:29 — Burnout and disengagement
What practices can do now to support staff and improve retention.
7:39 — The medical professional liability market
Competition, consolidation and what it means for rates.
10:06 — Nuclear and thermonuclear verdicts
Why outsized jury awards are becoming more common — and costly.
13:06 — Cyber risk and vendor exposure
Common misconceptions about data ownership and responsibility.
16:29 — P2 Management Minute
Keith Reynolds shares practical tips for practice leaders.
17:21 — Enterprise risk management
Why even small practices need a formal risk mindset.
20:10 — Blind spots in physician practices
Risks practices don’t always see coming.
22:23 — Physical and location-based risk
Why storefront care and parking lots matter.
23:16 — Weather and disaster planning
Natural disasters as a growing operational risk.
25:33 — Closing thoughts
Why proactive planning beats constant reaction.
26:00 — Outro
Wrap-up, subscription reminder and Practice Academy note.
Rising minimum wages, fierce labor competition and persistent turnover are reshaping how physician practices operate — and higher pay alone isn’t solving the problem.
Rihan Javid, D.O., J.D., a psychiatrist and co-founder and president of Edge, a remote staffing organization, about how staffing pressures are landing inside medical practices in 2026.
Javid explains why small practices and rural hospitals are feeling the impact first, which roles are hardest to replace, and how frequent turnover quickly turns into operational and financial strain for physicians. He also shares practical guidance on retention, budgeting for the year ahead, and why flexibility — including remote staffing — is becoming essential as practices adapt to a changing labor market.
Music Credits:
Super Vibe Vlog by Elonix - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Cold open
Why increasing salaries alone isn’t enough to solve staffing challenges.
0:22 — Intro
Austin Littrell introduces the episode, the Practice Academy note, and previews the discussion with Rihan Javid.
1:34 — Interview begins
Austin welcomes Javid and kicks off the conversation.
1:40 — Minimum wage increases hit practices
How rising minimum wages are affecting physician practices and rural hospitals.
1:53 — Tight margins, big jumps
Why sudden wage increases can blow up practice budgets.
2:55 — Why higher pay isn’t stopping turnover
Competing with large health systems, universities and public-sector benefits.
4:13 — The hardest roles to replace
Why patient-facing staff and billing roles create the biggest bottlenecks.
5:30 — The salary arms race
How pay increases turn into a cycle that practices can’t win.
5:48 — Building a core workforce
Why long-term retention matters more than constant replacement.
7:15 — P2 Management Minute
Keith Reynolds shares a quick note for practice leaders.
8:05 — When turnover hits daily operations
How staffing shortages push more work onto physicians.
8:42 — Budgeting for 2026
Why flexibility matters more than precision.
9:38 — One piece of retention advice
Treat employees well, pay competitively and be clear about expectations.
10:07 — Responding when staff leave
Why practices need to look inward — and outward.
10:22 — Thinking beyond local hiring
How remote staffing is filling gaps practices can’t solve locally.
11:39 — Roles that can go remote
Deciding which positions need to be in-person and which don’t.
12:27 — Closing thoughts
Final takeaways on flexibility and planning.
12:36 — Outro
Wrap-up, subscription reminder and Practice Academy note.
Independent medical practices are facing more competition than ever — from hospital systems, urgent care chains, private equity–backed groups and other local practices just down the road.
Medical Economics Content Vice President Chris Mazzolini sat down with Carl White, president and founder of MarketVisory Group, to talk about what it actually takes for independent practices to stay visible, relevant and competitive.
White explains why simply providing good care is no longer enough, how practices should think about differentiation and where marketing efforts often miss the mark. They also explore the growing role of generative artificial intelligence (GenAI) in health care marketing, why fundamentals like search and consistency still matter most and how practices can avoid blending into the noise.
They discuss patient retention, operational friction points that quietly drive patients away and the small set of metrics practice leaders should watch to understand whether their strategy is working.
Music Credits:
Quiet Dawn by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Cold open**
Why independent practices are competing for a shrinking pool of patients.
0:19 — Intro
Austin Littrell introduces the episode and previews the conversation with Carl White on physician marketing.
1:36 — Interview begins
Chris Mazzolini welcomes Carl White and frames the marketing challenges facing independent practices in 2026.
1:49 — The competition problem
Why independent practices are fighting for attention against urgent care, hospital systems and retail clinics.
2:19 — A shrinking patient pool
How rising insurance costs are quietly reducing the number of insured patients.
3:20 — Standing out in a smaller market
Why practices must clearly show value as competition intensifies.
3:35 — Private-pay and concierge realities
Why not every private-pay idea meets real patient demand.
5:00 — “Good care isn’t enough” anymore
Why quality medicine is expected — not a differentiator.
5:26 — Why patients comparison shop
How patients choose between practices when clinical quality looks the same.
6:51 — When marketing gaps start to show
Why ignoring competition is no longer an option.
7:03 — Generative artificial intelligence enters marketing
How artificial intelligence is changing content and visibility.
8:48 — “Teach me” vs recommendations
Which artificial intelligence prompts practices can realistically compete for.
9:33 — Why search still matters most
How artificial intelligence tools pull from Google, reviews and local search.
10:13 — Artificial intelligence and content quality
Why sounding authentic still matters more than speed.
11:18 — Where artificial intelligence actually helps
Using artificial intelligence for internal operations like appeals and documentation.
12:09 — What actually moves the needle
Identifying what’s valuable and different for patients.
13:30 — Consistency beats volume
Why repeating a clear message matters more than chasing trends.
14:32 — Location still matters
Why practice placement can make or break growth.
15:43 — Thought leadership as marketing
How physicians can build credibility without becoming full-time creators.
18:06 — Setting goals for thought leadership
Why marketing must align with a clear objective.
19:04 — Retention vs acquisition
Keeping patients loyal without feeling “salesy.”
21:12 — Operational friction drives patients away
Scheduling, reminders and visit efficiency as marketing tools.
22:26 — Making the practice experience easier
Why convenience matters as much as care.
23:54 — Measuring success in 2026
Which metrics actually predict growth and stability.
25:00 — Reviews, satisfaction and staff retention
Why feedback and employee morale matter more than trends.
26:53 — A critical HIPAA reminder
Where marketing and compliance overlap — and why it matters.
27:48 — Final thoughts
Carl White’s closing advice for independent practices.
28:22 — Outro
Austin Littrell wraps up the episode.
Patients are making health decisions in a very different information environment — one shaped by social media, search engines, generative artificial intelligence (AI) and increasingly politicized medical claims.
Medical Economics Senior Editor Richard Payerchin sat down with Colleen Denny, M.D., FACOG, chief ethics officer for the American College of Obstetricians and Gynecologists (ACOG), to talk about where patients are hearing medical misinformation, how it's showing up in exam rooms and what physicians can do about it.
Denny explains why misinformation now extends far beyond vaccines, touching everything from contraception and pregnancy care to acetaminophen use during pregnancy and reproductive health more broadly. She discusses how patients weigh online claims alongside clinical advice, how conflicting federal messaging can complicate care and why physicians have a responsibility to clarify evidence even when the science is nuanced.
Music Credits:
Sky drifter by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Cold open**
Why it’s more complicated to be a patient today than it was before the internet.
0:13 — Intro
Austin Littrell introduces the episode and previews the discussion with Colleen Denny, M.D., FACOG, on medical misinformation.
1:12 — Interview begins
Richard Payerchin welcomes Denny and asks about trust in medicine and whether science is under attack.
1:35 — The information overload problem
How social media, search engines and generative AI have changed patient decision-making.
3:21 — Erosion of trust — and what hasn’t changed
Why patients still say they want information from physicians, even as other sources grow louder.
4:44 — “Dr. Google” in the exam room
Real examples of misinformation patients bring to OB-GYN visits.
5:00 — Contraception myths and clickbait headlines
From benign concerns to fears about permanent infertility.
5:46 — Depo-Provera and meningioma headlines
How partial data and sensational framing complicate patient counseling.
6:34 — Balancing risk and reality
Helping patients weigh rare risks against the real consequences of pregnancy.
8:05 — Misinformation beyond vaccines
How acetaminophen guidance during pregnancy became a flashpoint.
8:23 — Physicians’ responsibility to clarify evidence
Why doctors must speak up when high-profile claims conflict with training and data.
9:15 — ACOG’s stance on Tylenol during pregnancy
Explaining the disconnect between FDA messaging and clinical recommendations.
10:00 — ACOG resources for physicians and patients
How the college is pushing back on non-medical voices shaping care.
12:52 — Should physicians be on social media?
Why avoiding platforms like TikTok may be a mistake.
14:01 — Meeting patients where they are
Why misinformation is the competition — and how physicians can respond.
15:40 — Supporting physicians who speak online
Why practices may need to invest time and resources.
16:18 — A message for primary care physicians
Why reproductive health misinformation is increasingly landing in primary care.
17:24 — Partnering with OB-GYNs
Using collaboration and telemedicine to improve patient care.
19:25 — Vaccines in pregnancy
Why pregnancy changes the vaccine conversation.
19:52 — HPV vaccination reframed
Why it should be discussed as cancer prevention.
22:09 — Trust, burnout and persistence
Why physicians should remember patients still trust them — even when they say they don’t.
24:59 — Outro
Closing remarks and where to find more Off the Chart episodes.
Physicians spend years mastering medicine, but many leave training with little guidance on managing money, debt or long-term financial decisions.
Michael Jerkins, M.D., M.Ed., an internal medicine and pediatrics physician and co-founder of Panacea Financial, sits down with Medical Economics Senior Editor Richard Payerchin to break down what financial pressures look like at every stage of a physician’s career — from residency cash-flow strain and student loans to practice ownership and long-term stability.
They explore why so many physicians struggle with traditional banking models, what “financial independence” really means for physicians and how financial decisions can quietly limit control over time. Jerkins also discusses growing interest in independent practice, direct primary care (DPC) and concierge models, along with the importance of financial literacy early in a medical career.
Music Credits:
Healing breeze by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Cold open
Michael Jerkins, M.D., M.Ed., practicing internal medicine and pediatrics physician and co-founder of Panacea Financial, explains how physicians can earn enough to mask financial mistakes — while debt quietly takes control of their time and flexibility.
0:28 — Intro
Austin Littrell introduces the episode and previews Richard Payerchin’s conversation with Jerkins on physician debt, cash flow and long-term financial stability.
1:30 — Interview begins
Payerchin welcomes Jerkins to the podcast and opens the discussion.
1:35 — Physicians seeking control over their practices
Jerkins discusses growing interest among physicians in independence, the lack of business exposure in medical training and why many doctors don’t know where to start when considering ownership.
4:51 — Employment vs. independence for new physicians
Why most new residency and fellowship graduates still choose employed roles, even as entrepreneurial interest slowly increases.
6:28 — When physicians aren’t ready for financing
Jerkins explains common reasons loan applications fall short and how Panacea focuses on coaching and connection rather than simple rejection.
9:14 — Fixing financial literacy in medical education
Why meaningful financial and business training won’t improve without accreditation requirements—and how current systems waste effort reinventing the wheel.
11:51 — P2 Management Minute
Keith Reynolds delivers a one-minute segment inviting physicians to share real-world workflow and leadership lessons.
12:43 — Financial trends shaping the next decade
Jerkins outlines looming pressures including Medicaid cuts, rural hospital instability, private equity consolidation and maldistribution of care.
15:30 — Defining wealth for physicians
Why controlling time—not income or lifestyle upgrades—is the real measure of financial success.
18:38 — A message to primary care physicians
Jerkins reflects on the pressures facing primary care and urges physicians to seek leadership roles to influence systemic change.
20:02 — Closing remarks
Payerchin thanks Jerkins and wraps the interview.
20:31 — Outro**
Littrell closes the episode with subscription details and production credits.
Health systems and medical groups are fighting the same three-headed problem: money, access and staffing.
In this episode, American Medical Group Association (AMGA) President and CEO Jerry Penso, M.D., MBA, and Practicing Excellence founder Stephen Beeson, M.D., discuss their new partnership meant to strengthen physician development without pulling clinicians out of the exam room.
They explain why traditional half-day seminars have lost their edge, how context-driven micro-coaching powered by artificial intelligence (AI) fits into daily clinical workflows and how organizations should measure success — including turnover, burnout, engagement and patient experience.
Music Credits:
Groovy 90s Hip Hop Acid Jazz by Musinova - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Cold open**
Why growth and development are becoming central to retention.
0:33 — Intro
Austin Littrell sets up the partnership and what’s at stake for practices and health systems.
1:39 — The partnership, in plain terms
Keith Reynolds opens: what does the partnership entail?
1:56 — AMGA’s “top three” problems
Finances, access and workforce—and why workforce is the root issue.
3:32 — Why human development, why now
Beeson on creating cultures where people feel seen, supported and want to stay.
5:10 — Why AMGA chose Practicing Excellence
Members want solutions; AMGA vets partners through set criteria.
6:19 — The new “must-have” for retention
Clinicians increasingly choose organizations where they can grow and “ascend.”
7:21 — What feels different vs. traditional training
Why half-day seminars and PowerPoints don’t meet the moment.
8:34 — “Context is king”
Personalized, in-work learning that actually changes behavior.
11:12 — Beyond “see one, do one, teach one”
Why clinician development needs new tools in a faster-changing system.
12:10 — How AMGA members access it
Already used by 30 member organizations; AMGA facilitates and offers discounted rates.
13:20 — P2 Management Minute promo (mid-roll)
Keith Reynolds invites listener tips and submissions.
14:13 — What the coaching looks like in practice
Four domains: patient experience, team engagement, leadership effectiveness, clinical excellence/high reliability.
17:27 — Measuring success
Turnover, burnout, engagement surveys, outcomes tracking, use analytics and CME.
20:59 — Scorecards and culture
Why successful orgs define metrics and support clinicians with real tools.
22:53 — “One more tool” problem
Why it’s designed to fit into workflow in minutes/seconds at a time.
25:34 — Trust, guardrails and governance
AI governance expectations from member organizations.
26:36 — Security posture + no patient data claim
SOC 2 in progress; “no patient information” in the ecosystem.
27:38 — Final thoughts
“What got you here won’t get you there,” and a people-first closing.
29:52 — Outro
Wrap-up, subscribe CTA, production credits.
Pediatrician and author David Higgins, M.D., M.P.H., M.S., joins the show to unpack what’s really happening with vaccine confidence. Higgins explains why true anti-vaccine activists are a tiny minority, how media coverage can exaggerate hesitancy and why most parents still want vaccines for their children — even if they come in with questions. He also digs into the role of social media algorithms in amplifying misinformation and the policy risks of assuming “everyone” is skeptical of shots.
Higgins shares practical, exam room–tested communication strategies that busy clinicians can use right away, including how to open vaccine conversations with confidence, use motivational interviewing without adding time to visits and apply his “fact–warning–fact” approach to defuse persistent myths.
Music Credits:
Kind Winds by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Cold open**
An individual’s physician remains the most trusted source of vaccine information.
0:19 — Intro
Austin Littrell introduces Medical Economics Senior Editor Richard Payerchin and guest David Higgins, M.D., M.P.H., M.S., previewing their discussion on vaccine hesitancy, misinformation, and communication strategies for physicians.
1:11 — Interview begins
Payerchin welcomes Higgins and asks about the current state of trust in medicine and science.
1:25 — Trust in institutions and experts
Higgins discusses the erosion of trust in public institutions and how it affects confidence in medicine and vaccines.
2:37 — The risks of normalizing vaccine hesitancy
Higgins explains why overstating vaccine hesitancy can distort public health policy and harm provider confidence.
4:20 — Policy and perception
How misconceptions about vaccine refusal influence lawmakers, and why most parents still want vaccines for their children.
6:10 — The provider mindset
Why assuming every patient is hesitant changes physician behavior and weakens communication.
8:04 — Barriers to eradication and the importance of uptake
Higgins underscores that vaccines don’t save lives unless vaccination occurs—and the human factors that determine success.
13:13 — P2 Management Minute
Keith Reynolds shares a one-minute practice management segment on workflow and leadership insights.
14:02 — The Wakefield study and lasting damage
Higgins recounts how fraudulent MMR-autism claims sparked long-lasting fear and skepticism.
18:09 — How anti-vaccine activism spreads online
Higgins distinguishes true activists from confused sharers and explains how algorithms amplify fear-based content.
21:22 — Beyond facts: improving physician communication
Why information alone doesn’t change minds, and the key communication techniques every clinician should use.
25:33 — The “fact–warning–fact” method
Higgins breaks down his “truth sandwich” approach for addressing vaccine myths effectively.
27:05 — Final thoughts: trust in the physician’s voice
Higgins closes with why patients still look to their doctors as “lighthouses in the storm” of misinformation.
29:16 — Outro
Richard Payerchin wraps the conversation and Austin Littrell closes the episode with subscription and contact details.
Two hours. One studio. Zero confetti (almost).
In the 2025 Off the Chart Holiday Spectacular, Off the Chart hosts Keith Reynolds and Austin Littrell race to clean the studio before a holiday party — and along the way, revisit some of the most important conversations of the year.
Listeners hear from Anders Gilberg of MGMA on what 2026 health care policy could actually bring for physician payment, prior authorization and value-based care. Deepika Srivastava breaks down how artificial intelligence is reshaping malpractice risk and what physicians need to do now to protect themselves. David Tawes of the HHS Office of Inspector General offers a clear warning on skin substitutes and sketchy offers targeting primary care. The episode also revisits leadership lessons from Dave Gans, practical branding advice from Scott Bartnick, and a quick victory lap from the show’s 100th episode.
It’s part year-in-review, part behind-the-scenes chaos and fully grounded in the real issues physicians are heading into the new year with — teamwork, boundaries and absolutely no confetti.
Happy holidays from the crew at Off the Chart: A Business of Medicine Podcast!Music Credits:
Joyful Christmas Adventure by TheRatu - stock.adobe.com
Various Holiday Songs by Elizabeth Klucher Reynolds
Editor's note: Episode timestamps and transcript produced using AI tools.
0:00–3:49
Cold open chaos: last-minute studio cleanup, holiday banter and rules about boxes, soundboards and “fast, ugly cleaning.”
3:49–4:39
The temptation to turn cleanup into a clip show — and why this year actually matters.
4:39–8:21
MGMA policy outlook: Anders Gilberg on what health care policy could realistically look like in 2026, from physician payment reform to prior authorization and value-based care tensions.
8:21–10:45
Back to cleaning: aging, disco lights, mystery cables and why some boxes must never be opened.
10:45–12:24
Artificial intelligence and malpractice risk: Deepika Srivastava on informed consent, documentation, AI scribes and why physicians remain ultimately responsible.
12:24–15:07
Mops, closets, confetti debates and the hidden costs of sticky floors.
15:07–16:27
Compliance warning for primary care: HHS Office of Inspector General’s David Tawes on skin substitutes, red flags and when “too good to be true” really is.
16:27–17:08
Banner hanging, tape as the “EHR of the party world” and clinical perfectionism.
17:08–18:08
Milestone moment: a quick victory lap from the Off the Chart 100th episode lightning round.
18:08–19:08
Holiday music, near-confetti incidents and metaphors for practice management debt.
19:08–20:33
Leadership and retention: Dave Gans on why taking care of staff directly improves efficiency and practice performance.
20:33–21:06
Mic stand mishaps and festive elbows.
21:06–22:11
Physician personal branding: Scott Bartnick on reviews, local reputation and why doctors don’t need national brands to stand out.
22:11–23:36
Final checks: chairs set, snacks staged, disco light defeated.
23:36–25:14
Wrap-up, holiday thanks, subscription reminders and a firm no-confetti policy.
Today’s episode is brought to you by Specialdocs Consultants, and our topic today is the growing popularity of concierge medicine. As physician burnout, payer pressures, and patient expectations reach new inflection points, many doctors are rethinking how they practice medicine.
For this episode, Medical Economics Content Vice President Chris Mazzolini sat down with Greg Grant, the Chief Operating Officer of Specialdocs Consultants to explore why 2026 may be a pivotal year for physicians considering the transition to membership-based care. From financial models and patient demand to technology and lifestyle balance, Greg uncovers what’s driving the next wave of concierge medicine and what it could mean for your future in practice.
Music Credits:
Coffee Shop Sketches by Buurd - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
(00:00:00)Overview of physician administrative burden, episode introduction, and the focus on concierge medicine trends. Macro trends shaping concierge medicine (00:01:32)Discussion of macro trends: physician burnout, patient expectations, and the mainstreaming of concierge medicine.
Economic pressures and growth trajectory (00:04:06)Impact of inflation, payer pressures, physician shortages and economic data on the growth of concierge medicine. Physician specialties adopting concierge models (00:07:48)Analysis of which specialties (primary care, cardiology, endocrinology, geriatrics, pediatrics, OB/GYN) are moving into concierge medicine.
Patient willingness to pay and changing expectations (00:11:22)Exploration of patient attitudes toward paying for personalized care and the rise of health optimization trends.
Structure of modern concierge practices (00:14:45)Details on practice structure: panel size, visit length, communication, care coordination, and work-life balance. Integration with hospital systems (00:18:57)Challenges and models for integrating concierge medicine within hospital systems and health networks. Specialdocs’ unique approach (00:22:03)What differentiates Specialdocs in the concierge medicine space and their support model for physicians. Physician burnout and post-conversion experiences (00:26:24)Physician stress and burnout before conversion, and improvements after transitioning to concierge medicine. Hospitality mindset in concierge medicine (00:29:08)How hospitality principles enhance patient experience and satisfaction in concierge practices. Transition timeline and readiness signs (00:32:08)Typical timeline for converting to concierge medicine and indicators that a physician is ready for the change. Financial realities and misconceptions (00:35:31)Common misconceptions about the economics of concierge medicine and financial outlook for 2026. Advice for hesitant physicians (00:38:11)Guidance for physicians considering the transition and reassurance about the mainstream status of concierge medicine. Future outlook and excitement (00:40:14)Predictions for the future growth of concierge and direct primary care, and reasons for optimism. Closing remarks (00:42:41)**Final thanks, episode wrap-up, and information on subscribing and future episodes.
Most physicians say they’re satisfied with their jobs — but far fewer say they feel engaged at work. That disconnect is at the center of CHG Healthcare’s 2025 Physician Sentiment Survey, which draws on responses from more than 900 physicians nationwide.
In this episode of Off the Chart, Medical Economics Assistant Editor Austin Littrell speaks with Bill Heller, chief operating officer at CHG Healthcare, about what’s driving low engagement despite relatively high satisfaction. They break down the survey’s findings on trust in leadership, communication gaps, administrative burden, economic pressure and why engagement plays such a critical role in retention.
Heller also discusses what highly engaged physicians say makes the biggest difference in their day-to-day work, why involvement in decision-making, including around technology and artificial intelligence (AI), matters more than ever, and what health care leaders can do now to improve engagement without major new spending.
Music Credits:
Midnight Serenade by MORRIX Holyhold - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Cold open**
Why physician engagement is one of the most powerful retention tools health systems have.
0:16 — Intro
Austin Littrell introduces CHG Healthcare’s 2025 Physician Sentiment Survey and its core findings.
1:31 — Satisfaction vs. engagement
Why 75% job satisfaction doesn’t prevent turnover when only 18% of physicians feel engaged.
2:55 — What highly engaged physicians report differently
Transparency, open communication and trust in leadership stand out.
3:09 — How leaders build trust day to day
Visibility, explaining the “why,” frequent check-ins, and closing feedback loops.
5:40 — Trust gaps between physicians and executives
Why physicians trust direct supervisors far more than executive leadership.
7:46 — Net Promoter Score and physician loyalty
What a negative NPS says about physician advocacy and organizational risk.
10:56 — Physicians want a voice — but feel excluded
Why most doctors want input into decisions and how leaders can meaningfully involve them.
13:10 — When physician input becomes performative
Why late-stage consultation undermines trust and better decision-making.
15:13 — P2 Management Minute
Keith Reynolds on practical, real-world workflow and engagement ideas.
16:02 — Moonlighting, job changes and economic uncertainty
How engagement dramatically lowers the likelihood physicians will leave.
19:16 — Financial stress and physician decision-making
Why economic uncertainty affects physicians more than leaders may assume.
21:16 — Administrative burden and documentation pressure
What engaged physicians say helps make daily pressures more manageable.
24:44 — Artificial intelligence: hope and concern
Why physicians want AI to reduce burden — not simply increase patient volume.
27:01 — The message physicians want leaders to hear
Visibility, listening, well-being and time for patient care.
27:50 — What leaders may be underestimating
Why small changes can produce meaningful gains in engagement.
29:13 — Outro
Final thanks, credits and where to find future episodes.
Vaccine conversations have changed. Sure, there have always been skeptics, but since the COVID-19 pandemic — and especially since Robert F. Kennedy, Jr., has headed Health and Human Services (HHS) — debates have only intensified.
For physicians, what used to be occasional questions in the exam room have become daily conversations that are more emotional, more complex and more consequential for public health.
Paul Offit, M.D., one of the nation’s leading vaccine experts, joins the show to talk about the state of vaccine and public health skepticism we’re in — and what it means for physicians.
Offit explains why confidence in vaccines has slipped, how federal advisory processes have become more politicized and why rising outbreaks of measles, pertussis and other preventable diseases are a warning sign of things to come.
He discusses how misinformation shows up in the exam room, what’s worked for him when talking with hesitant patients and what physicians should keep in mind as they navigate these increasingly complex conversations.
This interview was conducted in preparation for Medical Economics November-December cover story, "Medicine under attack: How physicians can help their patients navigate the disinformation age."
Read more: https://www.medicaleconomics.com/view/medicine-under-attack-how-physicians-can-help-their-patients-navigate-the-disinformation-age
Music Credits:
After Hours by Yigit Atilla - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Cold open**
Dr. Offit on public health being “under siege.”
0:21 — Intro
Austin sets up the episode on vaccine skepticism and the rise of patient uncertainty.
1:18 — Where trust in science stands now
Offit describes the erosion of confidence in medicine and the rise of “make-your-own-truth” thinking.
2:06 — Vaccine skepticism before and after COVID
How distrust long predates the pandemic — and why mandated vaccines have always faced pushback.
2:38 — Vaccines as “victims of their own success”
Why younger parents must rely on faith, not firsthand memory of disease.
4:22 — Do people need to see disease return to believe in vaccines?
The Maurice Hilleman story and why outbreaks often precede attitude shifts.
6:37 — The politicization of immunization
Why Offit says vaccine science has collided with politics in unprecedented ways.
8:05 — What’s happened to ACIP
Offit’s concerns about expertise, bias, and the breakdown of federal vaccine guidance.
10:04 — Following ACIP’s recent votes
Why Offit saw “anti-science” decisions in 2025 influenza and hepatitis B deliberations.
12:20 — Debating unproven harm vs. studying real risk
How flawed research diverts attention, funding, and global vaccine support.
14:28 — P2 Management Minute
Keith Reynolds with practical, daily practice-improvement insights.
15:19 — Global ripple effects of U.S. vaccine misinformation
How America’s internal debates are shaping vaccine attitudes overseas.
16:26 — Communication strategies for frontline clinicians
How physicians can respond when patients bring vaccine misinformation into the exam room.
19:10 — How vaccines continue to be monitored
Why post-approval surveillance is essential — and how rare events are detected.
19:35 — Where COVID vaccine communication went wrong
Offit on “warp speed,” emergency-use confusion, breakthrough infections, and lost public trust.
21:30 — Will young scientists avoid vaccine research?
How funding cuts and political hostility may shift innovation overseas.
24:07 — States stepping in with their own guidance
Fragmented recommendations and the risks for states that do nothing.
25:08 — Surveillance breakdown and rising outbreaks
Why the U.S. is undercounting measles, flu, and pertussis — and the consequences of “see no evil” policies.
27:32 — Responding to conflict-of-interest accusations
Offit addresses claims about patent profits and ACIP voting.
29:11 — What changes things now?
Why Offit says the turning point will come from parents, not politicians.
30:41 — Closing with Richard Payerchin
Final thoughts and thanks.
31:01 — Outro
Austin wraps with credits and where to find future episodes.
Point-of-care testing has become a core part of how many primary care practices diagnose, treat and manage patients — but deciding which tests to offer, how to implement them and whether the investment makes sense isn’t always straightforward.
Daniel Krajcik, D.O., MBA, a primary care physician with the Cleveland Clinic, joins the show to break down the real-world considerations of bringing rapid testing into the office. He talks about which low-cost tests make sense for small practices, how to evaluate your patient population, what fixed and variable costs look like, and what it actually takes to manage staffing, training and compliance.
This interview was conducted in preparation for the feature-length Medical Economics article: "Rapid Testing: Is it right for your practice?"
Read more: https://www.medicaleconomics.com/view/rapid-testing-is-it-right-for-your-practice-
Music Credits:
FUN PLAYFUL POWERFUL FUNK by Resolute Audio - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Cold open**
Why rapid COVID and flu diagnosis can reduce hospitalization risk.
0:21 — Intro
Austin Littrell sets up the conversation on point-of-care testing in primary care.
1:23 — Where practices should start with testing
How patient population and practice location shape which tests make sense.
1:41 — Low-cost testing essentials
Why urine dip tests and glucometers offer high clinical value with minimal upfront cost.
3:05 — What a CLIA waiver is and how to get one
What practices need to know about federal requirements and eligible tests.
4:37 — Which rapid tests practices can offer
Strep, STIs, pregnancy, A1C, INR and the real cost tradeoffs.
6:27 — Who manages and runs point-of-care tests
Training staff, assigning a compliance lead and maintaining quality control.
7:36 — How rapid testing changes clinical workflow
When testing adds time—and when it actually saves visits and improves care.
8:50 — Revenue and patient satisfaction impact
How in-office testing boosts both billing opportunities and patient experience.
9:05 — Competing with urgent care centers
Why rapid testing has become part of primary care’s market positioning.
9:54 — P2 Management Minute
Keith Reynolds on real-world practice workflow, efficiency and engagement.
10:48 — Legal, documentation and ethical considerations
What physicians must disclose about test accuracy and limitations.
12:53 — Inventory, expiration dates and waste
Why test tracking matters for small practices and revenue protection.
13:56 — How molecular rapid tests expand primary care capabilities
STIs, COVID, flu and testing for vulnerable populations.
15:15 — Value-based care and reimbursement incentives
How point-of-care diagnostics support chronic disease quality metrics.
16:28 — Advice for overwhelmed small practices
Why starting with a single test often leads to sustainable growth.
17:29 — Geography, labs and rural access challenges
When in-office testing matters most based on distance to labs.
19:23 — The economics of primary care
Why prevention and early intervention are finally gaining financial recognition.
20:03 — Outro
Final thanks, credits and where to find future episodes.
American College of Physicians President Jason Goldman, M.D., MACP joins the show to talk about one of the most difficult realities in clinical practice today: medical misinformation.
Goldman discusses the ripple effects he sees in the exam room — confused patients, politicized vaccine debates and growing skepticism toward scientific evidence. He also shares his perspective on the broader challenges weighing on primary care, including stagnant reimbursement, administrative overload and the deepening physician shortage.
Music Credits:
Coffee Lo-Fi by Mit-Rich - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Intro**
Trust in medicine breaks down as misinformation and politicization reshape patient care.
1:12 — The current state of trust in science
Jason Goldman, M.D., MACP, describes a “polarized” environment where echo chambers replace evidence.
2:17 — A public challenge to federal vaccine advisors
Why Goldman says the Advisory Committee on Immunization Practices must return to basic evidence standards.
4:59 — The real damage of vaccine politicization
How confusion, outbreaks, and patient doubt are reshaping public health.
7:58 — Vaccine access vs. vaccine uptake
Supply barriers, pharmacy restrictions, and rising patient hesitation collide in clinical practice.
10:53 — How physicians fight misinformation in the exam room
Goldman walks through the communication strategies that work — and the ones that fail.
13:31 — When vaccine resistance harms families
Preventable disease, household transmission, and the limits of “personal choice.”
19:43 — Autism, Tylenol and recycled health rumors
Why debunked claims still gain traction — and what real science says.
23:00 — Life inside the misinformation echo chamber
Why patients rely on filtered sources instead of public data and primary evidence.
25:04 — P2 Management Minute
Keith Reynolds on real-world practice workflows, staff morale and engagement.
26:03 — The reality of private practice economics
Flat reimbursements, crushing regulation and why primary care is financially fragile.
28:53 — Prior authorization: promises vs. reality
Why physicians still aren’t seeing relief from payer restrictions.
31:19 — Fixing the physician shortage
Medical education reform, student debt, and why primary care needs structural investment.
34:01 — A message to primary care physicians
Advocacy, resilience and unity in a strained system.
35:08 — Outro
Final thoughts, credits and where to find future episodes.
Jared Rhoads, M.S., M.P.H., founder of the Center for Modern Health and senior lecturer of health policy at the Dartmouth Institute for Health Policy and Clinical Practice, joins the show to talk about private equity’s role in health care and how politics are reshaping policy.
Rhoads offers a different take on private equity, arguing that current research is too mixed and fragmented to justify sweeping conclusions or aggressive regulation. He notes that outcomes differ widely across sectors and that positive cases are likely underreported. He also outlines findings from his 2024 prediction survey on health reform, highlighting rising expectations for psychedelic-assisted therapy legalization, growth in direct-pay models, expanded direct primary care and loosened HSA limits.
Throughout, he emphasizes market incentives, empirical evidence and caution against ideology-driven policymaking.
Check out Rhoads' September 2025 article in Medical Economics, "In defense of private equity in health care, mostly."
Music Credits:Rooftops by Buurd - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
00:00 — Why it’s too early to vilify private equity**
Rhoads questions strong anti–private equity narratives and discusses limitations in current evidence.
01:20 — How the literature frames costs, outcomes, and price effects
He points to the BMJ systematic review and mixed findings on quality, utilization, and pricing.
04:55 — The case against broad private equity regulation
Concerns about deal-size review thresholds, bans, and financial instruments; Rhoads favors targeted guardrails over blanket restrictions.
08:50 — When private capital may actually help
Why hospitals in financial distress or needing infrastructure upgrades might benefit from outside investment — and why positive cases rarely surface.
12:30 — Surveying policy under Make America Healthy Again
Rhoads outlines his prediction survey on 28 health policy propositions tied to the Trump administration.
14:50 — Psychedelic-assisted therapy on the rise?
Why he sees legalization in several states as increasingly likely.
16:15 — Direct pay surgery centers and direct primary care
Cultural alignment with MaHA principles driving expectations of growth.
18:10 — HSAs: modest movement, but real movement
Contribution-limit changes and why he sees further shifts ahead.
20:35 — Call for clinicians to join the next prediction survey
Rhoads encourages physicians to participate in the 2025 policy outlook assessment.
21:00 — Close
Final thoughts.
David N. Gans, MSHA, FACMPE, retired senior fellow at MGMA, joins the show to talk about the real pressures facing practices today — rising costs, flat reimbursement, staffing strain and the push for efficiency.
Gans breaks down the key metrics leaders should watch in 2026, the compliance gaps he sees most often, and how to evaluate new technologies like automation and artificial intelligence. He also shares why private-practice profits may have peaked and what that means for administrators planning ahead.
Music Credits:
SEDUCCION by Bopper Beats - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
00:00 — Introduction**
Austin opens the episode and tees up the conversation with David Gans, retired senior fellow at MGMA.
01:15 — Setting the stage
Keith greets David and dives straight into the big-picture question: which operational and financial trends practice leaders are still underestimating.
01:38 — The real cost pressures
David breaks down rising costs, static reimbursement, wage competition, and why efficiency is now non-negotiable for practices.
03:19 — The reimbursement squeeze
How Medicare, commercial insurers, and Medicaid leave little room for negotiation—and what that means for practices of different sizes.
04:22 — Efficiency or bust
Why “doing more with less” has become the only path forward, and how automation, workflows, and scheduling changes help practices stay afloat.
05:00 — Primary care vs. surgical pressures
David explains why cognitive specialties feel revenue constraints differently than procedural ones.
06:34 — What can practices actually control?
Coding accuracy, revenue cycle discipline, and the push to optimize every minute.
06:55 — What data should leaders watch in 2026?
David lays out the essential metrics: top-line revenue, encounter mix, RVUs, staffing costs, and net income trends.
07:33 — Productivity & expense alignment
Why practices need to understand revenue drivers and compare staffing benchmarks against peers.
08:52 — Quality and safety without more admin burden
David shares a framework: right staff, right tasks, right incentives, right outcomes.
09:46 — Technology and environment matter
How COVID reshaped expectations for clinical environments and cleanliness standards.
10:40 — Accreditation realities
David describes Triple-A-HC and where practices most often fall short in compliance.
12:23 — The metrics administrators misinterpret
David explains why FTE calculations are often flawed—and how job-sharing, varied schedules, and workload mismatches distort perceptions.
14:54 — Tech adoption: what’s really new?
Keith asks about telehealth, automation, and artificial intelligence. David places today’s tech challenges in a 100-year historical context.
16:31 — Practices have always adapted
From telephones to punch-card records to EHRs, David highlights the through-line of efficiency.
18:00 — How to evaluate AI today
Use case frequency, patient impact, niche opportunities, and reimbursement potential.
19:49 — Leadership in uncertainty
David identifies the core leadership trait that matters most: cultivating a healthy work environment that boosts efficiency.
20:02 — Staff morale as a performance driver
How workplace culture alone can lift productivity by up to 20%.
20:54 — The surprising trend in private-practice profits
David breaks down his recent Data Mine column on revenue after operating expenses and why private practices may have hit “peak profits.”
22:39 — A 15-year look at the numbers
Inflation-adjusted revenue trends, productivity gains, and why the recent plateau is worrisome.
25:00 — Why profits finally dropped
Payment constraints, supply-chain fallout from COVID, and shifts in patient services.
25:40 — Closing thoughts
Keith and David wrap up and agree to revisit the data when the next column comes out.
26:16 — Outro
Austin closes the show and promotes upcoming episodes, newsletters, and subscription options.
Krista Blackwell, Ph.D., clinical assistant professor of biomedical sciences at the University of South Carolina School of Medicine, Greenville, joins the show to talk about two new reports from the U.S. Centers for Disease Control and Prevention (CDC) and the American Heart Association (AHA) examining ultraprocessed foods and their growing role in the American diet.
Blackwell explains why youth consumption stood out in the data, how convenience, family routines, school meals and food marketing influence eating patterns, and what the latest research says about cardiometabolic risks. She also discusses how primary care physicians can approach nutrition counseling more effectively using motivational interviewing and principles of culinary medicine.
AHA report:
"Ultraprocessed Foods and Their Association With Cardiometabolic Health: Evidence, Gaps, and Opportunities: A Science Advisory From the American Heart Association" https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000001365
CDC report:
"Ultra-processed Food Consumption in Youth and Adults: United States, August 2021–August 2023"
https://www.cdc.gov/nchs/products/databriefs/db536.htm
Music Credits:Midnight Jazz by Alexey Anisimov - stock.adobe.comRelaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Intro**
Overview of today’s topic: new CDC and American Heart Association reports on ultra-processed foods.
1:30 — First impressions of the new data
Dr. Blackwell explains why the findings align with lifestyle-medicine training and culinary-medicine education.
2:43 — CDC survey surprises
Why children ages 6–11 had the highest intake of ultra-processed foods.
3:56 — Pandemic effects on diet
How COVID-19 changed food preparation, access, and reliance on processed foods differently for different populations.
5:56 — Why kids consume so many ultra-processed foods
Marketing, school meals, fast-food access, and environmental factors.
6:40 — Key takeaways from the AHA scientific advisory
What the advisory says about saturated fat, sugar, sodium, additives, and unknowns about processing techniques.
8:47 — Are 70% of grocery-store products “bad”?
How to evaluate ultra-processed foods using nutrition labels and the “1:1 sodium-to-calories” rule taught in culinary medicine.
10:24 — How physicians can approach nutrition counseling
Motivational interviewing, identifying small changes, and real-world examples for primary care.
12:20 — How patients respond to motivational interviewing
Why meeting people where they are leads to better engagement.
14:09 — What culinary medicine looks like in practice
Hands-on patient cases, meal prep, and teaching medical students practical nutrition skills.
16:29 — What future research needs to explore
Additives, processing methods, and understanding their impact on cardio-metabolic disease.
17:41 — The GLP-1 conversation
How GLP-1 drugs fit into the gut-brain axis research and what they mean for individualized patient care.
19:29 — Ultra-processed foods and national policy
How MAHA and recent federal attention could accelerate progress.
21:03 — Defining “ultra-processed” foods
Why the lack of a unified definition complicates dietary guidelines.
22:23 — Where primary care physicians can learn more
Culinary-medicine certification and integrating nutrition into practice.
24:12 — What global models can teach the U.S.
Australia and EU “health scores” and how clearer labeling could help patients.
25:47 — Closing thoughts
Full-circle wrap-up and final remarks from Richard Payerchin and Dr. Blackwell.
26:12 — Outro
Show credits and where to find future episodes.
Loren Adler, fellow and associate director at the Brookings Institution's Center on Health Policy, joins the show to talk about his new Health Affairs study examining the rise of insurer-owned primary care practices.
Adler breaks down how quickly payer ownership has expanded, why certain markets are seeing far higher concentrations and what this consolidation means for costs, competition, Medicare Advantage and independent physicians. He also discusses the data sources behind the research, the role risk adjustment plays in shaping insurer incentives and the policy questions that come with these trends.
Music Credits:Cozy Evening Time Coffee by BJBeats - stock.adobe.comRelaxing Lounge by Classy Call me Man - stock.adobe.com
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**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – Cold open**
“There are a few markets where nearly half of the primary care market is payer-operated — and typically those are largely Optum operated.”
0:20 – Introduction
Austin Littrell introduces Off the Chart and previews the conversation between Richard Payerchin and Brookings Institution health policy expert Loren Adler.
1:35 – How the study began
Richard asks Adler what sparked the analysis behind The Changing Landscape of Primary Care, and why payer ownership needed real measurement.
1:54 – Why insurers are acquiring practices
Adler explains the motivations behind payer acquisitions and the lack of hard data before this study.
3:05 – Key findings
A breakdown of how payer-owned primary care grew from under 1% in 2016 to more than 4% by 2023 — and why 6% of clinicians now work for a payer.
4:17 – The biggest surprises
Adler discusses misconceptions about Optum’s size and the complexity of “affiliated” versus employed clinicians.
4:22 – Where consolidation is happening
Why markets with high Medicare Advantage penetration and less hospital consolidation are hotspots for insurer acquisitions.
7:10 – Why 4–6% matters
Adler explains how national averages hide dramatic geographic concentration — including counties where Optum controls nearly 40–50% of primary care.
7:35 – Antitrust implications
A look at counties with more than 10% payer ownership and the antitrust concerns that follow.
9:31 – Input from payers
What Brookings learned from stakeholder interviews — and why major insurers didn’t influence the data.
9:54 – Why Kaiser and Intermountain were excluded
Adler clarifies why hospital-integrated payers were left out of this analysis.
11:29 – How the data was built
Behind the scenes of the dataset: Medicare claims, ownership tracking, press releases, and acquisition timelines.
14:11 – P2 Management Minute
A quick workflow and operations segment with Keith Reynolds.
14:57 – Core concerns about integration
Adler outlines the biggest risks: antitrust issues, risk-coding incentives, and how payer ownership can change documentation behavior.
15:27 – Risk adjustment and coding intensity
How Medicare Advantage payment design creates incentives to document as many diagnoses as possible.
17:12 – Market foreclosure concerns
Could payer-owned practices limit access to rival insurers? Adler explains the risk — and the open questions.
18:40 – Potential benefits
Areas where payer ownership could improve care coordination, cost alignment, or reduce hospital use.
21:12 – What the study didn’t yet measure
Why patient outcomes remain an open research area — and what anecdotal reports suggest.
23:15 – Pressure on independent practices
Adler discusses aggressive contracting tactics, including first-right-of-refusal clauses.
25:19 – The reality for small practices
Why some independents join IPAs or third-party organizations for leverage and better reimbursement.
25:37 – How this fits into MAHA
Adler’s take on how consolidation trends intersect with federal policy priorities.
26:32 – Policy actions that matter most
The need for transparency, antitrust scrutiny, and major changes to Medicare Advantage risk adjustment.
29:08 – The role of AI
How large language models can help track ownership and consolidation across markets.
30:19 – What’s still unknown
Will payer ownership keep accelerating, or level off? Adler outlines the unanswered questions.
31:26 – What independent physicians should know
Why hospitals — not payers — remain the dominant consolidator of primary care, and how Medicare policy shapes that.
33:04 – Closing thoughts
Richard wraps up the conversation and thanks Adler for joining.
33:27 – Outro
Austin closes the episode with subscription reminders, publishing schedule, newsletter information, and production credits.
Mental health remains a silent crisis among physicians.
Medical Economics Senior Editor Richard Payerchin sat down with Daniel Saddawi-Konefka, M.D., MBA, and Christine Yu Moutier, M.D., to learn more about the rising rates of depression and suicidal ideation among physicians, why stigma and licensing questions still keep many from seeking help, and how to separate burnout from true mental health conditions.
They also outline practical steps that can make care safer and more accessible for clinicians at every stage of training and practice.
Saddawi-Konefka and Moutier are co-authors of a JAMA Special Communicationon reducing barriers to mental health care for physicians, published earlier this year.
Learn more: https://www.medicaleconomics.com/view/barriers-remain-between-physicians-and-needed-mental-health-care
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**Editor's note: Episode timestamps and transcript produced using AI tools.
00:00 — Opening statistic: Hidden physician mental health crisis**
Depression, suicidal ideation and suicide attempts among physicians.
00:22 — Welcome + episode setup
Austin introduces the guests and framing of the discussion.
01:24 — Conversation begins
Richard welcomes Dr. Saddawi-Konefka and Dr. Moutier.
01:29 — Why the JAMA special communication was needed
How the paper came together and why the topic remains urgent.
02:28 — Personal stakes: Colleagues lost, suffering overlooked
Both guests explain how their own experiences pushed this work forward.
03:47 — The current state of physician mental health
What the latest data reveals — and why so much remains hidden.
04:49 — Silence, stigma and the treatment gap
Why physicians rarely seek help even when symptoms are severe.
05:54 — Burnout vs. diagnosable mental health conditions
A clear distinction — and why conflating the two can be dangerous.
08:48 — How burnout gets mislabeled — and why it matters
Why calling every form of distress “burnout” can delay real treatment.
09:41 — The culture of medicine: perfectionism, toughness and silence
How training and tradition fuel stigma and avoidance.
11:15 — Stigma beyond medicine: Broader cultural misunderstandings
Why mental health remains poorly recognized even at the societal level.
14:25 — The role of medical schools
Accreditation requirements, missed opportunities and needed reforms.
15:44 — What med schools still get wrong
How fear of stigma grows during training — and what could change it.
17:15 — Normalizing vulnerability through education
Why modeling “being human” matters for future physicians.
18:35 — Self-prescribing: How common it is and why it’s risky
Data on antidepressant self-prescribing and its consequences.
19:50 — Suicide data: Physicians less likely to be in treatment
How self-management and avoidance increase long-term danger.
21:45 — Fixing licensing and credentialing questions
Why outdated forms perpetuate stigma — and where reforms stand.
24:10 — Why changing the forms isn’t enough
Remaining cultural barriers even after policy fixes.
25:22 — Multi-level solutions: What leaders can actually do
Approaches from screening tools to sustained institutional strategy.
26:45 — Opt-out therapy programs
A promising model that flips the default on seeking help.
28:12 — The most vulnerable moments in training
ACGME mortality findings and early-year risk.
28:28 — Closing reflections + sign-off
Richard wraps the discussion; Austin closes the show.
After the longest federal shutdown in U.S. history, the government is finally open again — but for medical practices, the relief is short-lived. In this episode, Physicians Practice editor Keith Reynolds sits down with Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association (MGMA), to talk about what the reopening actually means for medical groups.
Gilberg breaks down the temporary deal that extends key health policies only through January 30, including Medicare telehealth flexibilities and the geographic work floor. He explains the ripple effects practices are already feeling — from underpaid Medicare claims that now need to be reprocessed to renewed uncertainty around ACA premium tax credits heading into 2026.
Read more from Physicians Practice: "Shutdown deal offers short-term relief, long-term headaches for medical practices"
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**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – Cold open**
Anders on key issues for medical practices being delayed only a few months.
0:18 – Intro
Austin introduces the show, Keith, and Anders, and sets up the shutdown, short-term deal, ACA credits, telehealth, and Medicare underpayments.
1:22 – Setting the scene
Keith welcomes Anders and notes the government reopening after a historic shutdown.
1:49 – 6:13 | What’s in the deal?
ACA premium tax credits, short-term telehealth extension, 1.0 work floor issues, Medicare underpayments, and avoided PAYGO cuts.
6:13 – 7:36 | Immediate impact on practices
Reprocessing guidance, telehealth coverage, and the 2.5% conversion factor bump for 2026.
7:36 – 9:02 | How hard did the shutdown hit?
Different effects depending on Medicare volume, telehealth use, and location.
9:02 – 13:37 | 2026 Medicare fee schedule
Conversion factor increase, work RVU “efficiency” cut, practice expense changes, and which specialties may see real hits.
13:37 – 18:11 | Shutdown politics and ‘health care extenders’
How short-term budget bills, telehealth, rural floors, and APM incentives keep getting tied together and delayed.
18:11 – 18:59 | P2 Management Minute promo
Keith invites listeners to share practice tips and workflow hacks.
18:59 – 22:59 | Looking ahead to 2026
Telehealth flexibilities, ACA tax credits in an election year, and a historically unproductive Congress.
22:59 – 26:46 | Noncompetes
FTC interest in noncompete bans, state patchwork, and MGMA’s balanced view for employed physicians vs independent groups.
26:46 – 30:41 | Policy horizon
Physician payment reform, new prior auth rules, value-based care concerns, and what MGMA will push for next.
31:22 – 31:58 | Outro
Austin closes the episode, plugs subscriptions, and gives production credits.
Denied claims are cutting deeper into practice revenue — and the numbers are getting worse.
In this episode, Medical Economics Managing Editor Todd Shryock talks with Clarissa Riggins, chief product officer at Experian Health, about the company’s 2025 State of Claims Report.
Riggins explains why claim denials are rising, how inaccurate patient data and staffing shortages are fueling the problem, and where artificial intelligence (AI) can make a measurable difference. She also discusses how practices can use automation and predictive analytics to prevent denials before they happen, and why getting ahead of payer complexity is now essential to financial survival.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – Cold open**
“If you can address the issues from the outset of the revenue cycle, it makes everything so much easier — and helps prevent denials before they happen.”
0:20 – Introduction
Austin Littrell introduces Off the Chart and previews the conversation between Todd Shryock and Clarissa Riggins, Chief Product Officer at Experian Health.
1:22 – Setting the stage
Todd introduces the 2025 State of Claims Report and asks what’s driving the sharp rise in claim denials.
1:59 – The top cause: bad data
Riggins explains how missing or inaccurate patient data has become the leading driver of denials — and why AI could help fix it.
2:32 – Why clean claims are harder to submit
Riggins discusses new regulatory pressures, workflow friction, and the challenges of preparing for complex documentation requirements.
4:01 – Staffing shortages and technology gaps
How workforce turnover and fragmented tech stacks compound denial problems and strain practice operations.
5:34 – The biggest problem areas
Why fixing inaccurate data and registration errors at intake remains the most urgent step for revenue recovery.
6:32 – The AI awareness gap
Although 62% of providers say they understand AI, only 14% use it. Riggins explains the hesitation — and how to start small.
7:59 – Lessons from early adopters
Practices seeing ROI from AI share common traits: they start small, track measurable outcomes, and scale success.
9:01 – Building trust in AI
Riggins discusses HIPAA, payer rules, and why transparency is key to physician confidence in AI-driven claims tools.
12:01 – Falling confidence in tech
Todd asks why fewer providers feel their claims systems are effective — and what’s behind the frustration.
12:56 – Fixing payer–provider collaboration
Why better technology and open communication are both needed to reduce denials for good.
13:59 – Where providers should start with AI
Practical first steps for adopting automation — from identifying pain points to choosing the right technology partners.
16:36 – Training and workflow integration
How to implement new AI tools with minimal disruption and staff retraining.
18:28 – What surprised Experian most
Riggins shares the biggest takeaways from the State of Claims data — and why adoption still lags optimism.
19:30 – Final takeaways
Why AI works best when it starts small, delivers measurable ROI, and helps staff focus on higher-value work.
22:12 – Closing
Todd thanks Clarissa for joining, followed by Austin’s closing credits and subscription reminder.
In the 100th episode of Off the Chart: A Business of Medicine Podcast, host Austin Littrell is joined by Todd Shryock, Richard Payerchin, and Keith Reynolds — the editors from Medical Economics and Physicians Practice who helped build Off the Chart into what it is today. Together, they look back on favorite conversations, memorable guests and defining trends from the show’s first 100 episodes.
From the rise of artificial intelligence and new liability concerns to the return of independent practice, rising costs and shifting patient trust, the team discusses how medicine’s business landscape continues to evolve — and what stories they plan to chase next.
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Editor's note: Episode timestamps and transcript produced using AI tools.0:00 – Opening thanks
Richard opens with gratitude to guests and listeners who helped shape 100 episodes of Off the Chart.
0:20 – Introduction
Austin welcomes listeners to the 100th episode and introduces Todd Shryock, Richard Payerchin and Keith Reynolds.
1:17 – Looking back on the journey
Austin recalls joining the show at episode 48 and asks what the 100-episode milestone means to the team.
1:42 – Milestone reflections
Austin shares appreciation for the show’s growth and its role as a forum for fresh ideas in medicine.
2:17 – Podcast evolution
Todd Shryock on how Off the Chart grew from a side project into a polished, professional production.
3:01 – Early days and transition
Keith Reynolds describes taking over around episode 35 and credits Austin for elevating production and consistency.
4:15 – Memorable episodes
Austin asks which episodes have stuck with the editors over the years.
4:24 – Running for office
Richard Payerchin highlights Episode 43: The Physician’s Guide to Running for Office and lessons from doctors-turned-policymakers.
5:06 – What’s broken in healthcare
Todd Shryock revisits his interview with Michigan Medicine’s Marschall Runge, M.D., Ph.D., and how academic leaders see systemic challenges.
6:18 – Behind the mic
Keith recalls producing the “Running for Office” episode, his conversations with MGMA’s Anders Gilberg, and his latest chat with attorney Katie Russell, J.D.
8:03 – AI and malpractice
Austin reflects on Episode 97: AI, malpractice and the future of physician liability, and the October cover story on artificial-intelligence liability in medicine.
8:28 – Team reflections
Keith shares why editor roundtables and behind-the-scenes episodes remain his favorite part of the job.
9:04 – How medicine has changed
Austin asks how the health care landscape has shifted since the podcast began.
9:30 – AI everywhere
Todd explains how artificial intelligence went from novelty to necessity — and raises the looming question: who pays for it?
12:05 – The changing public mood
Keith discusses how public perception of physicians has evolved since the pandemic and why trust feels more fragile today.
13:41 – Independence and private practice
Richard points to episodes 70 and 95 on physician autonomy and the growing nuance around private-equity partnerships.
15:25 – Lightning round: trends for 2026
Austin asks each editor for one trend to watch in the year ahead.
15:35 – Price transparency
Richard predicts renewed momentum for transparency policy under the current administration.
15:53 – Trust in AI
Todd warns that adoption will hinge on physicians’ confidence in AI accuracy.
16:29 – Return to independence
Keith expects a migration back to physician-owned practices as consolidation stalls.
17:14 – P2 Management Minute
Keith delivers a quick interlude of practice-management advice and listener call-to-action.
18:04 – Looking ahead: the next 100
Austin asks what stories or themes should shape Off the Chart going forward.
18:16 – Keith: More creative episodes
Keith lobbies (again) for holiday specials and continued AI coverage.
19:06 – Richard: Rural healthcare and affordability
Richard calls for deeper dives into rural access, insurance costs and medical debt.
20:08 – Todd: Front-line voices
Todd wants more firsthand perspectives from practicing physicians on fixing medicine.
20:47 – Austin: Financial literacy
Austin advocates expanding coverage of physician wealth-building, taxes, and loan repayment.
21:08 – Lightning round: advice for 2026
One-sentence takeaways from each editor for practice leaders.
21:08 – Richard's advice
“Tune in twice a week to Off the Chart.”
21:15 – Todd’s advice
“You can’t save the world — start with the patient in front of you.”
21:25 – Keith’s advice
“Take care of your coders; they make everything work.”
21:33 – Closing and gratitude
Austin thanks the editorial team and listeners for helping reach the 100-episode milestone.
21:57 – Outro
Final wrap-up, subscription reminder and acknowledgments to the Medical Economics and Physicians Practice teams.
Jennifer Trilk, Ph.D., FACSM, DipACLM, professor of biomedical sciences and director of lifestyle medicine programs at the University of South Carolina School of Medicine Greenville, joins the show to discuss how her program is reshaping physician education through lifestyle medicine.
Trilk explains how training future doctors in nutrition, physical activity, behavior change and self-care is key to preventing chronic disease — and why prevention needs to be valued as highly as treatment. She also shares how the school’s hands-on approach, including culinary and teaching kitchens, helps students translate science into real-world patient care.
The discussion covers the evolution of nutrition education in medical schools, national policy efforts to prioritize “food as medicine,” and what it will take for lifestyle medicine to become a standard part of every physician’s toolkit.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – Cold open**
Hippocrates said, “Let food be thy medicine, and medicine be thy food.” If that was said so long ago — how did we miss that in treating our patients?
0:20 – Introduction
Austin Littrell introduces Off the Chart and previews the conversation between Richard Payerchin and Dr. Jennifer Trilk, professor and director of lifestyle medicine programs at the University of South Carolina School of Medicine Greenville.
1:30 – Why nutrition belongs in medical education
Dr. Trilk explains why future physicians need formal training in nutrition, exercise, and behavior change to help patients prevent and reverse chronic disease.
2:23 – Lifestyle medicine vs. conventional medicine
She describes how lifestyle medicine focuses on root causes of illness, shared decision-making, and long-term patient partnerships — not just symptom management.
7:13 – Why doctors weren’t taught nutrition
Dr. Trilk traces the history of medical education, from the Nutrition Academic Award in the 1990s to why most schools still lack meaningful nutrition training.
11:55 – Sorting fact from fad
How physicians can navigate conflicting diet advice, dispel misinformation, and focus on evidence-based nutrition — starting with the Mediterranean diet.
17:14 – Reimbursement for prevention
Dr. Trilk calls for Medicare, Medicaid, and private payers to reimburse physicians for lifestyle and nutrition counseling to make prevention financially sustainable.
20:12 – Inside the teaching kitchen
She describes Greenville’s hands-on culinary medicine program — where medical students and patients cook together — and how it’s changing health outcomes.
25:06 – Cooking as CME
How practicing physicians and fellows are returning to the kitchen to earn CME credit and rediscover the joy of learning through food and connection.
26:22 – Creating national nutrition competencies
Dr. Trilk explains how the new consensus statement, “Proposed Nutrition Competencies for Medical Students and Physician Trainees,” is shaping the future of medical education.
30:09 – The ‘Make America Healthy Again’ initiative
A look at current federal efforts to promote prevention, lifestyle medicine, and nutrition under HHS and CMS.
32:34 – A message to primary care physicians
Dr. Trilk thanks primary care clinicians for their foundational role in patient wellness and encourages them to explore lifestyle medicine in their own practices.
34:29 – Closing
Austin Littrell wraps up the episode with production credits and links to subscribe and learn more at MedicalEconomics.com and PhysiciansPractice.com.
Stefanie Simmons, M.D., FACEP, chief medical officer of the Dr. Lorna Breen Heroes’ Foundation, joins the show to talk about the state of burnout in health care and what’s being done to fix it.
She explains how the foundation is working to remove stigmatizing mental health questions from licensing and credentialing forms, and why addressing burnout requires systemic change — not just resilience training. Simmons also shares what’s giving her hope, how organizations can better support their teams and what a healthier culture in medicine could look like.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – Cold open**
Stefanie Simmons, M.D., FACEP, on how changing licensing language is helping health care workers seek mental health care without fear of losing their ability to practice.
0:29 – Introduction
Austin Littrell introduces Off the Chart and previews the conversation with Stefanie Simmons of the Dr. Lorna Breen Heroes’ Foundation.
1:34 – About the Foundation
Simmons explains the mission of the Dr. Lorna Breen Heroes’ Foundation and its national coalition, “All In: WellBeing First for Healthcare.”
3:02 – The state of burnout
How burnout has changed since the pandemic, and why administrative burden continues to strain the workforce.
4:41 – Which specialties are most affected
Emergency medicine and mid-career physicians continue to report the highest burnout rates.
6:15 – Signs of progress
A look at licensing and credentialing reforms across the country — and why they matter for clinician mental health.
8:07 – The importance of peer support
Simmons explains why peer support is one of the most powerful tools for health care workers in crisis.
10:17 – Generational perspectives
How younger clinicians are changing attitudes about work-life balance and mental health in medicine.
15:00 – Human performance and system design
Why medicine should take lessons from athletic performance — and how rest, coaching, and system design improve care.
16:50 – The Impact Wellbeing Guide
How the foundation’s guide and the Caring for Caregivers program are helping hospitals and states build sustainable well-being initiatives.
19:54 – The Lorna Breen Act reauthorization
Updates on federal legislation to reduce administrative burden and support clinician mental health.
21:02 – Technology and AI
The promise and limits of artificial intelligence in reducing administrative work for clinicians.
23:45 – Hope and the path forward
Simmons shares why she’s optimistic about the growing attention to workforce well-being.
25:49 – A message to primary care physicians
Encouragement and gratitude for primary care clinicians — and a reminder that improving care starts with supporting the whole team.
28:16 – Closing
Austin Littrell closes the episode with show credits and information on where to find Off the Chart and related Medical Economics content.
Artificial intelligence (AI) is entering everyday care, so of course it’s raising questions about malpractice. In this episode, we sat down with three national experts shaping how AI liability will evolve: Sara Gerke, associate professor of law at the University of Illinois Urbana-Champaign; David A. Simon, J.D., LL.M., Ph.D., associate professor of law at Northeastern University; and Deepika Srivastava, chief operating officer at The Doctors Company.
They explain how AI could redefine the standard of care, what happens when an algorithm contributes to patient harm, and practical steps physicians can take now to protect themselves — including documentation, communication and clear internal policies.
Check out our October cover story for a deeper look at how AI is reshaping medical malpractice: "The new malpractice frontier: Who’s liable when AI gets it wrong?" available online at: www.medicaleconomics.com/view/the-new-malpractice-frontier-who-s-liable-when-ai-gets-it-wrong-
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Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – Opening: The AI malpractice paradoxWhy using too little or too much AI can both create legal risk.
0:13 – Episode setupAustin introduces the guests and frames the core question: How does AI shift malpractice liability?
1:14 – AI and the standard of careGerke explains how jurors already view AI-guided decisions as potentially “reasonable.”
2:07 – Adoption drives legal expectationsSimon outlines how widespread use — not hype — determines when AI becomes mandatory practice.
4:03 – When AI harms a patientGerke on physician and hospital exposure today — and surgeons’ skepticism of manufacturer liability.
5:51 – Regulated devices enter the chatWhy manufacturers get pulled in when AI tools behave like medical devices.
6:04 – Device pathways and lawsuitsSimon details 510(k) vs. De Novo vs. PMA — and how each influences manufacturer accountability.
8:27 – Policy leversHow FDA and state decisions could shift responsibility upstream.
9:25 – Insurance reality checkSrivastava: Physicians still bear primary legal risk since they make the clinical call and sign the chart.
10:29 – Transition: From risk to actionBefore pulling the plug on AI tools — what physicians should actually do.
10:43 – Practical protectionsSrivastava’s immediate steps: informed consent, chart review, governance, and patient disclosure.
12:01 – Transparency as defenseHow clear communication about AI use strengthens trust and reduces exposure.
13:20 – Training + governance gapsKeeping workflows tight matters just as much as clinical judgment.
14:02 – Vetting tools and contractsSimon: If AI claims accuracy, ask for validation — and liability protections.
15:30 – Labeling mattersGerke calls for food-style transparency labels for AI devices.
16:27 – The “learned intermediary” burdenEven with better labels, liability flows back to the physician.
17:01 – P2 Management MinuteQuick interlude from Keith Reynolds.
17:54 – Rapid compliance playbookFive habits that will hold up in court — whether you follow or override AI suggestions.
18:40 – ClosingWhy AI is here to stay — and why documentation discipline must evolve with it.
19:10 – OutroCredits, subscription reminder and link to October cover story.
David Ford, CEO of MedWay, joins the show to discuss how the California Medical Association’s (CMA's) new business support program is helping independent physicians take control of their practices without taking on more administrative work.
Launched in 2025, MedWay is a subscription-based management service designed to handle HR, payroll, benefits, insurance and other day-to-day business operations for smaller, physician-owned practices. Ford explains how the program was built, what kinds of support it offers and how it aims to give doctors more time to focus on patients instead of paperwork.
He also talks big picture — why independent practice remains vital to the health care system, how administrative complexity drives burnout and what MedWay’s success could mean for the future of independent medicine in California.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 — Why Medway?**
Independent physicians didn’t spend 20 years training to run payroll. Ford explains the need for a business-support solution.
0:22 — Welcome to Off the Chart
Austin introduces the episode and outlines what Medway offers for practices.
1:14 — Who is David Ford?
Ford shares his background in practice transformation and supporting physician practices.
2:30 — The Birth of Medway
How CMA identified the universal administrative struggles facing independent practices.
4:29 — A Platform Built for Doctors
HR, payroll, benefits, compliance — and real human support when physicians need it.
5:32 — Early Success & Expansion Plans
Medway launches in California and gains national interest quickly.
7:08 — The Business Burden Behind Burnout
Why administrative stress is driving physicians out of independent practice.
8:58 — Burnout in the Post-Pandemic Era
Workload, staffing strain, and the need for relief.
10:00 — California Challenges
The state’s strong but complex regulatory environment for independent practices.
11:47 — Why Independent Physicians Matter
Better access for underserved patients and stronger provider-patient relationships.
14:05 — Supporting the Support Staff
Freeing clinical teams for patient care — and allowing everyone to go home on time.
15:14 — How Practices Enroll
Fast onboarding, one login, and training for staff.
17:33 — Cybersecurity Boundaries
Medway stays away from EMRs and patient data to simplify compliance.
18:44 — Transparent Pricing
A flat $89 per employee per month — and no co-employment arrangement.
22:00 — Billing & Reimbursement?
Not yet — but potentially on the roadmap.
23:10 — Conservative Growth Strategy
Ensuring excellent service for every early adopter.
26:01 — A First-of-Its-Kind Model
Medical societies in other states want to replicate Medway’s approach.
28:47 — Expansion Beyond Medicine
Dental practices begin adopting the service as well.
29:50 — For Any Specialty
Applicable whether pediatrics, ENT, surgery, or anything in between.
30:52 — Final Thoughts
Where to find Medway and who it’s designed to help.
32:19 — Helping New Practices Get Started
Supporting physicians launching their own groups from the ground up.
33:40 — Closing & What’s Ahead
Austin wraps the episode and encourages listeners to subscribe.
Paul Merrick, M.D., and Dan Greenleaf of Duly Health and Care join the show to discuss why independent medical practices deliver high-quality care at lower costs — and why that matters for the future of U.S. health care.
They share insights from a Duly study on health care spending, the importance of physician autonomy and how independent groups can stay competitive amid industry consolidation.
Learn more about their report, “Chicago provider market trends: Key considerations for employers,” here: https://www.medicaleconomics.com/view/independent-physicians-are-a-viable-alternative-to-hospitals-for-patient-outcomes-lower-costs-study-says
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**Editor's note: Episode timestamps and transcript produced using AI tools.
0:20 – Introduction**
Austin Littrell introduces the guests and outlines the episode’s focus on independent medicine.
1:35 – Defining independence
How Duly differs from large hospital systems despite its size and reach.
2:10 – Governance and ownership
Merrick explains Duly’s physician-led board and private equity partnership structure.
5:00 – Cost and quality advantage
Greenleaf compares Duly’s lower prices and stronger outcomes against Chicago hospital systems.
8:20 – The Avalere Health study
How Duly’s collaboration quantified the value of independent practice in the Chicago market.
11:00 – Breaking nonprofit myths
Merrick argues that outcomes — not ownership status — define real community value.
14:10 – Study findings
Duly patients experience lower costs, fewer hospital stays and faster follow-up care.
19:20 – Primary care and coordination
Why integrated teams and close specialist ties improve patient outcomes.
21:10 – Using AI to cut friction
How Duly applies artificial intelligence to streamline documentation, scheduling and coding.
23:50 – Battling burnout
Inside Duly’s “Joy in Medicine” program and how it helps physicians rediscover purpose.
27:35 – Prevention and wellness
Duly’s “Make America Healthy Again” initiative, culinary medicine and supplement education.
32:15 – Message to independents
Advice for smaller practices on collaboration, technology and sustaining autonomy.
36:40 – Closing thoughts
Greenleaf and Merrick on the future of physician-led medicine.
37:10 – Outro
Host wrap-up, credits and subscription reminder.
Katie P. Russell, J.D., partner at Brown Immigration Law in Cleveland, Ohio, joins the show to explain what physicians and practice managers should do if Immigration and Customs Enforcement (ICE) comes knocking at their practice door.
She discusses how to identify valid warrants, protect patient information under HIPAA, and prepare staff with clear response plans. Russell also shares how practices that employ international medical graduates can stay compliant and avoid costly mistakes.
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Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Episode Overview (00:00:00)** Katie Russell discusses the importance of not over-cooperating with ICE and introduces the episode’s focus.
Podcast Welcome and Guest Introduction (00:00:29) Austin Littrell introduces the podcast, the topic and guest Katie Russell.
Preparing for an ICE Visit: First Steps (00:01:29) Katie Russell explains the need for a plan, designating a point of contact and having written protocols.
Responding to ICE: Initial Actions (00:03:29) Guidance on being calm, respectful and directing ICE to the designated compliance officer.
Understanding Warrants: Administrative vs. Judicial (00:03:54) Explanation of the differences between administrative and judicial warrants and their implications.
Safeguarding Patient Information and HIPAA (00:06:28) Discussion on HIPAA protections and when ICE can access patient records or treatment areas.
Employer Responsibilities and Employee Rights (00:07:23) Advice on I-9 audits, handling ICE requests for employee information and avoiding over-cooperation.
When to Call an Attorney and Their Role (00:10:28) Guidance on involving legal counsel, attorney roles during/after ICE visits and staff training.
P2 Management Minute Segment (00:13:28) Keith Reynolds shares quick management tips and invites listener contributions.
Post-ICE Visit: Documentation and Managing Anxiety (00:14:20) Steps for documenting ICE visits, protecting reputation and supporting staff and patients.
Best Practices for Employing International Medical Graduates (00:15:35) Measures and audits to reduce ICE visits and manage visa compliance for international staff.
Final Thoughts and Additional Advice (00:17:40) Katie Russell emphasizes preparation, dispelling misinformation and the value of legal counsel.
Episode Closing and Credits (00:18:19) Hosts thank Katie Russell, recap the episode and provide subscription information.
David Tawes, regional inspector general in the Office of Evaluation and Inspections at HHS’ Office of Inspector General, joins the show to discuss the agency’s new report on the massive rise in Medicare spending for skin substitutes.
He explains what’s driving the surge — from changing billing practices to outright fraud — and how policymakers can balance patient access with stronger oversight. Tawes also shares what physicians should know about potential red flags and how to report suspicious activity.
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Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Overview (00:00:00)** Explosive growth in Medicare Part B spending on skin substitutes; vulnerability to fraud, waste and abuse.
Podcast Introduction and Guest Background (00:00:33) Host introduces the episode, guests and outlines the focus on Medicare Part B skin substitute spending.
David Tawes’ Background and OIG Mission (00:01:50) David Tawes introduces himself and explains the Office of Inspector General’s mission and scope.
OIG’s Oversight and Specialization (00:02:28) Discussion of OIG’s focus areas, including prescription drugs, Medicare, Medicaid and other HHS programs.
How the Skin Substitutes Report Originated (00:04:20) Explanation of why OIG began investigating skin substitute payments and compliance with new reporting laws.
Findings on Increased Billing (00:05:56) Analysis of factors driving increased skin substitute billing: more enrollees, higher units per patient, rising costs.
Total Dollar Amounts and Growth (00:08:11) Details on the magnitude of spending: over $10 billion in 2024, projected $15 billion in 2025.
Fraud Indicators and Investigations (00:08:49) Discussion of fraud’s role in increased spending and the vulnerability of skin substitutes to abuse.
Major Fraud Case Example (00:09:28) Description of a $1.2 billion fraud case involving non-medical professionals and fraudulent billing schemes.
Medicare Part B vs. Medicare Advantage Trends (00:12:11) Comparison of skin substitute spending and utilization between Medicare Part B and Medicare Advantage.
Role of Prior Authorization in Medicare Advantage (00:13:49) How prior authorization in Medicare Advantage helps limit fraud compared to traditional Medicare.
Care Settings and Utilization Patterns (00:14:45) Trends in where skin substitutes are used most — physician offices, home care, and expenditure differences.
Enforcement and Compliance Process (00:16:32) How OIG detects trends, enforces compliance, and the lag between data anomalies and enforcement action.
Policy Recommendations to Curb Spending (00:18:47) OIG’s recommendations for policymakers: reconsider payment classification, explore alternative payment methods and learn from Medicare Advantage.
Ongoing OIG and CMS Actions (00:20:31) CMS’s proposed changes, use of AI, and OIG’s continued monitoring of skin substitute billing and fraud.
Prior Authorization as a Safeguard (00:21:28) Discussion of prior authorization’s role in preventing inappropriate or fraudulent skin substitute claims.
Advice for Physicians (00:22:22) Warning to physicians about aggressive marketing and fraudulent schemes involving skin substitutes.
Emphasis on Payment Incentives (00:23:08) Highlighting how reimbursement differences drive provider behavior and the need for payment reform.
Closing Remarks and Podcast Outro (00:24:21) Thanking the guest, summarizing the conversation, and providing subscription information for listeners.
Bryan Jepson, M.D., CFP, joins the show to explain what “true wealth” really means for physicians, and why retirement planning goes far beyond money.
He explains how to balance financial goals with personal fulfillment, tackle student debt and make smart decisions about saving, investing and enjoying life along the way.
Music Credits:Distant Memories by Buurd - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Episode Overview (00:00:19)** Host introduces the podcast, Dr. Jepson, and outlines topics: true wealth, financial planning, overcoming hurdles and work-life balance.
Defining True Wealth (00:01:33) Dr. Jepson distinguishes between being rich and being truly wealthy, emphasizing freedom, fulfillment and relationships.
Mindset Shifts for Early Financial Planning (00:03:41) Discussion on the importance of intentionality, compounding interest and starting early to build assets for true wealth.
Carving Out Time and Building Habits (00:05:42) Strategies for physicians to create financial plans, develop good habits and work with planners to enjoy life before retirement.
Clinical Resource Promotion (00:07:46) Brief segment promoting Patient Care Online as a clinical resource for physicians.
Balancing Retirement Accounts and Flexible Investments (00:08:04) Advice on prioritizing tax-advantaged retirement accounts before exploring alternative investments like real estate or crypto.
Incorporating Philanthropy and Service (00:10:16) Ways to include giving — both money and time — into financial plans without risking personal security.
True Wealth and Career Fulfillment (00:11:56) How financial independence empowers physicians to avoid burnout, pivot careers or retire early while staying fulfilled.
P2 Management Minute Segment (00:14:32) Short segment offering practical management tips and inviting listener contributions.
First Steps Toward True Wealth (00:15:23) Dr. Jepson’s advice for residents: live below your means, pay off high-interest debt and build an emergency fund.
Emergency Fund Guidelines (00:18:15) Recommendations for emergency savings: 3–6 months of expenses, adjusted for single or dual income households.
Final Advice and Resources (00:19:25) Emphasis on intentionality, understanding basics, and choosing the right financial planner; resources and website shared.
Episode Closing and Credits (00:22:44) Host wraps up, thanks listeners, and provides subscription and newsletter information.
Kyle Zebley, senior vice president of the American Telemedicine Association (ATA) and executive director of ATA Action, joins the show to talk about what happened when Medicare’s telehealth flexibilities expired during the federal government shutdown earlier this month.
In discussion with Medical Economics Senior Editor Richard Payerchin on October 3, 2025, Zebley explains how the lapse has disrupted care for patients and physicians nationwide, what Congress can do to fix it and why making telehealth permanent remains one of the most urgent priorities in U.S. health policy.
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Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
0:00 – 1:42 | Introduction**
Austin Littrell introduces the episode, summarizing the telehealth lapse following the federal government shutdown and previewing the interview with Kyle Zebley.
1:42 – 2:32 | Setting the stage
Host Richard Payerchin introduces Kyle Zebley. Zebley opens with a description of the “sad, desperate state” of telehealth following the October 1 shutdown.
2:32 – 4:09 | How the lapse happened
Zebley explains the simultaneous expiration of pandemic-era telehealth flexibilities and the government shutdown — calling it a “victim of circumstance.”
4:09 – 6:34 | How telehealth evolved since COVID-19
Discussion of how the COVID-19 pandemic transformed telehealth and accelerated its adoption across Medicare and private insurance.
6:34 – 8:06 | The scope of telehealth today
Zebley outlines usage statistics: about one in four Medicare beneficiaries now use telehealth, accounting for roughly 13% of all visits.
8:06 – 10:15 | Shutdown vs. policy lapse
Clarifying that telehealth’s expiration isn’t automatically tied to the government shutdown — Congress must act to reauthorize.
10:15 – 12:30 | Why permanence matters
Why ATA advocates for making telehealth flexibilities permanent; the legislative gridlock preventing it.
12:30 – 14:07 | Will retroactive reimbursement happen?
Zebley predicts retroactive payments are likely but not guaranteed — urging continued advocacy.
14:07 – 14:21 | Patient Care Online plug
Quick mention of sister site PatientCareOnline.com for additional clinical information.
14:21 – 16:20 | Advice for medical practices
Guidance for physicians weighing whether to continue virtual visits during the lapse; balancing financial risk with patient needs.
16:20 – 18:45 | Impact on private insurance
Zebley notes no major changes among private insurers — but Medicare sets the “floor” for telehealth expectations.
18:45 – 20:40 | Bipartisan support in Congress
Discussion of political dynamics; Zebley praises continued bipartisan support for telehealth under both Trump and Biden administrations.
20:40 – 24:18 | Mental health coverage and the in-person requirement
Explains permanent coverage for telemental health but criticizes the “clinically inappropriate” in-person requirement as a barrier.
24:18 – 25:09 | P2 Management Minute
Interlude with Keith Reynolds sharing practice management tips and inviting audience participation.
25:09 – 25:54 | The Acute Hospital Care at Home program
Zebley discusses why the program is vital for expanding capacity and patient satisfaction — and how the shutdown halted it.
25:54 – 28:47 | Rural health clinics and FQHCs
Why distant-site telehealth flexibilities are critical for rural and underserved communities.
28:47 – 30:30 | How to advocate for telehealth
Zebley explains ATA’s grassroots advocacy tool that connects citizens with Congress to restore telehealth and hospital-at-home programs.
30:30 – 32:31 | What physicians can do now
Calls on physicians to use their credibility to pressure lawmakers: “Stop the insanity and bring back these programs.”
33:53 – 35:12 | Closing remarks
Richard Payerchin closes the interview; Austin Littrell wraps up the episode and reminds listeners to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.
35:12 – 35:40 | Credits
Kevin Schulman, M.D., MBA, professor of medicine, clinical excellence research center at Stanford University, joins the show to talk about why the U.S. spends more on health care administration than many countries spend on care itself.
Schulman explains how complexity in billing and payment drives up costs, why current processes are still stuck in the analog era and how ideas from other industries could help create more efficient, digital systems. The conversation also explores the role of AI, the impact of prior authorizations and what reducing administrative waste could mean for physicians, patients and the future of health care.
Read "Addressing Health Care’s Administrative Cost Crisis," Schulman's co-authored viewpoint in JAMA. (https://jamanetwork.com/journals/jama/fullarticle/2829283)
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Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.00:00 – 01:32 | Opening & Introduction
Austin Littrell introduces Off the Chart and sets up the interview with Dr. Kevin Schulman, professor of medicine at Stanford, to discuss the administrative cost crisis and “precedence thinking” in health care.
01:32 – 03:01 | Scope of the Problem
Dr. Schulman describes the staggering scale of administrative spending — roughly a third of all U.S. health care costs — and the chaos of 318,000 plans, 600,000 billing codes and 57 billion prices.
03:01 – 04:34 | Administrative Burden in Practice
He shares firsthand frustrations from hospital medicine — coding queries, irrelevant documentation and network gaps that cause endless rework.
04:34 – 14:11 | Precedent Thinking Explained
Defines “precedence thinking,” contrasting analog vs. digital processes, and explores how other industries solved analogous problems.
14:11 – 14:30 | Promo Break – PatientCareOnline.com
14:30 – 19:25 | “Health care Is Different?” and Rebuttal
Addresses skepticism that medicine is too complex to standardize; compares U.S. costs with the Netherlands, explains why analog systems worsen prior auth inefficiencies and warns of fraud risks in analog transactions.
19:25 – 22:49 | Centralization vs. Standardization
Discusses the difference between those concepts, citing Medicare-for-All debates and arguing for a mixed public-private system with streamlined transactions rather than government centralization.
(Includes Keith Reynolds’ “P2 Management Minute” segment at 22:00 – 22:49.)
22:49 – 27:15 | Digital Contracts and Payment Reform
Explains modular, machine-readable contracts to reduce manual renegotiation, modernize prior authorization and target fraud and waste digitally instead of analog paper processes.
27:15 – 30:03 | Physician Burnout and Workforce Impact
Links admin burden to burnout and hospital employment trends; warns AI could double documentation queries and further erode job satisfaction.
30:03 – 32:32 | AI in Research and Payments
Describes how AI was used in his research and how unregulated AI in payer systems could increase complexity and drive physicians from practice.
32:32 – 34:00 | Policy Context – “Make America Healthy Again”
Frames administrative reform as aligned with federal anti-fraud and efficiency initiatives; calls it a rare bipartisan opportunity.
34:00 – 34:53 | Message to Primary Care Physicians
Urges doctors to advocate for change and reject the notion that current administrative complexity is inevitable.
34:53 – 35:46 | Closing Exchange
Richard Payerchin summarizes themes and thanks Dr. Schulman for joining.
36:01 – 36:58 | Outro and Credits
Austin Littrell closes the episode with subscription and newsletter reminders and production credits.
At the MGMA Leaders Conference 2025 in Orlando, Florida, Andrew Swanson, M.P.A., FACMPE, spoke with Physicians Practice Editor Keith Reynolds about the pressures facing practices, from shrinking reimbursements to rising costs.
He shared why technology, stronger leadership and a focus on patient experience are key to staying resilient — and why finding community and even humor can help practices weather today’s challenges.
Check out all of our MGMA 2025 coverage: https://www.medicaleconomics.com/conference/mgmaMusic Credits:
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Opening Reflections on Resilience (00:00:00)**
Finding joy and levity in health care helps teams stay resilient through challenges.
Podcast Introduction & Episode Overview (00:00:32)
Host introduces the episode, guests, and main topics: financial pressures, technology, leadership and resilience.
Live Conference Introduction (00:01:28)
Introduction of Andrew Swanson and the setting at the MGMA Leaders Conference in Orlando.
Biggest Financial Challenge: Compressing Reimbursement (00:01:51)
Discussion of rising overhead costs, shrinking reimbursements and financial pressures on medical practices.
MGMA’s Value to Members (00:02:48)
How MGMA helps practices operate more efficiently, especially through technology and process improvements.
Maintaining Profitability Amid Shrinking Margins (00:03:39)
Strategies for keeping practices profitable despite financial pressures.
Clinical Resource Plug: Patient Care Online (00:03:54)
Brief mention of Patient Care Online as a clinical resource for primary care physicians.
Conference Theme: “Next is Now” (00:04:19)
Emphasizing leadership, action and embracing current challenges in health care.
Empowering Leaders & Building Community (00:05:45)
Encouraging leaders to take ownership, act now and support each other through challenges.
Staff Shortages & Patient Consumerism (00:06:07)
Addressing staff shortages and the shift to viewing patients as consumers in a digital age.
Embracing Consumerism in Health care (00:07:45)
How adopting a consumer-friendly mindset benefits both patients and practices.
P2 Management Minute Segment (00:08:13)
Quick tips for practice management and a call for listener contributions.
Critical Leadership Skill: Finding Joy (00:09:03)
The importance of humor and joy in leadership to foster resilience and team cohesion.
Advice for 2026: Leveraging Technology (00:11:05)
Encouragement to adopt technology and find people who can implement it for greater efficiency and scalability.
Final Thoughts: Community and Support (00:12:55)
Emphasizing the value of community and mutual support in overcoming industry challenges.
Episode Closing & Subscription Info (00:13:52)
Host wraps up, provides subscription info and thanks listeners.
As Women in Medicine Month comes to a close, Yalda Jabbarpour, M.D., director of the Robert Graham Center at the American Academy of Family Physicians and Annie Koempel, Ph.D., M.A., RDN, LD, qualitative scientist at the American Board of Family Medicine, join the show to discuss their recent study on early career women in family medicine.
They share insights on how women physicians are already leading in unrecognized ways, why traditional definitions of leadership often miss their contributions and what needs to change to create more inclusive models of leadership in medicine.
Read their full study, "'I consider myself to be a leader': a qualitative exploration of early career women family physicians' intentions to assume a leadership role," published in Family Practice.Music Credits:
Lo-Fi Chillhop by AVANT-BEATS - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Episode Overview (00:00:00)** Host introduces the podcast, guests, and the focus on women in medicine and leadership roles.
Invisible Leadership Roles of Women Physicians (00:01:07) Discussion of unrecognized leadership tasks like mentorship, teaching, and collaborative team leadership.
Impact of Unrecognized Leadership on Career Advancement (00:04:02) Explores how lack of recognition affects career progression, compensation and contributes to burnout.
Emotional Labor and Frustration (00:05:25) Addresses the emotional toll and frustration women experience from unacknowledged leadership work.
Traditional Definitions of Leadership in Medicine (00:05:43) Examines why leadership is seen as bureaucratic and disciplinary, and its impact on women’s aspirations.
Collaborative vs. Traditional Leadership Styles (00:08:25) Highlights how women define and practice leadership differently, emphasizing collaboration and community.
Examples of Invisible Leadership in Practice (00:09:01) Specific examples of quality improvement and collaborative leadership that go unrecognized.
Balancing Leadership, Career and Family (00:11:10) Discusses challenges and myths around balancing family responsibilities with leadership roles.
Consequences of Narrow Leadership Definitions (00:13:42) Explores risks to primary care, workforce and patient outcomes if leadership definitions don’t broaden.
Innovative Leadership Models: Collaboration and Flexibility (00:16:53) Describes what collaborative, flexible leadership models could look like in real practice.
Small Changes and Practical Examples (00:19:23) Shares practical, everyday changes that foster a more inclusive and supportive work environment.
Restructuring Leadership in Family Medicine (00:20:55) Suggestions for changing leadership structures to include those impacted by decisions.
Advice for Early Career Women Physicians (00:21:49) Guidance on mentorship, self-advocacy and redefining leadership for early career women.
Optimism for the Future of Women in Leadership (00:24:53) Panelists share reasons for hope, including the new generation’s willingness to challenge the status quo.
Acknowledging Gender Diversity and Broader Relevance (00:26:30) Notes the importance of recognizing gender diversity and the relevance of these issues beyond medicine.
Closing and Podcast Information (00:27:20) Host wraps up, thanks guests and provides information on subscribing and further resources.
Justin Osmond, international keynote speaker, best-selling author, producer and humanitarian, joins the show to share his journey of overcoming profound hearing loss and breaking through self-imposed limits. In conversation with Keith Reynolds, editor of Physicians Practice, Osmond explains how leaders can reframe setbacks, build supportive teams and use mindset as a powerful tool to turn challenges into opportunities for growth.
Interested in the upcoming HCLA Virginia 2025 Fall Conference (Oct. 5-7, 2025)? Click here to register!
And don't miss Justin's keynote presentation, "Don't Limit Your Challenges... Challenge Your Limits," on Tuesday, Oct. 7 at 10:30 a.m.
Music Credits:
LoFi Morning Coffee by Elonix - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Episode Overview (00:00:18)** Austin Littrell introduces the podcast, speakers, and Justin Osmond’s background and keynote topic.
Common Self-Imposed Limitations (00:01:35) Justin discusses the stories professionals tell themselves and the importance of a mindset shift to overcome limitations.
Living Below Your Capacities (00:03:01) Explores what it means to live below potential, the dangers of “faking it” and Justin’s personal journey with his deaf accent.
Embracing Authenticity and Overcoming Fear (00:04:46) Justin shares how embracing his unique voice led to freedom and joy, encouraging others to be authentic.
Settling for Comfort vs. Pursuing Growth (00:05:47) Discusses why people settle for comfort, and how true success comes from facing fears and discomfort.
Clinical Resource Interjection (00:06:46) Brief mention of Patient Care Online as a clinical resource for physicians.
Living Above Your Abilities and Team Support (00:07:09) Justin explains living above abilities, avoiding burnout and the importance of supportive teams using his 250-mile run as an example.
Building High-Performance Teams (00:08:15) Advice on fostering team support, knowing when to push or pause and celebrating milestones together.
Reframing Challenges as Growth Opportunities (00:08:53) How leaders can help teams see setbacks as opportunities for growth, using Justin’s hearing loss as an example.
The Power of Mindset in Unlocking Potential (00:11:04) Justin discusses how mindset shapes outcomes, the importance of positivity and leading by example.
Overcoming Obstacles Through Mindset (00:12:53) Encourages seeing limitations as launchpads, not barriers and shares his personal motto about overcoming hearing loss.
P2 Management Minute Segment (00:14:04) Keith Reynolds introduces a quick segment on practical management tips for medical practices.
Challenging Limits: Personal Example (00:15:10) Justin recounts running 250 miles to raise awareness for deaf children, illustrating how challenging limits reshaped his perspective.
First Steps to Overcoming Doubt and Fear (00:17:04) Advice on taking small, bold actions to break cycles of doubt and build confidence.
Keynote Takeaway: Redefining Limitations (00:18:41) Justin’s core message: limitations don’t define you—your response does. Challenges can refine and empower you.
Episode Closing and Credits (00:20:16) Austin Littrell thanks listeners, recaps the episode and provides subscription and newsletter information.
In the U.S., billions of dollars are spent each year on medical research and drug development, but too often those dollars don't match up with the diseases and patient needs that matter most.
In this episode of Off the Chart: A Business of Medicine Podcast, Donald Berwick, M.D., M.P.P., president emeritus and senior fellow at the Institute for Healthcare Improvement, and former director of the Centers for Medicare & Medicaid Services (CMS) joins Medical Economics Senior Editor Richard Payerchin to discuss a new National Academies of Sciences, Engineering, and Medicinereport on aligning therapeutic investments with actual disease burden and unmet needs.
Berwick explains why the U.S. lacks the data needed to track disease burden and research funding, how market forces and policy decisions shape drug development and what role agencies like CMS and the Food and Drug Administration (FDA) can play in closing the gap.
Check out the National Academies article: https://nap.nationalacademies.org/catalog/29157/aligning-investments-in-therapeutic-development-with-therapeutic-need-closing-the
Check out IHI's Turn on the Lights Podcast:
https://www.ihi.org/library/turn-on-the-lights-podcast
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Golden Swing by Fatima Mhedden - stock.adobe.com
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A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Podcast Overview (00:00:19)** Host introduces the podcast, guests, and main topics: medical research alignment and the National Academies report.
Dr. Berwick’s Background (00:01:25) Dr. Berwick shares his education, career, and experience in healthcare improvement and policy.
Origins of the National Academies Report (00:02:34) Discussion of how the report on aligning research investments with need was initiated and funded.
Report’s Five Goals and Committee Approach (00:03:29) Overview of the committee’s goals: disease burden, unmet needs, investment mapping, causes of mismatch, and recommendations.
Data Gaps and the Need for Transparency (00:05:24) Explains the lack of comprehensive data on disease burden and research investment, and the need for a tracking consortium.
Recommendation: Interagency Consortium (00:06:19) Details on the proposed federal consortium to track unmet needs and investment, and its reporting structure.
Causes of Misalignment: Science and Markets (00:08:41) Explores why research investment doesn’t match disease burden: scientific gaps and market forces.
Role of CMS and Medicare in Drug Development (00:12:32) How CMS coverage, reimbursement, and price negotiation can influence research and drug development priorities.
FDA’s Role and Accelerated Approval (00:13:50) Discussion of FDA’s regulatory standards, accelerated approval, and the need for confirmatory studies.
Challenges with Confirmatory Studies and FDA Resources (00:17:39) Problems with incomplete confirmatory studies and the need for more FDA resources to ensure drug safety.
Private Sector’s Role and Transparency (00:19:36) How private funders can help realign research, the need for public data, and public-private partnerships.
Primary Care and Research Alignment (00:23:39) How research priorities affect primary care, and the importance of physician advocacy for research funding.
Underinvestment in Key Disease Areas (00:26:27) Specific examples of underfunded conditions in public and private sectors, and the need for targeted investment.
Social Determinants of Health and Policy (00:29:44) Emphasis on non-medical factors affecting health, and concern over declining investment in social supports.
Potential of Artificial Intelligence in Research (00:31:06) AI’s promise for identifying research gaps, supporting clinical decisions, and accelerating therapeutic development.
Values and Rare Diseases in Research Prioritization (00:32:53) The ethical challenge of balancing investment in common versus rare diseases, and the importance of value judgments.
Message to Primary Care Physicians (00:34:22) Dr. Berwick urges primary care physicians to advocate for science and research funding.
Closing and Podcast Outro (00:35:46) Host wraps up the episode, thanks guests, and provides subscription and contact information.
In today’s digital marketplace, a physician’s reputation is no longer shaped only by word-of-mouth — it’s built online through reviews, search results and digital presence. In this episode of Off the Chart, Scott Bartnick, co-founder & CEO of Otter Public Relations, sits down with Medical Economics Managing Editor Todd Shryock to explore how physicians can create strong, credible personal brands that attract patients and support practice growth.
Bartnick shares practical advice on starting with reviews, managing negative feedback, leveraging social media without sacrificing professionalism and using storytelling to build patient trust. He also discusses common mistakes to avoid, the role of SEO and online visibility and how a strong personal brand can expand a physician’s influence beyond the clinic.
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Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Episode Overview (00:00:24)** Austin Littrell introduces the episode, focusing on personal branding for physicians with guest Scott Bartnick, co-founder and CEO of Otter Public Relations.
Why Personal Branding Matters for Doctors (00:01:15) Scott Bartnick explains the importance of personal branding in attracting patients and building trust in the digital age.
Defining a Strong Personal Brand for Physicians (00:01:55) Discussion on what constitutes a strong personal brand, emphasizing reviews and online presence.
First Steps to Building a Personal Brand (00:02:47) Advice on starting with good patient care, collecting reviews and gradually expanding to social media and SEO.
Differentiation While Maintaining Professionalism (00:04:15) How physicians can stand out without compromising credibility or trust.
Importance of Digital Presence (00:05:36) The role of websites, blogs and social media in building and defending a physician’s brand.
Best Platforms and Content Types (00:07:11) Which platforms and content formats (video, writing, podcasts) work best for physician visibility.
Engaging Audiences Through Storytelling (00:08:11) Using storytelling and authentic content to connect with patients and build trust.
Clinical Information Resources Mention (00:09:28) Brief mention of Patient Care Online as a clinical resource for physicians.
Common Mistakes in Personal Branding (00:09:47) Pitfalls like chasing trends or trying to go viral, and the importance of authenticity.
Successful Physician Branding Example (00:11:42) Case study of Dr. Ben Fleischman and how strong reviews benefited his practice.
Extending Influence Beyond the Clinic (00:13:35) How a strong brand enables doctors to speak, appear in media and launch related businesses.
Handling Negative Reviews (00:15:26) Strategies for addressing and resolving negative patient reviews to protect reputation.
P2 Management Minute Segment (00:17:47) Keith Reynolds shares quick practice management tips and invites listener contributions.
Responding to Negative Reviews Publicly (00:18:36) Best practices for responding to negative reviews online, including timing and personalization.
Avoiding Automated Responses (00:20:11) Why automated or copy-paste responses to reviews should be avoided in favor of personalized replies.
Final Tips for Building a Personal Brand (00:21:54) Scott Bartnick's closing advice: focus on one platform, build credibility and expand gradually.
Episode Closing and Credits (00:23:14) Austin Littrell wraps up the episode, provides subscription info and credits the production team.
David Eisenberg, M.D., director of culinary nutrition at the Harvard T. H. Chan School of Public Health, founding co-director of the Healthy Kitchens, Healthy Lives conference, and founder and former executive director of the Teaching Kitchen Collaborative, joins the show to talk about the importance of nutritional education for physicians.
"Proposed Nutrition Competencies for Medical Students and Physician Trainees: A Consensus Statement" in JAMA Network Open.
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Relaxing Lounge by Classy Call me Man - stock.adobe.com
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Podcast Overview (00:00:00) Podcast introduction, host and guest introductions, and overview of the episode’s focus on nutrition in medical education.
Dr. Eisenberg’s Background and Motivation (00:01:34) Dr. Eisenberg shares his personal and professional background, and how he became interested in culinary medicine.
Defining Lifestyle Medicine and Teaching Kitchens (00:02:53)** Explanation of lifestyle medicine, the concept of teaching kitchens and their role in health education.
Development and Impact of Teaching Kitchens (00:03:13) History and evolution of teaching kitchens, their integration into health care and ongoing research and collaborations.
Teaching Kitchens Collaborative and Clinical Integration (00:05:23) Formation of the Teaching Kitchen Collaborative, multi-site trials and the potential for primary care integration.
Clinical Resource Interlude (00:08:28) Brief mention of Patient Care Online as a clinical resource for primary care physicians.
Nutrition Competencies in Medical Education: Policy and Advocacy (00:08:58) Discussion of efforts to mandate nutrition education for physicians, including congressional action and policy changes.
Medical Education Response and Consensus Building (00:11:38) Medical education organizations’ response to policy pressure, the need for experiential learning and the rise of teaching kitchens in medical schools.
Developing and Publishing Nutrition Competencies (00:13:22) Process of creating consensus-based nutrition competencies for medical students and residents, and their publication.
Challenges in Nutrition Counseling and Social Determinants (00:16:17) Barriers to effective nutrition counseling, social determinants of health and the need for improved physician training.
Transformational Moment in Medical Education (00:18:10) Current momentum and transformation in nutrition education for primary care and the broader medical field.
Primary Care Practices and Teaching Kitchens (00:19:09) Adoption of teaching kitchens in primary care, benefits for patients and clinicians and impact on burnout.
P2 Management Minute Interlude (00:19:43) Short segment offering practice management tips and inviting listener contributions.
Ethnographic Food Life Questions in Patient Interviews (00:20:33) Introduction of ethnographic questions to improve patient communication about food and nutrition.
Building Trust and Non-Judgmental Nutrition Conversations (00:20:58) Strategies for empathetic, non-judgmental conversations about food and the importance of trust in patient care.
Practical Application and Referral Pathways (00:23:18) How to use food life questions to guide referrals and support patients in changing their relationship with food.
Historical Analogy and Value Proposition (00:24:46) Comparison to mental health screening, and the value of improving nutrition conversations in clinical practice.
Reimbursement and Policy for Nutrition Interventions (00:26:34) Discussion of insurance coverage for nutrition interventions, the Diabetes Prevention Program and future opportunities.
GLP-1 Drugs and Teaching Kitchens: Future Directions (00:27:45) Potential for combining medication with teaching kitchen interventions to improve outcomes and reduce costs.
Quality of Life, Prevention, and Physician Burnout (00:31:01) Broader benefits of lifestyle interventions for patients and clinicians, including prevention and reduced burnout.
Final Thoughts and Message to Primary Care Physicians (00:32:16) Encouragement for primary care doctors to engage with teaching kitchens and lifestyle medicine for professional fulfillment.
Closing Remarks and Episode Wrap-Up (00:33:27) Final thanks, closing statements and information on subscribing to the podcast and newsletter.
Robert G.G. Piccinini, D.O., D.FACN, an adult, geriatric and forensic psychiatrist and recently-appointed president of the American Osteopathic Association (AOA), joins the show to talk about leadership, mental and behavioral health and his goals as president.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Episode Overview (00:00:00)** Overview of the episode, guest introduction and topics to be discussed.
Dr. Piccinini’s Background and Career Path (00:01:26) Dr. Piccinini shares his education, training and journey into psychiatry and private practice.
Importance of Community and Mentorship (00:03:12) Discussion on the value of mentorship, community support and its impact on leadership and medicine.
Advice for Physician Mentors (00:04:31) Tips for physicians on mentoring younger colleagues and fostering supportive relationships.
Leadership Philosophy: Strength and Humility (00:06:27) Exploring what it means to lead with strength and humility in the medical profession.
Improving AOA Communication and “Mind the Gap” (00:07:52) Plans to enhance communication within the AOA and ensure all members are connected and heard.
Certifying Board Services Reform (00:10:17) Current certification process and proposed improvements for osteopathic board exams and communication.
Supporting First-Generation Medical Students (00:13:27) Dr. Piccinini’s personal experience as a first-generation physician and initiatives to support similar students.
Physician Mental Health and Barriers to Support (00:17:02) Current state of mental health support for physicians and needed changes to reduce stigma and barriers.
Osteopathic Medicine’s Role in National Health Initiatives (00:20:29) How osteopathic medicine aligns with national health initiatives and the importance of research and whole-person care.
Integrating Behavioral Health into Primary Care (00:22:57) Collaboration between primary care and mental health, strengths and areas for improvement.
Addressing Physician Shortages (00:28:03) Policies and actions needed to increase the number of physicians, especially in primary care.
Artificial Intelligence in Mental Health (00:29:48) Dr. Piccinini’s views on the role and limitations of AI in mental health treatment.
Message to Primary Care Physicians and Building Community (00:33:04) Encouragement for primary care physicians to seek community, support, and connection within osteopathic medicine.
Closing Remarks and Outro (00:36:32) Final thanks, episode wrap-up and information on subscribing to the podcast.
Kem Tolliver, FACMPE, CPC, CMOM, president and CEO of Medical Revenue Cycle Specialists, joins the show to talk leadership in medicine, including key insights into the importance of innovation, vulnerability and teamwork, and how to recognize and reduce burnout and prepare for upcoming changes in medicine.
Kem will also be the opening keynote speaker at the HCLA Virginia 2025 Fall Conference, October 5-7 in Williamsburg, Virginia.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
0:20** – Introduction to the episode and guest: Kem Tolliver, President & CEO of Medical Revenue Cycle Specialists
1:43 – Moving beyond personal insights to create measurable improvements
3:48 – Essential leadership competencies: innovation, vulnerability and team mentality
6:10 – Applying solutions strategically across organizations (patient portal example)
6:55 – Turning strategy into execution: readmission reduction in Maryland
10:39 – Quick promo for PatientCareOnline.com
10:58 – Addressing burnout: listening for unspoken messages and reducing workflow burdens
15:53 – Supporting team growth with empathy and grace
15:53 – Using health care data effectively: accuracy, KPIs and frontline insights
20:00 – Preparing for the next five years: interoperability, analytics and AI adoption
23:42 – “P2 Management Minute” with Keith Reynolds: smarter data use and delegation tips
24:48 – Reflecting on pivotal leadership moments and lessons learned
27:54 – Key takeaway for conference attendees: “Lead where you stand”
29:48 – Preview of HCLA Virginia 2025 Fall Conference breakout session on revenue cycle oversight and workflow mapping
31:00 – Closing remarks and subscription reminder
Kedar Mate, M.D., founder and chief medical officer of Qualified Health, joins the show to talk about the promise and risks of artificial intelligence (AI) in health care. He discusses the importance of proper oversight and governance, the need for HIPAA-compliant tools and how health systems can operationalize ethical frameworks to ensure safe and effective AI use.
Mate also shares lessons from other industries and offers strategies for triaging and prioritizing AI ideas to maximize business and clinical impact.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Episode Overview (00:00:00)** AI as a potential solution for health care’s economic challenges; importance of smart implementation.
Podcast Introduction and Guest Introduction (00:00:22) Host and guest introductions; overview of episode topics: AI opportunities, risks, oversight and evaluation in health care.
Start of Interview: AI Safety and Governance (00:01:23) Dr. Kedar Mate joins to discuss AI safety, governance and responsible use in health care.
Opportunities and Risks of AI in Health care (00:01:49) AI’s promise for clinicians, shift from supply-driven to demand-led technology and risks like hallucinations and model changes.
Monitoring AI Performance and Mitigating Risks (00:04:48) Need for ongoing monitoring of AI model performance and application reliability in clinical settings.
National and Federal AI Frameworks (00:05:57) Overview of national frameworks and codes of conduct for ethical AI use; need for operationalizing these in practice.
Operationalizing AI Guardrails and HIPAA Compliance (00:07:03) Translating ethical frameworks into technology; importance of HIPAA compliance and risks of using public AI tools with PHI.
HIPAA-Compliant AI Tools and Data Security (00:08:14) Dangers of leaking protected health information; introduction of HIPAA-compliant chat tools for secure clinical use.
Public Service Announcement: Clinical Resources (00:10:12) Brief mention of Patient Care Online as a clinical resource for physicians.
Physician-Level AI Evaluation and Compliance (00:10:31) Questions physicians should ask about AI tools; lack of official approval seals; importance of validation and self-regulation.
Vendor Self-Reporting and Need for Independent Oversight (00:12:33) Risks of relying solely on vendor self-reporting; need for independent, ongoing monitoring similar to cybersecurity.
Measuring AI Safety and Value (00:14:27) How to assess AI safety: technical performance, value to clinicians and monitoring defect rates.
Lessons from Aviation and Automotive Industries (00:16:05) Applying high-reliability principles from aviation, automotive and nuclear industries to health care AI safety.
AI Reliability in Practice: Aviation and Automotive Examples (00:17:51) How AI is safely used in aviation and self-driving cars; importance of trustworthiness and reliability.
Practice Management Minute: Automation Tips (00:19:53) Tips for automating and simplifying medical practice management to save time and reduce costs.
Governance and Control of AI Usage in Health Systems (00:21:05) How health care leaders can govern and triage AI tool usage within large organizations.
AI Triage Systems and Vendor Proliferation (00:22:31) Implementing triage systems for AI ideas; challenges with numerous point-solution vendors; need for platform approaches.
Industry Consolidation and Final Thoughts (00:24:43) Industry trends toward consolidation; final advice on smart AI adoption and the importance of knowledgeable partners.
Episode Closing and Credits (00:26:28) Host thanks guest; episode credits and subscription information.
Gary Price, M.D., MBA, joins Medical Economics senior editor Richard Payerchin to discuss The Physicians Foundation’s latest initiatives, including open grants addressing social drivers of health and physician well-being. Price reflects on the legacy of Richard “Buz” Cooper, M.D.’s research linking poverty and health care costs, highlights examples of community-driven solutions and explains how food insecurity and local conditions shape patient outcomes.
The conversation also delves into new survey findings on medical misinformation and disinformation, why rural doctors see it as a bigger challenge and how physicians must evolve their communication strategies to meet patients where they get their information.
The Physician Foundation's survey: "The Effect of Misinformation and Disinformation on Physicians’ Ability to Provide Quality Care"
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Episode Overview (00:00:16) Host introduces the podcast, episode focus on physician workforce, burnout and future of medicine.
Introducing The Physicians Foundation (00:01:35) Dr. Price explains the Foundation’s mission to empower physicians and improve health care.
Current Grant Opportunities (00:02:06) Discussion of open grant applications, especially for drivers of health and physician wellbeing.
Defining Drivers of Health (00:02:52) Explanation of social drivers of health and their impact on patient outcomes and health care costs.
Dr. Richard “Buz” Cooper’s Research (00:03:39) Overview of Dr. Cooper’s work on poverty, health care costs and the Foundation’s support of his research.
Impact of Poverty on Health care Costs (00:05:10) How zip codes and poverty levels correlate with higher health care costs.
Working with Dr. Cooper (00:05:48) Dr. Price’s personal experience collaborating with Dr. Cooper on his research and book.
Dr. Cooper’s Findings and Examples (00:06:25) Details of Dr. Cooper’s analysis, including the “Take the A Train” chapter and cost disparities in NYC.
Economic Benefits of Addressing Social Drivers (00:07:49) Argument for investing in upstream social factors to reduce chronic disease and costs.
Health care Utilization in Impoverished Areas (00:08:41) Why patients in poorer areas require more services and face barriers to care.
Dr. Gabriel Oyeyemi and the Buzz Cooper Award (00:09:43) Highlighting Dr. Oyeyemi’s work at Cherry Hill Free Clinic and his approach to social drivers.
Lessons from Dr. Oyeyemi’s Example (00:11:15) What other physicians can learn from Dr. Oyeyemi’s creative, community-based interventions.
Foundation’s Grant Program Goals (00:12:14) Foundation’s interest in locally-based, creative solutions for addressing social drivers of health.
Importance of Local Approaches (00:13:11) Emphasis on tailoring interventions to local community needs and cultures.
Patient Care Online Resource Plug (00:13:46) Brief mention of Patient Care Online as a clinical resource for physicians.
Doctors’ Community Knowledge (00:14:04) Discussion of how physicians’ local knowledge benefits patient care.
Policy and the “Make America Healthy Again” Movement (00:14:43) How social drivers fit into new public health initiatives and policy changes.
Nutrition and Social Drivers (00:15:22) Importance of access to healthy food as a key social driver of health.
Physician Training on Food as Medicine (00:16:24) Anticipation of more doctors guiding patients on nutrition and food choices.
Policy Recommendations for Social Drivers (00:17:42) Suggestions for regulatory changes, such as including healthy food access in Medicare/Medicaid.
How to Apply for Foundation Grants (00:20:54) Information on grant application process and funding details.
Encouragement for Grant Applications (00:21:38) Foundation’s excitement about supporting new research proposals.
PTO Management Minute Segment (00:22:01) Brief interlude offering practice management tips and call for listener submissions.
Resource Limitations for Grants (00:22:53) Acknowledgment of limited resources and hope for more applicants.
Upcoming Physician Survey Results (00:23:13) Introduction to discussion on new survey about medical misinformation and disinformation.
Key Findings on Misinformation (00:23:43) Survey results: over half of physicians see misinformation as a barrier to care, especially in rural areas.
Physician Confidence vs. Reality (00:24:53) Surprising disconnect between physicians’ confidence in addressing misinformation and actual patient outcomes.
Need for New Communication Strategies (00:28:00) Call for improved, evidence-based communication methods to counter misinformation.
Personal Anecdote on Misinformation (00:28:59) Dr. Price shares a personal story about a patient refusing a COVID test due to misinformation.
Prevalence and Impact of Misinformation (00:31:25) Recognition that misinformation is a widespread, urgent issue in medicine.
Closing Thoughts on Survey and Action Needed (00:32:40) Emphasis on the need for more research and new approaches to address misinformation, especially in rural areas.
Episode Wrap-Up and Credits (00:33:20)** Host thanks guests and listeners, provides subscription information and credits production team.
Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association (MGMA), joins the show with updates from Washington on the most important topics affecting medical groups and health care policy.
Speaking with Keith A. Reynolds, editor of Physicians Practice, Gilberg talks about the impact of recent health care legislation on Medicaid and Medicare payments, the administrative and financial challenges facing medical groups, upcoming policy deadlines (e.g., telehealth, ACA subsidy expirations) and MGMA's ongoing advocacy efforts to support physicians and improve health care policy.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Episode Overview (00:00:13)** Host introduces the episode, guests and main topics: healthcare legislation, Medicaid/Medicare payments, administrative challenges and upcoming conference.
Introducing the "One Big Beautiful Bill Act" (00:01:34) Explanation of the bill’s name and focus on healthcare provisions relevant to medical groups.
Medicaid Cuts and Implementation Timeline (00:02:11) Discussion of predicted Medicaid cuts, administrative issues and the delayed implementation until 2027-2028.
Medicare Payment Adjustments and Ongoing Advocacy (00:04:37) Covers Medicare reimbursement increase, unaddressed 2025 cut and the need for a permanent solution.
Administrative Workload and Revenue Cycle Management (00:05:40) Addresses administrative challenges, eligibility verification and the impact of ACA subsidy expiration.
Legislative Productivity and Administrative Simplification (00:07:18) Talks about Congress’s productivity, legislative process and prospects for administrative simplification bills.
Prior Authorization Reform and Medicare Advantage (00:08:18) Focus on prior authorization issues in Medicare Advantage and the need for legislative reform.
Physician Fee Schedule Changes (00:09:38) Explains major changes in the physician fee schedule, including specialty vs. primary care payment shifts.
Impact of Fee Schedule on Specialties (00:10:54) Details how the new methodology may affect different specialties, especially non-primary care practices.
Promoting Patient Care Online (00:13:28) Brief mention of Patient Care Online as a clinical resource for primary care physicians.
Technology, EHR and Interoperability Initiatives (00:14:00) Discussion of AI in healthcare, interoperability and voluntary pledges for IT standardization.
Government Data and Physician Payment (00:16:21) Explores the potential impact of politicized economic data on physician payment calculations.
P2 Management Minute: Morale Boosters (00:18:25) Segment on practical tips for boosting staff morale and emotional intelligence in medical practices.
Upcoming Policy Deadlines: Telehealth and Rural Payment Parity (00:19:40) Overview of key policy issues expiring at end of September: telehealth flexibilities and rural payment parity.
Affordable Care Act Subsidies and Political Implications (00:22:32) Discusses the expiration of ACA subsidies, potential premium increases and political ramifications.
MGMA Leadership Conference Preview (00:24:44) Preview of the upcoming MGMA Leadership Conference, its content and networking opportunities.
Episode Wrap-Up and Closing Remarks (00:26:40) Host thanks guests and listeners, promotes newsletter and closes the episode.
Lucienne Marie Ide, M.D., Ph.D., founder and CEO of Rimidi, joins the show to discuss the proposed 2026 Medicare Physician Fee Schedule and its impact on remote patient monitoring (RPM) programs.
Ide shares insights on new billing codes, increased flexibility for physicians, the role of artificial intelligence (AI) and the evolving integration of RPM into standard health care practice.
Read her full analysis of changes coming to RPM in the proposed 2026 Medicare Physician Fee Schedule: "Big Changes Outlined for Remote Patient Monitoring in the Proposed 2026 Physician Fee Schedule."
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to the Episode (00:00:00)** Dr. Ide hopes RPM becomes a standard part of health care, not just an innovative modality.
Podcast Introduction and Overview (00:00:25) Host Austin Littrell introduces the episode, guests, and the focus on RPM and Medicare fee schedule changes.
Guest Introduction (00:01:19) Richard Payerchin introduces Dr. Lucienne Ide and Rimidi's focus on RPM and chronic condition management.
State of Remote Patient Monitoring (00:02:05) Dr. Ide discusses the maturity and mainstream adoption of RPM in the US health care system.
Defining RPM and RTM (00:02:22) Clarification of remote physiologic monitoring vs. remote therapeutic monitoring and their respective focuses.
Current and Proposed RPM Billing Codes (00:03:19) Explanation of code 99454, current requirements, and proposed changes for more flexible billing.
Proposed Time-Based Codes for RPM (00:04:58) Discussion of new codes allowing billing in 10-minute increments, increasing flexibility for practices.
Importance of Flexibility in RPM (00:05:59) How new codes allow for clinical judgment and tailored interventions for different patient needs.
Financial Sustainability and Physician Appeal (00:07:42) How added flexibility reduces financial risk and may encourage more physicians to adopt RPM.
Physician Reimbursement Rates for RPM (00:09:35) CMS plans to hold RPM reimbursement rates steady for 2026, with possible overall rate increases.
Documentation and Audits in RPM (00:11:23) Importance of documentation for demonstrating patient benefit, compliance, and supporting continued reimbursement.
Addressing Fraud, Waste, and Abuse (00:13:12) Welcoming scrutiny to ensure appropriate use of RPM and prevent bad actors from exploiting the system.
Evidence and Research on RPM Outcomes (00:14:10) Discussion of accumulating evidence for RPM’s benefits and the need for more granular data on patient subgroups.
AI and the Future of RPM (00:15:28) Potential for AI to improve efficiency in RPM, and implications for physician compensation and CPT codes.
Wearables and Consumer Health Devices (00:17:52) Exploring the overlap between consumer wearables and formal RPM, and current limitations in mainstream medicine.
Cybersecurity and Data Privacy in RPM (00:20:34) Growing importance of cybersecurity as RPM integrates with EHRs and the need for high standards in data protection.
Industry Response to Proposed RPM Changes (00:22:31) Little protest to proposed RPM code changes; focus on reimbursement rates and public comment period.
Advice for Primary Care Physicians (00:24:13) Encouragement for physicians to view RPM as standard care, benefiting both patients and practice finances.
Patient Response and Selection for RPM (00:25:35) Importance of patient selection, communication of benefits, and addressing copay concerns for successful RPM adoption.
Episode Conclusion (00:27:33) Closing remarks, appreciation for the conversation, and episode wrap-up.
Podcast Outro and Subscription Information (00:28:00) Host thanks listeners, provides subscription info, and credits the production team.
Marschall Runge, M.D., Ph.D., dean of the University of Michigan Medical School, CEO of Michigan Medicine and author of The Great Healthcare Disruption, joins the show to dissect exactly what's broken in U.S. health care — and what we can do to fix it.
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A Textbook Example by Skip Peck - stock.adobe.com
**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Overview (00:00:00)** Dr. Runge and the hosts introduce the episode’s focus: challenges and dysfunctions in the U.S. health care system.
What’s Broken in U.S. Health care? (00:01:20) Discussion of patient frustrations: appointment delays, rising drug prices, insurance confusion and system complexity.
Retailers in Health care: Why Didn’t It Work? (00:02:22) Exploring why Walmart, Amazon and others struggled to deliver primary care and the issue of fragmented medical records.
Primary Care Challenges (00:06:08) Examining the importance of primary care, low physician numbers, burnout and why fewer medical students choose this path.
Practice Management Tip: Patient Care Online (00:09:30) Brief segment promoting Patient Care Online as a resource for clinical information.
AI in Medicine: Promise and Limitations (00:09:49) How AI is being used for note-taking, scheduling and efficiency; its current benefits and limitations in health care.
Health care Equity and Access (00:14:06) Concerns about technology access disparities between urban and rural/low-income areas; discussion of universal health care models.
History and Impact of HMOs and Capitation (00:17:31) Reflection on HMOs, capitation, and their effects on primary care and health care delivery in the U.S.
U.S. Health Outcomes and Prevention (00:19:07) U.S. ranking in healthy life expectancy, rising chronic diseases and the need for better prevention and health management.
Practice Management Minute: Staffing Metrics (00:19:55) Tips for medical practices on when to add staff, based on wait times, overtime and labor costs.
Health care Innovation and Drug Development (00:21:04) U.S. leadership in medical innovation, new weight loss and genetic therapies and the challenge of high drug costs.
Healthy Aging and Lifestyle Factors (00:24:16) Key lifestyle factors for healthy aging: sleep, fitness, community and policy approaches to promote healthy choices.
Misinformation in Medicine (00:26:43) Concerns about health misinformation on social media and the need for better health education in schools.
Conclusion and Farewell (00:28:46) Closing remarks, thanks to the guest and information on subscribing to the podcast.
Brad Boyd, principal of management consulting at BDO USA, joins the show to talk about how artificial intelligence (AI) and other health technologies are helping physicians navigate the prior authorization process, reduce administrative burdens and improve patient care.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to the Episode (00:00:21)** Overview of the podcast, episode focus on prior authorizations, and introduction of guest Brad Boyd.
Biggest Pain Points in Prior Authorization (00:01:36) Discussion of administrative burdens, labor shortages, increased denials, and financial pressures on providers.
AI’s Immediate Impact on Prior Authorization (00:04:47) How automation and AI can reduce administrative workload and free up clinical staff.
Rules-Based vs. Generative AI (00:06:26) Differences between rules-based automation and generative AI in revenue cycle management.
Data Requirements for AI Solutions (00:09:26) Discussion on the need for organized, governed data for effective AI implementation.
Provider vs. Payer AI Systems (00:10:54) Exploration of incentives, trust issues, and the divide between provider and payer AI tools.
AI “Battles” and Denial Increases (00:13:23) Concerns about AI systems on both sides increasing denials and administrative gamesmanship.
Integrating AI into EHR Workflow (00:16:14) Importance of embedding AI tools into existing clinical and administrative workflows.
AI Access for Small and Rural Practices (00:19:46) Challenges and opportunities for smaller practices to adopt AI, including reliance on vendors and clinical alignment.
Management Minute: Employee Red Flags (00:21:56) Three red flag behaviors that signal it’s time to let an employee go in a medical practice.
Are We at a Tipping Point? (00:23:09) Discussion on regulatory attention, public uproar, and whether technology can finally solve prior auth issues.
Ethics of AI in Prior Authorization (00:25:40) Ethical concerns, data protection, and responsible use of AI in healthcare.
How to Start Streamlining Prior Auth with AI (00:28:01) Advice on developing a strategy, prioritizing use cases, and building sustainable AI programs.
Final Thoughts and Emphasis on Strategy (00:32:38) Importance of a thoughtful, long-term strategy for AI adoption in healthcare revenue cycle management.
Episode Wrap-Up (00:34:09) Closing remarks, subscription reminders, and production credits.
This is an Off the Chart Special Report.
60 years ago today, on July 30, 1965, President Lyndon B. Johnson signed the Medicare and Medicaid Act — also known as the Social Security Amendments of 1965 — into law at the Truman Library in Independence, Missouri.
Years earlier, in 1945, it was President Harry S. Truman who first proposed a comprehensive national health insurance program to Congress. During the ceremony in 1965, President Johnson called Truman "the real daddy of Medicare," presenting the former President and the former first lady, Bess Truman, with the first and second Medicare cards.
Today, 60 years later, more than 66 million Americans are dependent on Medicare.
In this episode, Medical Economics Senior Editor Richard Payerchin is joined by Clifton Truman Daniel, President Truman's eldest grandson, and Mark Adams, the director of the Truman Library.
They reflect on Medicare’s legacy, Truman’s push for universal care and what his ideas still mean for health policy today.
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A Textbook Example by Skip Peck - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Historical Context (00:00:00) Overview of Medicare’s 60th anniversary, President Truman’s early advocacy, and introduction of guests.
Guest Introductions (00:01:17) Clifton Truman Daniel and Mark Adams introduce themselves and share their backgrounds.
Medicare’s Historic Connection to Truman (00:03:47) Discussion of why LBJ signed Medicare at the Truman Library and the Truman-Johnson relationship.
Personal Anecdotes: Truman and Johnson Families (00:07:03) Stories about the friendship between the Truman and Johnson families, including the portrait incident.
Truman’s Vision for Health Care (00:08:51) Truman’s 1945 message to Congress and why health care was central to his Fair Deal agenda.
Physician Leadership and Opposition (00:11:47) Truman’s views on physician leadership, AMA opposition, and his preference for decentralized health care.
Supporters and Opponents of Truman’s Health Initiatives (00:13:12) Who supported and opposed Truman’s health care proposals, including labor unions and conservative groups.
Historical Context: 1945–1965 (00:15:51) Social and political developments that led to Medicare and Medicaid, including the Great Society.
Truman’s Post-Presidency Involvement (00:17:10) Truman’s continued interest in national affairs and his relationships with later presidents.
Recurring Health Care Challenges (00:19:50) Discussion of persistent health care issues from Truman’s era to today and his likely reaction.
Decentralization in Health Care (00:23:28) Truman’s emphasis on state and local involvement in health care delivery.
Impact on Life Expectancy (00:25:51) Improvements in American life expectancy since Medicare’s passage and Truman’s likely response.
Personal Health and Family Legacy (00:27:24) Truman family health stories and the importance of health in their lives.
Closing Remarks and Podcast Outro (00:30:42) Thanking guests, encouraging subscriptions, and podcast credits.
Bobby Mukkamala, M.D., president of the American Medical Association (AMA) joins the show to talk about what the AMA is doing for pressing issues like prior authorizations, private practice, artificial intelligence and scope of practice.
This is part two of our conversation with Mukkamala. If you haven't already, be sure to check out part one, "From patient to president, with AMA President Bobby Mukkamala, M.D.," to hear about his personal health journey, in addition to the AMA’s stance on primary care, health policy and physician reimbursement.
The episode is out now, available below, or wherever you listen to your podcasts:
Medical Economics: https://www.medicaleconomics.com/view/ep-74-from-patient-to-president-with-ama-president-bobby-mukkamala-m-d-part-1-
Physicians Practice: https://www.physicianspractice.com/view/ep-74-from-patient-to-president-with-ama-president-bobby-mukkamala-m-d-part-1-
Apple Podcasts: https://podcasts.apple.com/us/podcast/from-patient-to-president-with-ama-president-bobby/id1522950336?i=1000718285185
Spotify: https://open.spotify.com/episode/6iM1U2tMLUAygnAKe1zlzY
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Episode Context (00:00:00)** Overview of the episode, speakers and recap of part one; sets up topics for this episode.
Prior Authorization Challenges and AMA Reform Efforts (00:01:15) Discussion of the frustrations with prior authorization, real-world examples and AMA's advocacy for reform.
Decline of Private Practice and Physician Autonomy (00:06:38) Explores the shift from private practice to employment, threats to autonomy and AMA's support for independent physicians.
Promoting Private Practice to Medical Students (00:08:39) Encouraging medical students to consider private practice and the importance of independence in medicine.
Clinical Resource Plug: Patient Care Online (00:10:02) Brief mention of Patient Care Online as a resource for primary care physicians.
Artificial Intelligence in Medicine: Promise and Pitfalls (00:10:14) Examines AI's potential in healthcare, concerns about implementation and AMA's approach to augmented intelligence.
P2 Management Minute: Reducing Malpractice Risk (00:13:44) Tips for physicians on reducing malpractice risk through communication, documentation and patient relationships.
Scope of Practice and Team-Based Care (00:14:48) Concerns about non-physician providers, importance of physician-led teams and maintaining care quality.
Closing Thoughts and Call for Unity (00:18:49) Dr. Mukkamala's message to physicians about working together to improve health care and the AMA's role.
Outro and Subscription Information (00:20:03) Wrap-up, how to find part one and information on subscribing to the podcast and newsletters.
Bobby Mukkamala, M.D., president of the American Medical Association (AMA) joins the show to discuss the AMA's mission in the year ahead, health care policy, challenges facing primary care and his personal health journey.
This is part one of a two-part interview with Mukkamala. Don't miss part two — where he talks about reimbursement struggles, prior authorization frustrations, the potential of artificial intelligence (AI) in medicine and physician autonomy — available next Monday, July 28, right here and wherever you get your podcasts.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Overview (00:00:00)** Dr. Mukkamala discusses advocacy for patients and physicians, setting the tone for the episode.
Podcast Introduction and Guest Background (00:00:22) Host Austin Littrell introduces the episode, guests and main topics to be discussed.
Dr. Mukkamala Personal and Professional Background (00:01:27) Dr. Mukkamala shares his medical background, family, and practice history in Flint, Michigan.
AMA’s Mission and Dr. Mukkamala's Goals (00:02:14) Discussion of the AMA’s mission, current challenges in medicine and Dr. Mukkamala's presidential goals.
Dr. Mukkamala's Experience as a Patient (00:03:42) He recounts his brain tumor diagnosis and how being a patient changed his perspective on health care.
Challenges in Primary Care (00:06:01) Exploration of the burdens facing primary care physicians, including regulations, burnout and workforce shortages.
Primary Care and Systemic Barriers (00:06:48) Further discussion on prior authorizations, insurance hurdles, and the impact on patient care and physician burnout.
Healthcare Becoming Transactional (00:09:21) Concerns about the loss of physician-patient relationships and the impact of insurance compensation models.
Policy, Politics and the AMA’s Role (00:11:19) Discussion of major policy changes in 2025, federal agency restructuring and the AMA’s advocacy approach.
Impact of Policy on Medical Research and Practice (00:13:13) How changes in funding and policy affect medical research, innovation and Dr. Mukkamala's personal treatment.
Medicare Reimbursement Challenges (00:16:21) Examination of stagnant Medicare reimbursement, its ripple effects and the AMA’s advocacy for payment reform.
Health Equity and Outcomes (00:20:31) Addressing health equity gaps, local disparities in Flint and the AMA’s efforts to raise awareness and drive change.
Episode Conclusion and Next Steps (00:23:52) Host wraps up, previews part two and provides subscription information for listeners.
Richard H. Hughes IV, J.D., M.P.H., joins the show to talk about the recent lawsuit filed against Health and Human Services Secretary Robert F. Kennedy, Jr., by major medical groups — including the American Academy of Pediatrics, the American College of Physicians, the Society for Maternal-Fetal Medicine and a "Jane Doe" pregnant physician — regarding the removal of the COVID-19 vaccination for pregnant women and healthy children from the immunization schedules of the U.S. Centers for Disease Control and Prevention (CDC).
Hughes is a health care attorney representing the plaintiffs in the lawsuit. He also serves as voting director for the nonprofit vaccine advocacy organization, Vaccinate Your Family.
For more information on the lawsuit, check out this Medical Economics article:
'Existential threat to vaccination' — Physicians, public health experts sue HHS over RFK Jr's COVID-19 vaccine directive
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to the Lawsuit (00:00:00)** Overview of the lawsuit challenging HHS Secretary’s actions undermining vaccine access and confidence.
Podcast and Guest Introduction (00:00:24) Host introduces the podcast, episode topic, and guest Richard H. Hughes.
Background of the Lawsuit and Plaintiffs (00:01:31) Details on the lawsuit’s plaintiffs and the specific HHS action being challenged.
Significance of Vaccine Recommendations (00:03:32) Discussion on the importance of official vaccine recommendations in clinical practice and policy.
Impact on Public Health and Clinical Practice (00:05:24) How the directive affects providers, patients, and vaccine access, especially for pregnant women and children.
Scientific Basis of the Directive (00:06:27) Questioning whether the HHS directive was based on established scientific evidence and proper procedures.
ACIP Deliberations and Future Vaccine Targets (00:07:55) Discussion of ACIP’s recent actions and potential future changes to the immunization schedule.
Role of Medical Organizations and Need for Legal Action (00:09:30) Why legal action is necessary despite strong medical society recommendations.
Continuation of Medical Recommendations (00:11:00) Assurance that medical organizations will continue to make vaccine recommendations.
Legal Process and Next Steps (00:11:31) Explanation of the legal process, upcoming hearings, and expected timeline for a court decision.
Potential Impact on Upcoming Flu Season (00:12:15) Whether court action can occur in time to affect the upcoming respiratory and flu season.
Message to Primary Care Physicians (00:12:54) Encouragement for physicians to rely on professional guidelines and address vaccine misinformation.
Closing Remarks and Farewell (00:13:35) Conclusion of the interview and expressions of appreciation.
Podcast Outro and Subscription Information (00:14:10) Host wraps up the episode, provides subscription and newsletter information.
Susan Dentzer, president and CEO of America's Physician Groups, joins the show to talk Medicare reform and the specific proposals included in America's Physician Group's latest report, "Medicare Done Right."
Download the full report: https://www.apg.org/wp-content/uploads/2025/04/Medicare-Done-Right-Final-4.1.25.pdf
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Episode Overview (00:00:00)** Austin introduces the episode, guest Susan Dentzer, and the focus on Medicare reform and accountability.
Biggest Issue with Medicare and Key Fix (00:01:18) Susan discusses the main problem with Medicare and the report’s top recommendation: increasing accountability in both Medicare arms.
Accountable Relationships in Practice (00:02:25) Explains what it means for every beneficiary to have an accountable relationship with a healthcare professional, especially for small practices.
Importance of Care Coordination and Outcomes (00:03:47) Highlights the value of primary care teams, care coordination, and minimizing unnecessary hospital use for better outcomes.
Problems with MIPS and MACRA (00:04:16) Critique of the current MIPS/MACRA system, why it hasn’t worked, and the need for system-level reforms.
Restoring and Expanding Incentives (00:06:24) Calls for restoring and expanding advanced alternative payment model bonuses to better reward clinicians in accountable models.
Challenges for Small and Independent Practices (00:07:28) Addresses the risks and complexities of two-sided ACOs for small practices and suggests partnership solutions.
How At-Risk MA Arrangements Save Money (00:10:04) Explains how Medicare Advantage at-risk models achieve better outcomes and could save $22 billion if replicated in traditional Medicare.
Improving Medicare Advantage: Prior Authorization and Star Ratings (00:14:00) Discusses the popularity of MA, issues with prior authorization and star ratings, and visions for improvement.
Dental, Vision, and Hearing Coverage in Accountable Models (00:17:10) Proposal to offer extra benefits to traditional Medicare patients who join accountable care models and how it could work.
Top Medicare Policy Change for 2025 (00:20:51) Susan’s pick for the most impactful policy change: updating the Medicare physician fee schedule to reflect practice cost inflation.
Clarifying Medicare Advantage Misconceptions (00:23:31) Emphasizes the diversity within MA, the benefits of delegated risk models, and the importance of understanding risk adjustment.
Conclusion and Report Access (00:26:37) Wrap-up, thanks to Susan, and information on where to find the full report and subscribe to the podcast.
Isaac Park, CEO of Keebler Health, joins the show to talk agentic AI and how it can be used in health care.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Pace of AI Change (00:00:00)** Discussion on the unprecedented speed and velocity of technological change, especially with AI.
Podcast Introduction and Guest Overview (00:00:26) Host introduces the podcast, the episode’s topic, and the guest, Isaac Park.
Defining Agent AI vs. Large Language Models (00:01:09) Explains what agent AI is, how it differs from large language models, and its core capabilities.
Agent AI Use Cases and Healthcare Applications (00:02:43) Describes agent AI’s potential to mimic human workflows and its analogy to customer service bots.
Appropriate Use Cases in Healthcare (00:04:31) Agent AI’s current use in low-clinical, high-administrative tasks like scheduling and EHR management.
Limitations and Human-in-the-Loop Necessity (00:06:09) Discusses why agent AI shouldn’t be used alone in high-stakes clinical decisions; need for human oversight.
Agent AI as a Tool for Physicians (00:07:16) Frames agent AI as a tool to empower clinicians, not replace them, and parallels with other tech advances.
Impact on Clinician Performance (00:08:23) How AI tools can amplify both good and bad performance, based on user expertise.
Building and Maintaining Trust in AI (00:09:31) Addresses the importance of trust, transparency, and evidence in AI adoption among clinicians.
AI in Staffing and Documentation (00:11:32) Explores AI’s role in automating scheduling and its success in clinical documentation (ambient scribing).
Future Steps in Documentation and Efficiency (00:13:49) Considers whether agent AI can further automate tasks like billing and multi-step processes.
Complexity and Limitations of AI in Healthcare (00:14:26) Explains healthcare’s complexity, AI’s struggles with structured tasks, and why full automation is risky.
Point Solutions and Future AI Trends (00:18:27) Predicts proliferation of small, effective AI tools in healthcare, but questions full autonomy.
Prospects for Artificial General Intelligence (AGI) (00:20:13) Discusses fluctuating industry opinions on AGI and the rapid pace of AI development.
Closing Remarks and Outro (00:21:52) Wrap-up of the conversation, thanks to the guest, and podcast subscription information.
Paul Berggreen, M.D., president of the American Independent Medical Practice Association (AIMPA), joins the show to talk about the current state of private practice, as well as the findings of the American Medical Association's (AMA's) Physician Practice Benchmark Survey.
Find the AMA survey here: https://www.ama-assn.org/about/ama-research/physician-practice-benchmark-survey
Download the survey here: https://www.ama-assn.org/system/files/2024-prp-pp-characteristics.pdf
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Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to Private Practice Medicine (00:00:00) Dr. Berggreen discusses the entrepreneurial nature of private practice and its importance compared to institutional employment models.
Podcast and Guest Introduction (00:00:29) Host introduces the podcast, episode context, and the main speakers.
AMA Physician Practice Benchmark Survey Overview (00:01:10) Discussion about the AMA survey, its methodology, and its relevance to physician employment trends.
Trends in Private Practice and Survey Data Limitations (00:02:09) Analysis of the declining percentage of physicians in private practice and issues with survey methodologies.
Factors Driving Decline in Private Practice (00:04:41) Exploration of inadequate payment rates, rising costs, and regulatory burdens affecting independent practices.
Impact of Payment and Regulatory Challenges (00:05:05) Detailed explanation of payment stagnation, rising costs, and regulatory complexity for independent physicians.
Physician Ownership and Autonomy (00:09:07) Discussion on the importance of physician ownership, autonomy, and its impact on burnout and patient care.
Loss of Autonomy in Large Systems (00:10:19) Real-world examples of how loss of autonomy affects physicians and patient referrals in large organizations.
Technology, AI, and Independent Practice (00:13:53) Consideration of how AI and technology may help or hinder independent practices, including cost and adoption.
AI Tools in Practice: Benefits and Costs (00:14:27) Specific examples of AI tools for documentation, their benefits, and financial implications for small practices.
Specialty Breakdown in Independent Practice (00:18:03) Review of AMA survey findings by specialty, with insights into which specialties remain more independent.
Private Equity and MSO Models in Healthcare (00:20:20) Discussion of private equity’s role, MSO models, and their impact on cost, quality, and physician autonomy.
Avalere Study on Practice Models and Costs (00:22:25) Summary of a study comparing cost and quality outcomes across different practice models, including private equity.
Independent Practice and National Health Initiatives (00:27:26) Role of independent practice in improving national health, access, and chronic disease management.
Innovation and Physician Shortage (00:30:36) Discussion on physician shortages, the need for innovation, and the importance of extending physicians’ careers.
Inclusivity of AIMPA Membership (00:32:08) Clarification that AIMPA welcomes all specialties, including internal and family medicine.
Episode Closing Remarks (00:32:37) Farewell, thanks, and information on subscribing to the podcast and newsletters.
Brian McKillop, president of AMN Healthcare's locum tenens division, joins the show to talk projections, causes and solutions for the U.S. physician shortage.
Find AMN Healthcare's latest report, "The Physician Shortage: Projections, Causes, and Solutions," here:
🔗 https://online.flippingbook.com/view/787974745/
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Episode Overview (00:00:25)** Host introduces the podcast, guests, and main topic: the physician shortage and AMN Healthcare’s latest report.
Projections of Physician Shortage (00:01:25) Discussion of recent projections and statistics on the physician shortage through 2036.
Implications for Patients and Doctors (00:02:23) Exploring what the shortage means for health care delivery, supply and demand, and patient care.
Seven P’s: Contributing Factors to the Shortage (00:02:46) Breakdown of the seven main factors driving the physician shortage, including population growth, aging, burnout and pipeline issues.
Underserved Communities and Access Disparities (00:05:58) Addressing the shortage’s impact on underserved areas and strategies to improve access to care.
Filling Gaps: Advanced Practice Providers and International Physicians (00:07:48) How nurse practitioners, PAs and international medical graduates help fill physician gaps, especially in rural areas.
Burnout: Causes and Solutions (00:09:06) Discussion of physician burnout, its causes, and both micro and macro solutions to improve retention.
Aging Population and Physician Retirement Cliff (00:11:43) Impact of an aging population and workforce on physician supply and patient care needs.
Medical Residency Caps and Funding (00:12:36) How residency slot caps and funding mechanisms affect the pipeline of new physicians.
Changing Practice Models: Employment and Flexibility (00:15:03) Shift from independent practice to employment, rise of telemedicine and the importance of flexible work models.
Short-Term Solutions to the Physician Shortage (00:17:21) Immediate actions to address the shortage, including international medical graduates and retention strategies.
About AMN Healthcare and Resources (00:19:01) Overview of AMN Healthcare’s services and resources available for physicians and health care organizations.
Closing Remarks and Credits (00:20:06) Thanking the guest, encouraging subscriptions and providing production credits.
Ericka L. Adler, J.D., a shareholder and manager of the health care group at Roetzel & Andress, joins the show to discuss the hidden risks of prescribing GLP-1 medications — like semaglutide and tirzepatide — that physicians need to know, from ensuring informed consent to navigating long-term safety data.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Overview (00:00:00)Brief mention of compliance issues and the evolving legal landscape for prescribing GLP-1 drugs. Podcast Introduction (00:00:29)Host introduces the episode, speakers, and main topics: legal risks, informed consent, and safety data for GLP-1 drugs.
Guest Introduction (00:01:05)Introduction of EricKa Adler and the focus on GLP-1 drug risks.
Liability Risks for Prescribing GLP-1 Drugs (00:01:19)Discussion of primary legal risks, compliance with state and federal laws, and proper office setup.
Off-Label Use Legal Concerns (00:02:49)Explains legal concerns with off-label prescribing and how to mitigate risks through documentation and informed consent.
Informed Consent Specifics for GLP-1 Drugs (00:05:53)Importance of tailored, robust informed consent forms for GLP-1 drugs, especially for off-label use.
Compounded Versions and Legal Risks (00:07:57)Legal risks of prescribing compounded GLP-1 drugs, including contamination, misbranding, and advertising issues.
Insurance Denials and Prior Authorizations (00:11:26)Challenges with insurance coverage, prior authorizations, and evolving insurer policies for GLP-1 prescriptions.
Telemedicine and Prescribing GLP-1 Drugs (00:14:10)Legal risks and compliance requirements for prescribing GLP-1 drugs via telemedicine, including licensure and administration rules.
Long-Term Safety and Liability Concerns (00:16:59)Emerging liability concerns regarding long-term safety and adverse effects, and the importance of malpractice coverage.
Financial Relationships with Pharmaceutical Companies (00:20:10)Legal and ethical concerns for physicians with financial ties to GLP-1 drug manufacturers, including anti-kickback laws.
Regulatory Changes and Evolving Landscape (00:21:40)Recent and anticipated legal or regulatory changes, state vs. federal oversight, and the need for ongoing compliance.
Conclusion and Closing Remarks (00:25:02)**Thanking the guest, closing the episode, and providing subscription information.
Thomas E. Price, M.D., an orthopedic surgeon and the 23rd secretary of the U.S. Department of Health and Human Services (HHS), joins the show with an idea to address the health care workforce shortage: legal, employment-based immigration.
According to a recent Staffing Stream article, "An overlooked answer to the US healthcare crisis: Skilled immigration," by Ron Hoppe, there are:* 10,000+ foreign trained physicians waiting overseas for U.S. visas; * 15,000+ immigrant physicians already practicing in the U.S., awaiting permanent residency; * 10,000+ internationally educated RNs who have passed the U.S. licensure exams and completed immigration requirements, unable to enter the country.
Is immigration policy reform the long-awaited solution to the health care workforce shortage in the U.S.?
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to the Episode (00:00:00)**
Overview of the podcast's focus on health care workforce challenges and immigration policy.
Background on Workforce Shortage (00:01:03)
Discussion on the long-standing health care workforce shortage and barriers to solving it.
Immigrant Contribution to Healthcare (00:02:30)
Highlighting the significant role of immigrant health care workers in the U.S. system.
Policy Changes for Workforce Solutions (00:04:33)
Exploration of federal and state policy changes needed to address healthcare workforce shortages.
Visa Backlogs for Clinicians (00:05:45)
Examination of the visa backlog issue preventing qualified international clinicians from practicing.
Challenges in Graduate Medical Education (00:06:04)
Discussion about limitations on residency slots affecting physician training and immigration.
Lack of Attention to Immigration Issues (00:07:28)
Analysis of why skilled immigration in health care isn't a priority in national policy discussions.
Role of Physicians in Advocacy (00:08:42)
Importance of communication and advocacy by physicians and medical organizations for policy change.
Alignment of Immigration and Border Security (00:10:36)
Agreement that immigration reform can coexist with border security priorities in health care.
Broad Scope of Healthcare Shortages (00:11:54)
Emphasis on the extensive range of health care worker shortages beyond just physicians and nurses.
Mark Daly, chief technology officer of Digital Diagnostics, joins the show to unpack artificial intelligence (AI) diagnostic tools, and what must be done to maintain both patient and physician trust.
Be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to AI in Medicine (00:00:20)**
Overview of the podcast and speakers discussing AI's role in diagnostics.
AI Transforming Diagnostics (00:01:11)
Mark Daly talks about AI's impact on image interpretation in medicine.
Concerns About AI Replacing Human Judgment (00:02:43)
Discussion on AI as a tool to assist physicians rather than replace them.
Regulatory Challenges for AI Diagnostics (00:04:04)
Exploration of the regulatory hurdles AI diagnostics face and their implications.
Ensuring Transparency and Trust in AI (00:06:25)
Importance of building trust and transparency with physicians regarding AI tools.
Patient Perception of AI Tools (00:08:38)
Discussion on how patients respond to AI in decision-making processes.
Reducing Physician Burnout with AI (00:11:43)
AI's potential to alleviate physician workload and reduce burnout.
Rapid Adoption in Medical Specialties (00:13:10)
Identifying specialties likely to adopt AI diagnostics quickly.
Equitable Access to AI Advancements (00:15:24)
Addressing the need for all patients, especially underserved populations, to benefit from AI.
AI's Potential in Mobile Clinics (00:17:02)
Discussion on AI's role in increasing access to healthcare through mobile clinics.
Funding AI Tools in Healthcare (00:17:43)
Exploration of the financial implications of integrating AI tools in the healthcare system.
Building Trust in AI Systems (00:18:21)
Importance of data collaboration and validation to enhance trust in AI diagnostic tools.
Vision for AI in Diagnostics (00:20:37)
Future prospects of low-cost, high-value diagnostic tests and their implications for patient care.
Leveraging Big Data for Rare Diseases (00:22:04)
Using AI to analyze large datasets for insights into rare diseases and unique patient populations.
Enhancing Patient Outcomes with AI (00:23:25)
AI's potential to improve patient outcomes while reducing costs in medical diagnostics.
Closing Remarks and Future Innovations (00:24:16)
Excitement about future AI innovations and their impact on patient care and outcomes.
Jeffrey A. Singer, M.D., a general surgeon and senior fellow at the Cato Institute, joins the show to talk about patient autonomy — which also happens to be the subject of his new book, "Your Body, Your Health Care."
For more from Singer, read his article in Medical Economics, or find a copy of his book here.
Be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to Patient Autonomy (00:00:00)**Discussion on the importance of respecting patient autonomy in healthcare.
Podcast Introduction (00:00:25)Austin Littrell introduces the podcast and the guest, Jeffrey A. Singer, M.D.
Dr. Singer's Background (00:01:01)Richard Payton introduces Dr. Singer and his credentials.
Origin of the Book (00:01:23)Dr. Singer explains the inspiration behind his book "Your Body, Your Healthcare."
Linking Policy Areas (00:02:20)Discussion on the overarching principle of autonomy in healthcare policy.
Informed Consent Evolution (00:03:58)Dr. Singer highlights the shift towards informed consent in medical practice.
Historical Case: Sloan v. Society of New York Hospital (00:06:15)Overview of the landmark case establishing patient consent rights.
Government Interference in Autonomy (00:07:56)Discussion on how government regulations infringe on patient autonomy.
Clinical Information Query (00:08:02)A question regarding the need for more clinical information in patient care.
Advancements in Medicine (00:08:15)Discussion on the impact of technology and AI on medical practice.
Importance of Doctor-Patient Communication (00:08:53)Dr. Singer emphasizes the need for effective communication in healthcare.
Empowerment through AI (00:09:38)Dr. Singer discusses how AI can enhance patient autonomy and healthcare access.
Scope of Practice Issues (00:10:49)Discussion on barriers created by licensing laws for healthcare providers.
Telehealth and Patient Autonomy (00:12:57)Exploration of how telehealth intersects with patient autonomy and informed consent.
State Licensing Barriers (00:13:17)Dr. Singer discusses the challenges posed by state licensing for telehealth services.
Proposed Solutions for Telehealth (00:15:15)Suggestions for reforming telehealth regulations to enhance patient access.
Physician Shortage Concerns (00:17:23)Discussion on the growing demand for healthcare amidst a physician shortage.
Government Mandates and Vaccination (00:21:06)Dr. Singer addresses informed consent related to vaccine mandates during the pandemic.
Public Health vs. Personal Health (00:23:38)Distinction between public health interventions and personal health choices.
Government Intrusion in Healthcare (00:24:42)Discussion on government regulations banning food colorings without scientific evidence, affecting consumer choices.
COVID-19 Response Critique (00:25:45)Criticism of public health agencies for their slow response and refusal to consider alternative strategies during the pandemic.
Testing Delays and Bureaucracy (00:26:49)Overview of delays in COVID-19 testing approvals and the paternalistic approach limiting self-testing options.
Value of Primary Care Physicians (00:28:34)Acknowledgment of primary care physicians' importance and the challenges they face in the healthcare system.
Balancing Clinical Judgment and Autonomy (00:30:11)Advice for medical professionals on respecting patient autonomy while managing personal biases and clinical responsibilities.
Daniel G. Aaron, MD, JD, an associate professor of law at the University of Utah's S.J. Quinney College of Law, joins the show to talk about the American Law Institute's revised legal standard for assessing medical negligence.
For more, check out Aaron's JAMA article, "A New Legal Standard for Medical Malpractice."
Be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to the Episode (00:00:00)**
Overview of the podcast and introduction of Dr. Daniel Aaron discussing medical malpractice standards.
Background on the Legal Standard Update (00:01:02)
Dr. Aaron explains the revisions to the medical malpractice standard by the American Law Institute.
Differences in the New Standard (00:03:16)
Discussion on how the new standard differs from traditional customary practice in malpractice cases.
Implications for Clinical Decision-Making (00:06:08)
How the new standard allows physicians more flexibility in clinical decision-making based on evidence.
Guidelines and Legal Scrutiny (00:08:31)
Advice for physicians on ensuring the guidelines they follow are legitimate and evidence-based.
Examples of Negligence Under the New Framework (00:10:00)
Exploration of how customary practices could still be deemed negligent with the new standard.
Effects on Defensive Medicine (00:11:36)
Discussion on how the revised standard may influence defensive medicine behaviors among physicians.
Monitoring Legislative Changes (00:13:10)
Guidance for physicians on keeping track of legislative developments in medical malpractice law.
Actions for Primary Care Physicians (00:16:09)
Recommendations for busy physicians to stay informed about the evolving legal landscape.
Closing Remarks (00:17:10)
Dr. Aaron's final thoughts on the significance of the changes in medical malpractice law.
2025 has brought new heights for vaccine innovation — and new lows in public trust. Medical Economics and Infection Control Today convened a panel of frontline physicians, policy leaders and infectious disease experts to unpack recent policy shifts, the impact of vaccine hesitancy and how we move forward with evidence, empathy and action.
Panelists
William Schaffner, M.D., Professor of Preventive Medicine and Infectious Diseases, Vanderbilt University School of Medicine
Charles Vega, M.D., FAAFP, Clinical Professor of Family Medicine, Associate Dean for Culture and Community Education, University of California, Irvine
Georges Benjamin, M.D., FACP, Executive Director, American Public Health Association
Jen Brull, M.D., FAAFP, President, American Academy of Family Physicians
Tina Q. Tan, M.D., FIDSA, FPIDS, FAAP, President, Infectious Diseases Society of America, Professor of Pediatrics, Feinberg School of Medicine, Northwestern University
Moderator:
Heather Stoltzfus, M.P.H., R.N., CIC Research nurse program manager, Johns Hopkins University Division of Infectious Disease, Consultant, Broad Street Prevention, Editorial Adviser, Infection Control Today
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**Vaccine panelist introductions (2:14 to 4:13)
Opening thoughts on 2025’s vaccination challenges (4:14 to 10:44)
The state of vaccine innovation (10:45 to 16:22)
Vaccine politics: ‘They’ve taken apart the infrastructure to get shots in arms’ (16:23 to 20:00)
Pediatric vaccines: Rates decline, parental skepticism grows (20:01 to 23:30)
Confronting the lack of public vaccine education (23:31 to 30:05)
Addressing vaccine-skeptical patients (30:06 to 35:05)
Rebuilding confidence in vaccination (35:06 to 37:54)
The role of medical societies in vaccine advocacy (37:55 to 44:37)
Practical tips for physicians to combat misinformation (44:38 to 50:26)
Closing thoughts on vaccines in 2025 (50:27 to 56:14)**
Michael S. Fenster, MD, FACC, FSCA&I, FRSM, MAINE, PEMBA — the cardiologist and professional chef better known as Chef Dr. Mike — joins the show to talk about a healthy diet and the importance of nutrition in primary care.
For more from Chef Dr. Mike, check out his deep dive on ultraprocessed foods and his recipe for pan-seared miso black cod with fresh fennel, broad beans and seafood broth on Medical Economics.
Be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to the Episode (00:00:00**Overview of the podcast and its focus on nutrition's role in healthcare.
Evolution of Diet and Heart Health (00:01:12)Discussion on how the understanding of diet's impact on heart health has changed over the years.
Historical Context of Medicine (00:02:41)Insights into the evolution of medicine from battlefield practices to modern health challenges.
Nutrition as a Young Science (00:03:57)Exploration of the origins of nutrition science and its early successes in addressing deficiency diseases.
Limitations of Traditional Nutrition Approaches (00:05:10)Critique of simplistic views on nutrition and the challenges of chronic disease management.
Holistic Approach to Nutrition (00:07:20)Advocacy for a more holistic understanding of nutrition, emphasizing food combinations and synergy.
Complex Systems in Nutrition (00:09:31)Introduction of a complex systems approach to nutrition, acknowledging the multitude of food compounds.
Personalized Nutrition (00:10:45)Discussion on the importance of personalized nutrition and individual dietary needs.
Clinical Advice for Physicians (00:11:25)Guidance for doctors on how to engage patients in discussions about nutrition and health.
Behavior Change in Patients (00:12:49)Emphasis on the need for behavioral strategies alongside medical interventions for long-term health.
Utilizing Physician Extenders (00:14:55)Suggestions on how to effectively use healthcare teams to address nutrition in patient care.
Books on Food and Medicine (00:15:49)Overview of Dr. Fenster's upcoming book and its focus on the communication of food experiences.
Quality of Food Matters (00:17:17)Highlighting the importance of food quality in overall health and wellness.
Navigating Misinformation (00:19:01)Discussion on the challenges posed by misinformation in nutrition and health.
Interpreting Contradictory Research (00:20:11)Advice on how to critically assess conflicting studies and their implications for health.
Understanding Data Analysis in Nutrition (00:21:57)Insights into how data analysis can influence perceptions of dietary impacts on health.
Real Food vs. Processed Food (00:23:07)Comparison of the health implications of real foods versus ultra-processed foods.
Understanding Food and Health (00:25:35)Discussion on how food additives can exacerbate health conditions like Crohn's disease.
Personalized Nutrition (00:26:50)Emphasis on the need for personalized dietary recommendations based on individual cultural backgrounds and preferences.
Culinary Medicine Education (00:28:21)Advice for doctors on learning about healthier food preparation through culinary medicine programs.
Zero Waste Cooking (00:30:56)The importance of minimizing waste in cooking and utilizing leftovers for healthier meals.
Patient Support Resources (00:32:00)Introduction to an app designed to help patients make healthier dietary choices based on culinary medicine principles.
James M. Dahle, MD, FACEP, founder of The White Coat Investor, joins the show to talk about common financial mistakes that physicians make — and what they should be doing instead.
For more financial advice, check out Dahle's Medical Economics article, "Achieving financial success as a physician: Mastering 5 money activities."
Also, learn how to "divorce-proof your marriage" with these eight tips from Physicians Practice.
Oh, and be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to the Podcast (00:00:13)Overview of the podcast and introduction of Jim Dahle, MD, FACEP, discussing financial mistakes for physicians. Vision of the White Coat Investor (00:01:02)Dahle explains the mission of The White Coat Investor to help doctors manage their finances.
Handling Market Shocks (00:02:10)Discussion on how to approach investments during economic uncertainties and market volatility.
Financial Stress and Burnout (00:04:23)Exploration of the connection between financial issues and physician burnout.
Four Contributing Factors to Burnout (00:05:19)Dahle outlines the main factors contributing to physician burnout, including financial stress.
Financial Planning as a Solution (00:06:16)Emphasis on how good financial planning can alleviate burnout and improve career choices.
Promoting Clinical Resources (00:07:57)Mention of sister sites for clinical information and practice management resources.
Managing Medical Student Loans (00:08:27)Advice for young physicians on balancing student loan debt with building a financial foundation.
Current Student Loan Landscape (00:09:32)Analysis of the evolving situation regarding medical student loans and repayment options.
Strategies for Paying Off Student Loans (00:10:43)Recommendations for managing and paying off student loans effectively.
Financial Independence for Primary Care Physicians (00:12:42)Discussion on how primary care physicians can achieve financial independence despite lower earnings.
Increasing Income as a Primary Care Physician (00:14:58)Advice on negotiating salaries and improving income potential in primary care.
Common Financial Pitfalls for Physicians (00:15:58)Overview of frequent financial mistakes made by physicians and how to avoid them.
Qualities of a Good Financial Advisor (00:19:06)Guidance on what physicians should look for when selecting a financial advisor.
Stock Market as Gambling Trend (00:21:34)Concerns about treating stock market investments like gambling, particularly among younger physicians.
Understanding Long-Term Investing (00:22:20)Dahle explains the difference between short-term trading and long-term investing in profitable companies.
Speculative Investments Explained (00:24:14)Discussion on the risks of investing in speculative assets compared to legitimate businesses.
Evaluating Investment Opportunities (00:25:29)Dahle shares insights on how physicians should assess investment opportunities.
Importance of Insurance for Physicians (00:27:44)Highlighting the necessity of proper insurance coverage for financial security among physicians.
Finding White Coat Investor Resources (00:28:24)**Information on where to access The White Coat Investor’s content and resources across various platforms.
Heather Bassett, MD, chief medical officer of Xsolis, joins the show to talk about prior authorizations and how artificial intelligence (AI) could change everything.
Be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to Prior Authorizations (00:00:00)Discussion on how prior authorizations can frustrate physicians.
Overview of the Podcast (00:00:09)Austin Littrell introduces the podcast and the speakers.
Pain Points in Prior Authorization (00:01:07)Dr. Heather Bassett outlines the major challenges physicians face in prior authorizations.
Current Use of Technology (00:03:11)Discussion on how technology is currently applied in the prior authorization process.
Potential of AI in Healthcare (00:05:56)Exploration of how AI could help alleviate administrative burdens in prior authorizations.
Concerns About Automation (00:08:04)Discussion on risks of over-relying on automation and potential complications.
Impact of AI on Denials (00:16:05)Analysis of how AI might reduce inappropriate denials in the prior authorization process.
Future of Prior Authorizations (00:19:06)Speculation on how prior authorizations may evolve over the next 5 to 10 years.
Physician Involvement in Technology Development (00:23:45)Encouragement for physicians to engage in the development of prior authorization technologies.
The Importance of Physician Involvement (00:25:27)Discussion on the need for physicians to engage in projects for their voices to be heard.
The Role of AI in Healthcare (00:26:31)Emphasis on the inevitability of AI's integration into healthcare and the importance of education.
Addressing Fears Surrounding AI (00:26:37)Highlighting misconceptions about AI replacing jobs and its potential to enhance physician work.
Recognizing AI's Benefits and Risks (00:27:55)Acknowledgment of AI's imperfections but its advantages over manual processes in healthcare.
Closing Remarks and Acknowledgments (00:28:49)**Concluding thoughts and thanks from Todd Shryock and Austin Littrell for the discussion.
Stephen A. Dickens, JD, MAEd, FACMPE, vice president of medical practice services at State Volunteer Mutual Insurance Company (SVMIC), joins the show to talk strategic planning and why it's so important for practices to stay prepared in times of uncertainty.
Be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to Strategic Planning (00:00:22)**
Austin introduces the podcast and discusses the importance of strategic planning in healthcare.
Context of Economic Uncertainty (00:01:00)
Stephen shares insights on the current economic uncertainty due to President Trump's tariffs and its implications.
Mindset for Strategic Planning (00:01:40)
Stephen discusses the evolving nature of strategic planning and the importance of focusing on patient care.
Impact of Tariffs on Practices (00:03:06)
Discussion on how tariffs may negatively affect independent practices and patient care.
Preparation for Rising Costs (00:05:40)
Advice on immediate actions practices can take to prepare for potential cost increases.
Ripple Effects of Tariffs (00:07:12)
Exploration of how tariffs may affect daily operations and patient care in practices.
Making Strategic Planning Actionable (00:09:05)
Stephen explains how to make strategic planning feel real and actionable for practices.
Signs for Strategy Reset (00:11:52)
Indicators that a practice's strategy may need to be reassessed or reset.
Balancing Daily Tasks and Long-Term Planning (00:13:11)
Discussion on the importance of prioritizing long-term planning amidst daily administrative burdens.
Example of Successful Strategic Planning (00:15:35)
Stephen shares a story illustrating how strategic planning positively impacted a medical practice.
Potential Changes in the Labor Market (00:19:24)
Discussion on the possibility of shifts in the labor market due to economic factors and staffing issues.
Neal K. Shah, CEO of CareYaya Health Technologies and co-founder of Counterforce Health, joins the show to talk about claim denials and how AI can help fight them.
Be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know.
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Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to Claim Denials (00:00:23)
Overview of the podcast and introduction of the guests discussing claim denials and AI's role.
Neil Shah's Background (00:01:05)
Neil Shah shares his experience in healthcare and the impact of claim denials on patients.
Personal Experience with Claim Denials (00:01:36)
Neil recounts his wife's cancer battle and the frustrations of dealing with denied claims.
The Asymmetric Warfare of AI (00:03:09)
Discussion on how insurance companies leverage AI against patients and providers.
Provider Perspective on Claim Denials (00:04:12)
Insight into the financial and administrative burdens claim denials impose on healthcare providers.
Financial Impact on Practices (00:05:59)
Details on how denied claims lead to significant financial losses for medical practices.
Need for AI in Appeals (00:07:01)
Discussion on the potential of AI to streamline the appeals process and reduce costs.
Introduction to Counterforce Health (00:08:15)
Neil introduces Counterforce Health and its mission to democratize access to AI tools.
Maxwell: The Voice AI (00:10:06)
Introduction of Maxwell, an AI designed to assist with health insurance appeals.
Statistics on Claim Denials (00:11:43)
Maxwell shares shocking statistics about the financial impact of denied claims on practices.
Common Denial Reasons (00:12:30)
Discussion of the three most common denial reasons that practices can address to improve collections.
Case Study: James Wilson (00:13:55)
Maxwell walks through a specific case of a denied claim for a CPAP machine.
Call to Action for Providers (00:15:40)
Neil encourages providers to use the tools offered by Counterforce Health to combat claim denials.
Regulatory Changes Needed (00:16:27)
Neil discusses potential reforms to the claim denial process and the need for better regulation.
Patient Education and Advocacy (00:18:07)
Importance of educating patients about their rights regarding claim denials and appeals.
Final Thoughts on Healthcare Challenges (00:19:47)
Neil emphasizes the need for advocacy and systemic change in the healthcare system.
Conclusion and Thanks (00:20:29)
Closing remarks and gratitude expressed for the discussion and insights shared.
Medical Economics Editorial Director Christopher Mazzolini and Senior Editor Richard Payerchin join the podcast to discuss the new issue of Medical Economics Insider, our brand-new premium interactive digital edition designed to provide physicians with the in-depth insights and practical tools needed to thrive in today’s evolving health care landscape.
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Medical Economics Insider: https://www.medicaleconomics.com/view/medical-economics-insider-march-2025-save-your-practice
Leah Binder, president and CEO of The Leapfrog Group, joins the show to talk about notable trends in patient safety.
Be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to Patient Safety (00:00:00)
Discussion on alarming statistics about patient harm in hospitals, highlighting the severity of the issue.
Overview of the Leapfrog Group (00:01:04)
Leah Binder introduces the Leapfrog Group's mission to improve health care quality and safety through public reporting.
Current Status of Patient Safety (00:02:38)
Leah Binder shares disturbing statistics about patient harm and preventable deaths in American health care.
Positive Trends in Patient Safety (00:04:51)
Despite bad news, Binder discusses successful hospitals demonstrating significant improvements in patient safety measures.
The Role of Physicians in Patient Safety (00:08:11)
Binder emphasizes the importance of primary care physicians using their voice to advocate for patient safety.
Building Relationships with Employers (00:10:29)
Discussion on the need for healthcare providers to connect with employers to enhance primary care's role.
Trends in Hospital Safety Measures (00:12:58)**
Binder describes trends in maternity care procedures, noting significant reductions in episiotomy and elective deliveries.
Impact of Technology on Patient Safety (00:18:45)
Discussion on the deployment of technology, including computerized physician order entry systems, to enhance patient safety.
Artificial Intelligence in Healthcare (00:19:08)
Exploration of how AI could improve patient care and safety through real-time data synthesis and alert systems.
Policy Solutions for Patient Safety (00:23:21)
Binder discusses the need for federal lawmakers to enhance patient safety and quality through better transparency measures.
Quality Measurement in Healthcare (00:24:38)
Discussion on improving quality and safety measurements by utilizing EMRs instead of traditional claims data.
Future of Quality Monitoring (00:25:43)
Anticipation of advancements in enterprise-wide monitoring of quality and safety in health care systems.
Appreciation for Healthcare Providers (00:26:13)
Acknowledgment of the vital role clinicians play in improving lives and the collective emphasis on healthcare.
Closing Remarks (00:27:08)
Gratitude expressed for the conversation and the importance of ongoing discussions in health care.
Episode Wrap-Up (00:27:41)
Final thanks and encouragement to subscribe for future episodes and updates from Medical Economics.
Rohit Harve, a technical operations partner and health care expert with PA Consulting, joins the show to talk tariffs and their impact on the medical device industry.
Be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Impact on Consumers (00:00:00)Prices will be passed on to consumers, affecting doctors, patients, and health care providers. Introduction to the Topic (00:00:14)Austin Littrell introduces the episode and the guest, Rohit Harve, focusing on tariffs in the medical device industry.
Current Landscape of Tariffs (00:01:01)Rohit discusses the volatile situation regarding tariffs and their effects on the medical device industry.
Profitability and Market Dynamics (00:01:20)Tariffs impact profitability, growth, and market dynamics, especially in discretionary care segments.
Cost of Goods and Components (00:02:29)Increased costs for components like semiconductors and materials will affect margins and pricing power.
Impact on Healthcare Costs (00:04:17)Increased costs will ultimately affect health care expenses for consumers, doctors, and patients.
Supply Chain Issues (00:06:14)Tariffs will complicate supply chains, pushing manufacturers to seek local suppliers amid regulatory challenges.
Challenges of Reshoring (00:09:07)Moving complex manufacturing back to the U.S. is challenging due to time, cost, and skill shortages.
Competitiveness in Global Market (00:11:17)Tariffs will hinder U.S. medical device companies' competitiveness and innovation in the global market.
Industry Response and Lobbying (00:12:22)Active lobbying efforts are ongoing to address tariffs and their implications for the health care sector.
Future of Tariffs (00:14:12)The likelihood of a deal on tariffs is uncertain, with potential adjustments in magnitude anticipated.
Uncertainty's Impact (00:15:18)Uncertainty surrounding tariffs affects the medical device industry, though it may handle fluctuations better than others.
Insights on Efficiency (00:16:41)Startups should focus on product efficiency and competitiveness in the global market amidst changing conditions.
Conclusion of Discussion (00:17:35)**Todd thanks Rohit for the insightful conversation on tariffs and their economic implications for health care.
Zed Williamson, founder and CEO of Physician Growth Accelerator, joins the show to talk about common challenges physicians face in private practice, explaining how to manage a successful practice without sacrificing patient care. For more from Zed and his team, check out the Physician Growth Accelerator website, podcast, and YouTube channel.
Plus, starting this Wednesday, March 19, find new episodes of the Physician Growth Accelerator podcast at MedicalEconomics.com.
Also, be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know.Music Credits:Acoustic Chill by Lorenzoangelucci/MusicRevolution - stock.adobe.comRelaxing Lounge by Classy Call me Man - stock.adobe.com
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to Burnout (00:00:00)
Discusses the misconception that burnout stems from busyness, emphasizing the emotional aspect instead.
Podcast Introduction (00:00:19)
Austin Littrell introduces the podcast and the guest speakers, setting the stage for the discussion.
Overview of Physician Growth Accelerator (00:01:05)
Zed Williamson explains the mission of his company and its focus on improving private practices.
Challenges in Private Practices (00:01:12)
Details the variability in outcomes among practices despite similar inputs, highlighting internal constraints.
Consulting Philosophy (00:02:26)
Zed describes the "do it with you" approach to consulting, emphasizing collaboration over mere advice.
Importance of Clinical Excellence (00:04:10)
Stresses that clinical excellence must be the primary focus of medical practices for patient trust.
Business vs. Patient Care Mindset (00:04:23)
Explains the need for physicians to shift their mindset from treating business issues like patient problems.
Cultural Foundations of Practice (00:07:01)
Discusses the significance of a supportive culture in practices and its impact on performance.
Creating a Supportive Culture (00:07:21)
Explores how to intentionally drive a practice's culture to align with its goals and values.
Revenue Cycle Management (00:09:22)
Highlights the importance of understanding the lifetime value of patients for better financial forecasting.
Managing Administrative Burdens (00:12:35)
Offers strategies for practices to proactively manage administrative tasks and reduce burdens.
Approaching Technology (00:14:48)
Discusses the double-edged sword of technology in practices and the importance of strategic implementation.
Shifting Mindsets for Business Success (00:18:19)
Encourages physicians to adapt their thinking to balance clinical practice and business management effectively.
Identifying the Destination (00:20:36)
Discusses the importance of setting measurable goals to guide physicians in their practice.
Addressing Physician Burnout (00:24:01)
Explores the causes of burnout and emphasizes rekindling passion for work to alleviate stress.
Creating a Better Work Environment (00:25:13)**
Suggests ways to improve the working conditions for private practice physicians and reduce anxiety.
Ericka Adler, JD, of Roetzel & Andress, joins the show to discuss factors you should consider before selling your practice.
For more, be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know.Music Credits:CHILL RELAXED JAZZ (DR SMOOTH) by Tasty Tunes - stock.adobe.comRelaxing Lounge by Classy Call me Man - stock.adobe.com
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Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to the episode (00:00:00)
Overview of the podcast and introduction of the speakers discussing selling a medical practice.
Importance of compliance review (00:01:05)
Discussion on the compliance review process and its significance in the sale of a medical practice.
Staff's role in compliance (00:02:27)
Exploration of how staff compliance affects the sale process and potential buyer decisions.
Billing issues in due diligence (00:03:38)
Insight into common billing issues that arise during due diligence and their implications.
Compensation arrangements and compliance (00:05:14)
Examination of how improper compensation can lead to compliance issues in medical practices.
Maintaining HIPAA compliance (00:08:20)
Strategies for ensuring HIPAA compliance during the due diligence process when selling a practice.
Impact of state laws on sales (00:10:13)
Discussion on how different state laws can complicate the sale of multi-state practices.
Common misconceptions in selling (00:13:04)
Addressing misconceptions physicians have about the sales process and buyer expectations.
Reasons sales fall through (00:14:46)
Examples of mistakes by practice owners that can lead to failed sales transactions.
Buyers' considerations beyond profitability (00:16:39)
Understanding that buyers evaluate more than just financials; they assess overall compliance and operations.
Due diligence variations by buyer type (00:17:50)
Comparison of due diligence levels between physician groups, private equity, and health systems.
Addressing unqualified staff (00:19:13)
Advice on whether to remove unqualified family members from payroll before selling.
Planning ahead for sale (00:20:38)
Emphasis on the importance of early planning and thorough preparation before selling a practice.
Conclusion and final thoughts (00:22:29)
Wrap-up of the conversation, highlighting key takeaways for physicians selling their practices.
Linda Stein Gold, MD, FAAD, discusses the late-breaking tapinarof cream 1% data from a new analysis of the ADORING-3 clinical trial. Interview recorded at the 2025 American Academy of Dermatology conference in Orlando, Florida.
Topics discussed include:* Key insights from the new analysis of the ADORING-3 clinical trial on the use of tapinarof cream, 1% in patients with atopic dermatitis. * Long-term safety and efficacy of tapinarof cream. * How tapinarof cream differs from existing treatment options. * Impacts on clinical practice.
Norman K. “Kip” Beals, MD, is executive director of primary care for Independence Health System in western Pennsylvania. He is board certified in family medicine and sports medicine. A physician practicing for 35 years, Beals has worked in independent practice and as a physician leader and chief innovation officer for health systems.
Beals joins the show to discuss the evolving landscape of health care reimbursement — and how physicians can weather the storm.
For more, be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know.Music Credits:Chill Lounge by Elonix - stock.adobe.comRelaxing Lounge by Classy Call me Man - stock.adobe.com
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Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to Healthcare Reimbursement (00:00:22)
Overview of the podcast and discussion topics, including Medicare cuts and financial pressures.
Physicians' Awareness of Medicare Cuts (00:01:04)
Dr. Beals discusses how physicians typically learn about Medicare reimbursement cuts through news rather than direct communication.
Reactions to Reimbursement Cuts (00:03:12)
Physicians often feel a mix of frustration and resignation regarding ongoing cuts to reimbursements.
Burnout Among Physicians (00:04:44)
Discussion on the alarming statistic of physician burnout and its impact on healthcare practices.
Business Training in Medical Education (00:07:08)
Dr. Beals highlights the lack of business training for physicians during medical school.
Strategies for Increasing Revenue or Cutting Expenses (00:09:32)
Exploration of how physicians can approach financial challenges in their practices.
Collaboration in Healthcare (00:10:36)
Emphasis on the need for intense collaboration among healthcare providers to improve efficiency.
Lessons from the COVID-19 Pandemic (00:13:30)
Reflections on how the pandemic has forced healthcare practices to adapt and become leaner.
Innovative Approaches in Healthcare (00:15:42)
Discussion on using technology and innovative thinking to enhance healthcare delivery.
Community Needs Assessment (00:18:23)
Dr. Beals shares the importance of understanding community needs for effective healthcare solutions.
Practical Examples of Community Engagement (00:19:10)
Examples of initiatives aimed at addressing barriers to healthcare access in rural areas.
Population Health and Cost Efficiency (00:22:40)
Discussion on improving healthcare outcomes and reducing costs through efficient disease management and early problem detection.
Government Cuts and Innovation (00:23:41)
Impact of potential Medicare cuts on driving innovation and finding better healthcare solutions.
Importance of Primary Care (00:25:46)
Encouragement for patients to seek care from primary care providers for efficient and comprehensive healthcare.
Collaboration in Healthcare Leadership (00:26:59)
Advocacy for collaboration between clinical and administrative leaders to enhance patient care and community health outcomes.
Closing Remarks and Gratitude (00:27:48)
Expression of appreciation for the conversation and acknowledgment of the importance of continued dialogue.
Andrea Greco, senior vice president of health care safety at CENTEGIX, joins the podcast to discuss keeping practices safe and how failing to do so can impact patient care.
For more, be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know. Music Credits:Retro Rhythm by BJBeats - stock.adobe.com
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Workplace Violence is Unacceptable (00:00:00)**
Discussion on the unacceptability of workplace violence in healthcare settings.
Introduction to the Episode (00:00:15)
Host Keith Reynolds introduces the episode's focus on workplace safety in healthcare.
Impact of Workplace Violence on Nurses (00:00:54)
Andrea Greco explains how workplace violence affects nurse satisfaction and patient care.
Workplace Safety and Staff Retention (00:02:25)
Discussion on the importance of workplace safety for retaining healthcare staff, especially younger workers.
Creating a Culture of Safety (00:03:00)
Strategies for fostering a culture of safety and well-being in healthcare organizations.
Situational Awareness for Incident Responders (00:05:33)
Importance of situational awareness and tools for employees to report incidents.
Barriers to Incident Reporting (00:07:42)
Exploration of barriers preventing effective incident reporting in healthcare settings.
Visitor Management Protocols (00:09:00)
Steps for primary care practices to enhance visitor management and reduce safety risks.
Prioritizing Workplace Safety (00:11:13)
Key priorities for healthcare leaders to ensure a safe workplace moving forward.
Final Thoughts on Caregiver Support (00:12:31)
Emphasis on putting caregivers first and maintaining a supportive environment.
Yashaswini Singh, PhD, MPH, a health care economist and assistant professor at Brown University's School of Public Health, joins the show to discuss her recent research article, "Growth of Private Equity and Hospital Consolidation in Primary Care and Price Implications," published in JAMA Health Forum.For more, be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know. Music Credits:Lofi Chillout Hip Hop Beat by Joystock - stock.adobe.com
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Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to Primary Care Pressures (00:00:00)Discussion on significant pressures faced by independent primary care practices in the U.S.
Podcast Introduction (00:00:17)Austin Littrell introduces the episode and the speakers, including guest Yashaswini Singh, PhD, MPH.
Trends in Hospital and Private Equity Consolidation (00:01:08)Dr. Singh discusses consolidation trends in primary care involving hospitals and private equity.
Market Dynamics of Healthcare (00:02:39)Insights on how U.S. healthcare markets struggle due to inadequate competition and increasing consolidation.
Private Equity Investment Overview (00:03:48)Discussion on the substantial investment by private equity firms in various healthcare settings.
Methodology of Research Study (00:04:00)Overview of the research objectives and methodology used to analyze primary care employment trends.
Findings on Primary Care Employment (00:05:01)Key findings reveal a significant increase in hospital-affiliated primary care physicians from 2009 to 2022.
Impact of Pricing on Care (00:06:18)Analysis of how physician employment trends affect healthcare costs and patient pricing.
Explaining Price Differences (00:08:14)Discussion on factors contributing to price differences between hospital-affiliated and independent practices.
Regional Disparities in Consolidation (00:10:27)Examination of geographic variations in hospital and private equity affiliations among primary care physicians.
Evolution of Private Equity in Healthcare (00:12:16)Insights into the timeline and focus shifts of private equity investment in physician practices.
Future Research Directions (00:15:05)Discussion on the need for further research on consolidation impacts and private equity exit strategies.
Implications for Primary Care Physicians (00:17:23)Advice for primary care physicians on navigating the changing landscape of healthcare consolidation.
Emerging Trends in Primary Care (00:19:15)Recognition of additional evolving models in primary care beyond hospital and private equity affiliations.
Ferhat Dikbiyik, chief research and intelligence officer at the cybersecurity firm Black Kite, joins the podcast to discuss cybersecurity and the evolving structure and threat of ransomware gangs.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to the episode (00:00:15)**
Host Keith Reynolds introduces the podcast and the discussion on cybersecurity and ransomware gangs.
Surge in ransomware attacks (00:00:49)
Ferhat discusses the 32% increase in ransomware attacks in healthcare from 2023 to 2024.
Dynamics of ransomware ecosystem (00:01:11)
Ferhat explains shifts in the ransomware ecosystem, emphasizing the rise of affiliate-driven models.
Affiliates in ransomware (00:03:39)
Discussion on how affiliates operate within the ransomware ecosystem and their motivations.
Targeting smaller medical practices (00:06:01)
Ferhat highlights the increased risk smaller medical practices face from ransomware attacks.
Banning ransom payments (00:08:33)
Discussion on the implications of banning ransom payments for victims under pressure.
Changing negotiation tactics (00:10:01)
Ferhat notes the shift towards urgent ransom demands with little room for negotiation.
Challenges for law enforcement (00:11:53)
Ferhat explains the difficulties law enforcement faces in combating organized ransomware groups.
Geographic distribution of ransomware groups (00:12:49)
Ferhat discusses the locations of ransomware groups, primarily in Eastern Europe and Russia.
Finding targets for attacks (00:14:35)
Ferhat describes how cybercriminals identify and select small medical practices to target.
Health care as a prime target (00:15:29)
Ferhat predicts that healthcare will continue to be a significant target for cybercriminals.
Protecting small medical practices (00:16:29)
Advice on proactive measures small practices can take to safeguard against ransomware.
Phishing and vulnerabilities (00:17:56)
Ferhat discusses the prevalence of phishing as an attack method for ransomware groups.
Training employees on phishing (00:18:30)
Emphasis on the importance of training staff to recognize phishing attempts.
Final thoughts on ransomware risks (00:18:37)
Ferhat stresses the need for vigilance and proactive measures against increasing ransomware risks.
Maryal Concepcion, MD, FAAFP, the owner and CEO of Big Trees MD, joins the show to talk direct primary care with Medical Economics Editorial Director, Chris Mazzolini. Concepcion shares the story of her own personal transition from traditional, fee-for-service medicine, to starting her own direct primary care practice.
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Introduction to Direct Primary Care (00:00:00)**
Maryal Concepcion, MD, FAAFP, shares her vision of primary care as it relates to direct primary care (DPC).
What is Direct Primary Care? (00:01:01)Concepcion explains DPC and its differences from traditional fee-for-service medicine.
The Community Aspect of DPC (00:02:42)Discussion on the importance of community relationships in DPC and patient care.
Challenges in Traditional Medicine (00:04:41)Concepcion reflects on her experiences in traditional fee-for-service medicine.
Journey Through Medical Training (00:05:02)Overview of Concepcion's medical education and her transition to attending physician.
Experience in Fee-for-Service (00:06:39)Concepcion describes the limitations and frustrations in her fee-for-service practice.
Impact of Corporate Medicine (00:08:47)Insights on corporate practices and the challenges faced by physicians.
Creating a Podcast for Healing (00:10:47)Concepcion discusses starting a podcast as a way to share experiences and heal.
Describing the DPC Practice (00:13:00)Concepcion explains how her DPC practice operates and its patient-centered focus.
Setting Up a DPC Practice (00:17:16)Discussion on the steps taken to establish her DPC practice from scratch.
Marketing and Communication in DPC (00:20:07)Concepcion talks about the importance of marketing and patient communication in DPC.
Elevator Pitch for Patients (00:20:59)Overview of how Concepcion introduces DPC to patients and addresses their concerns.
Understanding Patient Needs (00:22:06)Discussion on the importance of listening to patients and addressing their needs in healthcare.
Transitioning to Direct Primary Care (00:23:03)Advice for listeners on taking the first steps toward transitioning from fee-for-service to DPC.
Resources for DPC Transition (00:23:33)Introduction of various resources available for those interested in starting a DPC practice.
Support and Community in DPC (00:25:13)Emphasis on the supportive community available to DPC practitioners across the United States.
Closing Remarks (00:26:27)Thanking Maryal Concepcion for her insights and contributions to the discussion.
Anders Gilberg, senior vice president for government affairs with MGMA, joins us to discuss the second Trump administration and MGMA's policy wishlist.
MGMA's advocacy agenda
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and overview (00:00:00)**
Discussion begins with a mention of Elon Musk's impact on a significant healthcare bill.
Welcome and context (00:00:17)
Keith introduces Anders Gilberg and sets the context of the conversation regarding the second Trump administration.
Current state of health care (00:01:25)
Anders discusses the unfinished business from the previous Congress and the lack of political leadership in key agencies.
Key personalities in HHS (00:02:54)
Exploration of potential new leaders in HHS and their implications for healthcare legislation.
Challenges from previous Congress (00:04:38)
Discussion on the lingering effects of changes made to evaluation and management codes affecting physician payments.
Legislative uncertainty (00:08:08)
Anders reflects on the unexpected changes to a crucial healthcare bill and its impact on physician payments.
Regrouping and future strategies (00:09:58)
Anders outlines the need for re-education and regrouping following the shifts in Congress and political landscape.
Advocacy agenda overview (00:15:12)
Anders shares key priorities for the GMA, focusing on physician payment reform and reducing regulatory burdens.
Prior authorization issues (00:16:37)
Discussion on the burdens of prior authorization and efforts to improve transparency in insurance practices.
Quality reporting concerns (00:18:05)
Anders critiques the MIPS program and the need for a more efficient way to report quality measures.
Cybersecurity in health care (00:19:20)
Highlighting the importance of addressing cybersecurity threats and the implications for healthcare operations.
Conclusion and future check-ins (00:20:35)
Anders expresses willingness to return for future discussions as the political landscape evolves.
Medical Economics Managing Editor Todd Shryock and Peter H. Reilly, North American health care practice leader and chief sales officer at HUB International, discuss the top risks that medical practices face in 2025, as detailed in HUB International's 2025 Healthcare Outlook and Insurance Market Rate Report, from malpractice insurance rates to cybersecurity to natural disasters.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to the Episode (00:00:20)Overview of the podcast and introduction of speakers discussing healthcare risks for 2025. Discussion on Healthcare Costs (00:02:23)Exploration of rising costs and decreasing reimbursements in healthcare.
Rural Hospitals and Financial Pressures (00:05:49)Impact of financial strain on rural hospitals and the need for awareness among physicians.
Worker Shortages and Burnout (00:08:10)Addressing the challenges of worker shortages and mental strain in healthcare practices.
Malpractice Insurance Trends (00:12:08)Overview of the medical professional liability market and its financial pressures.
Mitigating Natural Disaster Risks (00:15:21)Strategies for practices to prepare for natural disasters and minimize operational disruptions.
Cybersecurity Risks in Healthcare (00:19:16)Discussion on the increasing threat of cybercrime and the importance of data security.
Final Thoughts on Risk Management (00:23:32)**Encouragement for practitioners to understand and proactively manage risks in their practices.
Medical Economics Senior Editor Richard Payerchin and Robert Kushner, MD, professor of medicine and medical education at Northwestern university talking about the latest advancements in treating obesity, and how physicians should approach the drugs making a splash across the industry.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to new medications (00:00:00)Discussion on understanding the administration and combination of new medications for weight loss and health improvement. Podcast introduction (00:00:20)Host introduces the episode featuring Richard Payerchin andRobert Kushner, MD, discussing obesity treatment advancements. Current status of physicians (00:01:15)Kushner highlights physicians' increasing awareness and adoption of new obesity medications. Effectiveness of new medications (00:02:02)Overview of how new medications improve weight loss and health outcomes compared to previous treatments. Not a cure-all (00:03:38)Kushner clarifies that while effective, these medications are not a complete solution for obesity. Patient questions and concerns (00:05:14)Common patient inquiries about candidacy for new medications and managing side effects. Criteria for candidacy (00:06:45)Discussion on body mass index (BMI) criteria for patients to qualify for obesity medications. Economic factors in treatment (00:08:34)Challenges regarding medication affordability and insurance coverage impacting treatment decisions. Personal experience with medications (00:09:03)Kushner shares his extensive experience prescribing various obesity medications. Treatment regimen approach (00:10:55)Emphasis on addressing obesity as a chronic disease with appropriate treatment strategies. Lifestyle foundation for treatment (00:13:10)Importance of lifestyle changes alongside pharmacotherapy in obesity management. Avoiding counterfeit medications (00:15:40)Discussion on the dangers of counterfeit drugs and the importance of sourcing legitimate medications. Long-term study insights (00:18:30)Insights from a study on semaglutide and its acceptance rate among patients regarding side effects. Future of obesity medications (00:21:18)Predictions on the long-term safety and efficacy of semaglutide based on recent studies. Financial predictions for coverage (00:23:54)Discussion on potential changes in medication coverage and the future of obesity treatment advancements. Introduction to new medications (00:24:36)Discussion on glucagon and amylin medications showing promise in obesity treatment trials. Oral medications development (00:25:10)Anticipation for oral small molecule medications that mimic injectable treatments for obesity. Medicare approvals and cost implications (00:25:42)Medicare's approval of semaglutide for certain patients and the need to reduce medication costs. Future of medication pricing (00:26:29)Expectations for price renegotiation and the potential for generic medications to lower costs. Importance of primary care engagement (00:26:48)Emphasis on primary care physicians' role in managing obesity with new medications and lifestyle changes. Closing remarks (00:27:59)**Gratitude expressed for the discussion and the importance of familiarity with obesity treatments.
Medical Economics Assistant Editor Austin Littrell and Richard Miller, MD, a psychiatrist with Elwyn Adult Behavioral Health in East Greenwich, Rhode Island, discuss how to talk to patients about health information they get from social media.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to social media's Impact (00:00:00)
Discussion on the prevalence of social media and its role in shaping health perceptions.
Host Introduction (00:00:21)
Keith Reynolds introduces the podcast and the guests for the episode.
Richard Miller's background (00:01:01)**
Miller shares his professional background and current practice details.
Misaligned patient expectations (00:02:28)
Exploration of how social media trends create unrealistic expectations for treatment options.
Addressing inappropriate treatment requests (00:04:45)
Strategies for physicians to manage patient requests for unproven treatments from social media.
Managing patient frustration (00:06:18)
Techniques for healthcare providers to handle misunderstandings and frustrations from patients.
Role of empathy in patient relationships (00:07:46)
Importance of empathy in maintaining strong patient-provider relationships amid misinformation.
Shared decision-making in treatment (00:09:42)
Discussion on how shared decision-making can help navigate patient concerns rooted in misinformation.
Educating patients on treatment plans (00:11:23)
Recommendations for healthcare providers to effectively educate patients about treatment options.
Improving patient education with social media (00:12:35)
Suggestions for healthcare providers to use social media as a tool for patient education.
Importance of reliable resources (00:14:17)
Advocacy for creating reliable resources to provide accurate health information to patients.
Closing thoughts on psychiatric treatments (00:15:18)Miller emphasizes the benefits of modern psychiatric medications and treatment options.
Conclusion and yhanks (00:16:22)
Keith Reynolds wraps up the episode, thanking the guests and listeners.
Medical Economics Assistant Editor Austin Littrell and Jay W. Lee, MD. MPH, FAAFP, board member at the AAFP and medical director at Integrated Health Partners of Southern California, discuss how to overcome vaccine hesitancy in patients.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to Vaccine Discussion (00:00:00)**
The podcast introduces the topic of vaccine hesitancy among patients.
Overview of CDC Recommendations (00:01:03)
Dr. Lee discusses the latest CDC recommendations on COVID-19 and pneumococcal vaccines.
Importance of Encouraging Vaccinations (00:03:19)
Dr. Lee emphasizes the need for physicians to promote vaccinations during the respiratory season.
Changing Approaches Post-COVID (00:06:02)
The conversation highlights how vaccine discussions have evolved due to misinformation since the pandemic.
Building Rapport with Patients (00:08:33)
Strategies for physicians to address vaccine hesitancy through establishing trust and open dialogue.
The Role of Family Practices (00:10:55)
Dr. Lee explains the importance of family practices in providing vaccines and maintaining patient relationships.
Encouraging Usual Source of Care (00:12:35)
The significance of having a consistent healthcare provider for better patient outcomes is discussed.
Medical Economics Managing Editor Todd Shryock and attorney Emma Schuering, of the Polsinelli law firm discuss non-compete agreements in health care.
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Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to Non-Compete Agreements (00:00:14) Introduction to the episode and the guests discussing non-compete agreements in healthcare.
Current Legal Landscape (00:01:06) Emma Schuering explains the ongoing uncertainty about non-compete agreements following the FTC's rule and legal challenges.
Elements of Non-Compete Agreements (00:03:19) Discussion of the typical components of non-compete agreements, including restrictions on employment and geographic limitations.
Public Policy Considerations (00:04:26) Emma highlights the strong public policy against restricting physicians from treating patients of their choice.
State Law Variations (00:05:38) Overview of how enforceability of non-compete agreements varies by state, including buyout clauses.
Alternatives to Non-Competes (00:08:36) Exploration of legal mechanisms that protect practices without limiting physicians' employment opportunities.
Risks of Hiring Physicians with Non-Competes (00:13:25) Discussion on the potential liability for practices hiring physicians with existing non-compete agreements.
Consequences of Termination (00:15:36) Explanation of the legal complications that arise if a physician is fired due to a non-compete issue.
Enforcement of Non-Solicitation Agreements (00:17:41) Details on the process and recourse for practices when a former employee violates a non-solicitation agreement.
Implementing Non-Compete Agreements (00:22:44) Advice for practice owners on assessing the need for non-compete agreements and understanding applicable laws.
The Future of Non-Compete Agreements (00:26:17) Discussion on the trend of banning non-compete agreements and preparing for a world without them.
Planning for Change (00:27:39) Importance of proactive planning for healthcare practices regarding non-compete agreements and future regulations.
Closing Remarks (00:28:13) Concluding thoughts and gratitude from the host and guest, emphasizing the conversation's significance.
Subscription Information (00:28:34) Encouragement to subscribe to the podcast and the Medical Economics newsletter for more insights.
Medical Economics presents the Physician’s Guide to Running for Office. This is a companion piece to the wonderful print feature by Medical Economics Editor Richard Payerchin. This episode has been pulled from the hours of interviews he performed with Physicians serving in government at the local, state, and federal level.
Physician politicians: Why doctors choose to serve -- and how you can too by Richard Payerchin
Cast list (in order of appearance)
Name: Jasmeet Bains, M.D.
City, State: Delano, California
Specialty: Family medicine, addiction medicine
Elected Office: Assemblymember, California State Assembly
Medical school: American University of Antigua
Name: Ken Moore, M.D.
City, State: Franklin, Tennessee
Specialty: Orthopedic surgery
Elected Office: Mayor, Franklin Tennessee
Medical school: University of Tennessee College of Medicine
Name: Elizabeth Steiner, M.D.
City, State: Portland, Oregon
Specialty: Family medicine
Elected Office: Senator, Oregon Senate, and running for Oregon state treasurer
Medical school: University of Massachusetts Medical School
Name: Alice Mann, M.D., M.P.H.
City, State: Edina, Minnesota
Specialty: Emergency medicine
Elected Office: Senator, Minnesota Senate
Medical school: Meharry Medical College, Johns Hopkins University
Name: Ami Bera, M.D.
City, State: Sacramento County, California
Specialty: Internal medicine
Elected Office: Congressman, U.S. House of Representatives
Medical school: University of California, Irvine
Name: Michael C. Burgess, M.D.
City, State: Cooke County, Texas
Specialty: Obstetrics/gynecology
Elected Office: Congressman, U.S. House of Representatives
Medical school: University of Texas Medical School
Name: Kim Schrier, M.D.
City, State: Sammamish, Washington
Specialty: Pediatrics
Elected Office: Congresswoman, U.S. House of Representatives
Medical school: University of California, Davis, School of Medicine
Name: Bill Hauter, M.D.
City, State: Morton, Illinois
Specialty: Emergency medicine, anesthesiology
Elected Office: Representative, Illinois House of Representatives
Medical school: Indiana University
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Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to the Episode (00:00:00)Discussion on the impact of policy decisions made by those without medical experience on healthcare practices. Challenges in Politics (00:01:11)Dr. Jasmeet Bains shares her hesitations about entering politics and the significant commitment required. Dr. Ken Moore's Quick Decision (00:02:10)Dr. Ken Moore explains his spontaneous decision to run for office in Tennessee. Dr. Elizabeth Steiner's Advocacy (00:02:51)Dr. Steiner discusses her advocacy work and the realization of the need for a physician's voice in legislation. Dr. Alice Mann's Motivation (00:04:50)Dr. Mann shares her concern for patients and her journey back into politics after initially stepping away. Dr. Ami Bera's Political Entry (00:06:51)Dr. Bera describes his motivation to run for office during the Affordable Care Act discussions. Dr. Michael Burgess's Influential Moment (00:07:31)Dr. Burgess reflects on how 9/11 influenced his decision to run for office. Fundraising Challenges (00:08:06)Dr. Kim Schrier discusses her discomfort with fundraising and the necessity of it in campaigning. Campaigning and Community Engagement (00:10:11)Dr. Steiner emphasizes the importance of community interaction during her campaign. Negative Campaigning Experiences (00:11:12)Dr. Bill Hauter recounts facing negative attacks from his own party during the primary election. Dr. Mann's Insight on Political Messaging (00:14:10)Dr. Mann shares her experiences with misleading attack ads during her campaign. Reflections on Losing Elections (00:16:34)Dr. Bera discusses his initial loss in 2010 and the valuable experiences gained from it. Trust in Election Results (00:17:42)Dr. Schrier expresses caution regarding election numbers but acknowledges the trust constituents place in her. Day-to-Day Life in Congress (00:18:58)Dr. Bera describes the demanding schedule of a U.S. House representative. Legislative Routine in Oregon (00:20:50)Dr. Steiner outlines her busy schedule during legislative sessions and the importance of relationship building. Full-Time Commitment in Politics (00:22:43)Dr. Mann explains her view of her legislative role as a full-time job alongside her medical practice. Balancing Family and Politics (00:24:02)Dr. Mann discusses how she incorporates her family into her political activities and campaign efforts. Balancing Politics and Practice (00:24:44)Dr. Bains shares her experience managing time between being a legislator and medical director. The Need for Physician Advocacy (00:25:53)Discussion on the importance of physician voices in state politics despite time constraints. The Dual Role of Physicians (00:26:59)Physicians must prioritize advocacy while managing their demanding medical careers. Diversity in Political Perspectives (00:28:51)Dr. Burgess highlights the lack of uniformity among physician politicians in Congress. Bipartisan Collaboration (00:29:53)Dr. Schreier emphasizes the importance of physician camaraderie across party lines for effective governance. Pressure and Freedom in Politics (00:31:05)Dr. Horton discusses the freedom of being a citizen legislator without career politician pressures. Advice for Aspiring Legislators (00:33:07)Dr. Steiner advises on the patience and tenacity required for legislative roles. Understanding Your Motivations (00:33:26)Reflecting on the importance of knowing why one wants to run for office. The Interconnection of Medicine and Politics (00:33:51)Dr. Mann stresses the necessity for physicians to engage in political processes affecting healthcare. Closing Remarks (00:35:01)Host Keith Reynolds concludes the episode, thanking contributors and encouraging political engagement.
Medical Economics Editorial Director Chris Mazzolini and Dr. Eve Cunningham, chief of virtual health and digital care at Providence and founder of MedPearl, discuss challenges with patient management and workflow.
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Editor's note: Episode timestamps and transcript produced using AI tools.
Access Challenges in Healthcare (00:00:00)
Discussion on the growing access challenges in healthcare if not addressed.
Introduction to the Podcast (00:00:18)
Keith Reynolds introduces the podcast and its focus on healthcare challenges.
Guest Introduction (00:00:50)
Dr. Eve Cunningham is welcomed to discuss patient management and workflow challenges.
Challenges in Patient Management (00:01:23)
Dr. Cunningham outlines the complexities of patient management and referral decisions for primary care physicians.
Overwhelming Medical Knowledge (00:01:27)
Discussion on the rapid increase of medical knowledge and its impact on clinicians.
Referral Dysfunction Issues (00:02:31)
Exploration of common referral dysfunctions and the need for optimized transitions.
Examples of Referral Issues (00:03:41)
Real-life examples illustrating the frequent misdirection in patient referrals.
Access to Care and Burnout (00:04:48)
Highlighting the shortage of doctors and its effect on access to care and clinician burnout.
Introduction to MedPearl (00:06:19)
Overview of MedPearl as a solution to the challenges faced by doctors.
Genesis of MedPearl (00:06:38)
Dr. Cunningham shares the story behind the development of MedPearl.
Communication Gaps in Healthcare (00:07:13)
Discussion on the knowledge-sharing gap between primary care and specialists.
Need for Clinician-Centric Technology (00:08:13)
Emphasis on creating technology that supports primary care clinicians effectively.
Med Pearl's Features (00:09:31)
Description of MedPearl's capabilities and how it aids clinicians at the point of care.
Case Study in NEJM Catalyst (00:11:35)
Discussion on a case study highlighting the impact of MedPearl in clinical settings.
Pilot Program Results (00:12:45)
Review of pilot results demonstrating Med Pearl's effectiveness in referrals and patient care.
Scaling MedPearl (00:13:58)
Description of MedPearl's scaling process and its growing user base.
Improving Referral Value (00:15:10)
Discussion on enhancing referral quality and outcomes through MedPearl.
Burnout and Clinician Efficiency (00:15:10)
Exploration of how MedPearl addresses clinician burnout and improves efficiency.
Importance of Clinician Involvement (00:17:02)
Discussion on why clinician input is essential in developing effective healthcare solutions.
Future Plans for Med Pearl (00:19:40)
Dr. Cunningham shares upcoming implementations and goals for MedPearl.
Medical Economics Managing Editor Todd Shryock sits down with Roger Kapoor, MD, author of "Work Happy" to discuss the scourge of burnout.
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**Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to Stress (00:00:00)**
Discussion on the nature of stress, highlighting that not all stress is detrimental.
Podcast Overview (00:00:14)
Keith Reynolds introduces the podcast and its focus on physician burnout.
Defining Burnout (00:01:29)
Kapoor explains burnout as a syndrome recognized by WHO, emphasizing its chronic nature.
Workplace Causes of Burnout (00:02:28)
Exploration of workplace factors contributing to burnout, such as administrative tasks and lack of control.
Lifestyle Choices and Burnout (00:03:41)
The impact of personal lifestyle choices on burnout, including sleep deprivation and work-life balance.
Differentiating Burnout from Stress (00:04:38)
Key signs of burnout versus normal work stress, including emotional exhaustion and depersonalization.
The Nature of Stress (00:06:22)
Discussion on how stress can be both beneficial and harmful, depending on its management.
Job Satisfaction and Change (00:07:57)
Kapoor discusses the importance of aligning career with personal purpose and the concept of ikigai.
Understanding Ikigai (00:08:59)
Introduction to ikigai, a Japanese concept for finding one's life purpose through self-reflection.
Example of Ikigai in Action (00:10:07)
Story of Joe Addis, illustrating how passion and purpose can lead to success.
The Importance of Nurturing Skills (00:11:14)
Metaphor of apple picking to emphasize the need to nurture personal skills and competencies.
Finding True Purpose (00:12:19)
Encouragement to explore personal passions and competencies to discover true purpose.
Mindset Around Job Change (00:16:10)
Discussion on the emotional struggle of leaving a job and the importance of prioritizing well-being.
Steps to Combat Burnout (00:18:58)
Practical advice for physicians experiencing burnout, including self-reflection and job satisfaction.
Prioritizing Sleep (00:22:07)
Emphasis on the critical role of sleep in preventing burnout and maintaining well-being.
Understanding Emotions and the Brain (00:24:31)
Overview of brain layers and their role in processing emotions, relevant to managing burnout.
Understanding Emotions and Burnout (00:27:11)
Discusses how emotions influence responses and the importance of pausing before reacting to avoid burnout.
Cumulative Negative Emotions (00:28:26)
Explores how unresolved emotions can build up, leading to cynicism and burnout.
The Power of Journaling (00:28:26)
Recommends keeping a daily journal to process emotions and allow rational thought to catch up.
Proactive Leadership to Prevent Burnout (00:30:14)
Highlights the need for leaders to recognize burnout signs in their staff and take proactive measures.
Stockholm Syndrome Analogy (00:31:08)
Compares employee burnout to Stockholm syndrome, emphasizing the difficulty in recognizing toxic environments.
Recognizing Team Efforts (00:32:19)
Stresses the importance of acknowledging team contributions to boost morale and prevent burnout.
Avoiding Micromanagement (00:32:19)
Discusses how micromanagement can drain energy and creativity from employees.
Constructive Feedback (00:32:19)
Emphasizes the need for clear, constructive feedback to reduce anxiety and burnout among teams.
Realistic Expectations (00:32:19)
Warns against setting unrealistic goals, advocating for achievable objectives to foster long-term success.
Hiring and Firing Practices (00:33:39)
Advises on hiring practices focused on insight and decisively addressing underperformance to maintain a healthy environment.
Burnout Awareness in Leadership (00:34:55)
Notes that if leaders feel burned out, their employees are likely experiencing it even more.
Book Overview (00:35:11)
Kapoor discusses his book "Working Happy," born from experiences during the COVID-19 pandemic.
Patient Care Online Editor Sydney Jennings and Dr. Steven P. Furr, Former President of the American Academy of Family Physicians sit down to discuss immunizations.
Medical Economics Editorial Director Chris Mazzolini sits down with Bob White, president of The Doctors Company to discuss trends in malpractice litigation and what recent verdicts mean for the industry at large.
Music Credits: Expressive Violin by Elonix - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
COCKTAIL by Mythical Audio - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to the Episode (00:00:21) Overview of the podcast and introduction of the speakers discussing malpractice caps.
Definition of Damage Caps (00:01:10) Bob White explains what medical malpractice damage caps are and why they are significant for physicians.
Inflation and Damage Caps (00:02:23) Discussion on whether damage caps are linked to inflation and how they can change over time.
Recent Changes in Colorado (00:03:37) Overview of recent developments in Colorado regarding malpractice caps and their implications.
Current Cap in California (00:05:40) Details about the current cap in California and how it has changed over time.
Colorado's Legislative Changes (00:07:32) Comparison of Colorado's recent legislation on malpractice caps to California's changes.
Arguments for Increasing Caps (00:08:18) Discussion on the plaintiffs' bar's rationale for advocating higher damage caps.
State Variations in Caps (00:09:49) Insight into how different states have varying laws regarding malpractice caps and potential trends.
Impact of High Verdicts (00:13:00) Examination of the increase in large verdicts and its effect on the malpractice landscape.
Consequences of Rising Caps (00:14:38) Exploration of the effects on insurance companies and physicians when damage caps rise.
Settlement Pressures (00:15:03) Discussion on how rising caps influence the decision-making process for settling lawsuits.
Historical Context of Verdicts (00:17:48) Comparison of significant verdict amounts over the years and the implications for the medical profession.
Public Perception and Caps (00:19:50) Discussion on societal attitudes towards caps and their impact on the medical field.
Advice for Physicians (00:21:09) Bob White shares best practices for physicians to protect themselves from malpractice claims.
Building Patient Rapport (00:23:37) Discusses the importance of patient-provider relationships for legal protection against lawsuits.
Transactional Healthcare Concerns (00:23:55) Explores the shift towards transactional healthcare and its impact on physician-patient relationships.
Retail Medicine Issues (00:24:44) Addresses the challenges of retail medicine in building rapport between patients and healthcare providers.
Physicians' Motivation (00:25:46) Highlights physicians' desire for strong relationships with patients as a primary reason for entering medicine.
Insurance Choices for Doctors (00:26:10) Discusses the importance of understanding insurance options and the advocacy role of insurance companies.
Advocacy in Malpractice Insurance (00:27:12) Emphasizes the need for insurers to advocate for doctors and engage in legislative matters.
Medical Economics Managing Editor Todd Shryock sits down with Scott Dewey, chief managed care officer at PayrHealth about the best strategies for payer negotiations.
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COCKTAIL by Mythical Audio - stock.adobe.com
The Joy of Being by Duke Herrington - stock.adobe.com
Introduction to Negotiations (00:00:12)
Overview of the podcast and introduction of the speakers discussing payer negotiations.
Starting Preparation for Negotiations (00:01:03)
Importance of having a strategy and understanding leverage before entering negotiations.
Timing for Preparation (00:04:04)
Advice on how far in advance physicians should prepare for payer negotiations.
Contract Length Considerations (00:05:11)
Discussion on the pros and cons of long-term versus short-term contracts.
Negotiating Power of Smaller Practices (00:06:47)
Insights on how smaller practices can find leverage against larger payer organizations.
Dealing with Non-Negotiable Contracts (00:08:54)
Advice for practices facing contracts labeled as "not negotiable."
Prior Authorizations in Contracts (00:09:53)
Strategies for negotiating limitations around prior authorization requirements.
Unilateral Amendments in Contracts (00:12:31)
Discussion on the commonality of unilateral contract amendments by payers.
Common Contract Mistakes (00:14:11)
Overview of frequent mistakes made by physicians in contract agreements.
Value-Based Care Contracts (00:16:34)
Differences between value-based care contracts and traditional fee-for-service agreements.
Final Contract Considerations (00:19:48)
Importance of getting all agreements in writing and understanding contract updates.
Conclusion (00:21:43)
Wrap-up of the discussion and thanks to the guest for sharing insights.
A special preview of what to expect at this year's Tri-State Healthcare Leaders Conference featuring interviews with three of the presenters.
Jennifer Wiggins, CEO of Aegis Malpractice Solutions, will take part in a roundtable discussion on the malpractice landscape on Sept. 19.
Ashkan Nikou, head of security at Bluegrass Orthopaedic, will present a session on using verbal judo to persuade on Sept. 19.
Stephen A. Dickens, vice president at SVMIC, will present a session entitled "Steps for Success in Strategic Planning & Leading Change" on Sept. 19.
Sign up for the conference here.
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Introduction to the Conference (00:00:00) Keith Reynolds introduces the special bulletin and previews the 2024 Tri-State Healthcare Leaders Conference.
Jennifer Wiggins on Networking (00:00:53) Jennifer Wiggins expresses excitement for the conference and networking opportunities among healthcare administrators.
Roundtable Discussion on Malpractice (00:01:38) Wiggins discusses her roundtable on the malpractice landscape, highlighting current trends and important changes.
Ashkan Nikou's Perspectives (00:02:24) Ashkan Nikou looks forward to hearing diverse perspectives from practices across Indiana, Ohio, and Kentucky.
Verbal Judo Presentation (00:02:37) Nikou shares details about his session on using verbal judo to persuade attendees on September 19th.
Stephen Dickens on Networking (00:03:08) Stephen Dickens shares his eagerness to network and learn new approaches at the conference.
Strategic Planning Session (00:03:43) Dickens presents his session titled "Steps for Success in Strategic Planning and Leading Change" on September 19th.
Closing Remarks (00:04:48) Reynolds concludes the bulletin, emphasizing the importance of this year's conference and encourages subscriptions.
Medical Economics Editorial Director Chris Mazzolini joins the show for a special bulletin detailing some of the top results of the Medical Economics 95th Physician Report.
The 95th Physician Report (free registration required):
https://www.medicaleconomics.com/view/2024-physician-report-exclusive-data-on-physician-salaries-practice-finances-and-more
Medical Economics Practice Academy Live, Sept 12, at 2pm Eastern. Register here:
https://cvent.me/AOoxQ8
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Medical Economics Editorial Director Chris Mazzolini sits down with Furman S. McDonald, MD, incoming president of ABIM to talk about maintenance of medical certifications.
Music Credit: Acute Imagination by Angus & Friends - stock.adobe.com
Medical Economics Editor Richard Payerchin and Steven P. Furr, MD, president of the American Academy of Family Physicians discuss cuts in the Medicare Fee Schedule, the AAFP’s work on increasing the number of physicians in rural areas, and even a bit about Furr’s own family medicine practice in Alabama.
Music Credit: Emotional Cinematic Piano by Elonix - stock.adobe.com
TimestampsIntroduction to the Episode (00:00:00)
Overview of the podcast and introduction of the guests discussing family physician challenges.
Medicare Fee Schedule Cuts (00:01:10)
Discussion on the 28% cut in physician reimbursement and its implications.
Impact on Practices (00:02:21)
Concerns about the sustainability of practices due to ongoing Medicare cuts.
Advocacy Efforts (00:02:26)
Efforts made by AAFP to inform Congress about the effects of physician cuts.
Importance of G2211 Code (00:03:12)
Significance of the G2211 code for increasing family physician reimbursement.
Congress and Medicare Economic Index (00:04:02)
Discussion on whether reimbursement should be based on the Medicare Economic Index.
Site Neutral Payments (00:05:13)
Effects of site neutral payments on family physicians and practice sustainability.
Consolidation in Healthcare (00:05:59)
Concerns regarding physician consolidation and its impact on patient care.
Non-Compete Agreements (00:06:54)
Discussion on the implications of non-compete clauses for family practices.
Cybersecurity in Healthcare (00:07:25)
Impact of the Change Healthcare cyberattack and recovery efforts in practices.
Practice Structure (00:09:06)
Overview of Dr. For's practice structure and its resilience to cyber threats.
Cybersecurity Measures (00:09:45)
Importance of cybersecurity measures and employee education in practices.
Obesity Treatment (00:10:50)
Discussion on new treatments for obesity and their implications for patient care.
Pharmaceutical Pricing Concerns (00:11:59)
Concerns regarding high pharmaceutical prices and their impact on patient equity.
New Physician Residencies (00:12:50)
Status and importance of new physician residencies in rural communities.
Closing Thoughts (00:13:36)
Final thoughts on the urgent need for Medicare reimbursement reform and its impact on healthcare.
Medical Economics Summer Intern Grace Koennecke and Alex Ashbrook, Director of WIC and Root Causes at the Food Research & Action Center discussing food insecurity and how physicians can help their patients overcome these burdens.
In this episode, Medical Economics Managing Editor Todd Shryock interviews Joseph Betancourt, MD, president of the Commonwealth Fund, about health care consolidation. Betancourt discusses the significant increase in consolidation over the past 7 to 10 years, driven by the goal of creating efficiencies and improving care. However, he notes that these benefits have not materialized, leading to challenges for patients and providers.
Medical Economics Editor Richard Payerchin sits down with U.S. Rep. Earl L. "Buddy" Carter to discuss the Affordable Care Act, Medicare and why physicians should get involved in policy decisions.
This episode of Off the Chart with Medical Economics explores how one hospital system has made mental and behavioral health services available in its primary care practices, and why that has improved clinical outcomes while enhancing health equity.
With its ability to scan and analyze large quantities of data, artificial intelligence (AI) has the potential to revolutionize medical research. But how do we balance that promise with peoples’ rights to keep their health information private and secure? Matt Hollingsworth, co-founder of Carta Healthcare, has been immersed in AI for most of his professional life. In this episode of Off the Chart he explains how AI’s growing use threatens data privacy and what can be done about it.
Scott Rivkees, M.D., former head of the Florida Department of Public Health, describes how distrust of scientific expertise is undercutting state and local laws designed to improve public health.
Why do Black and Hispanic people find it harder to access medical care than whites? Income inequality is a significant reason, but a recent study finds that people of color also encounter more non-financial barriers to care than whites. Cesar Caraballo, MD, the study’s lead author and a postdoctoral associate at the Yale School of Medicine, joins Off the Chart to explore its findings in more detail, and explain why disparities in care access have been growing worse.
How can the learning capabilities of artificial intelligence algorithms be used to complement primary care doctors' training and analytical skills to produce the best outcomes for patients? Ziad Obermeyer, MD, a researcher at the University of California-Berkeley School of Public Health focusing on the interconnections between machine learning, medicine and health policy, explains.
Kamala Green, MA, social drivers of health program manager for National Government Services, discusses how her organization's work with social service agencies and nonprofits is producing better outcomes for Medicare beneficiaries
Vivek Garg, MD, chief medical officer and senior vice president for primary care with Humana, explains how the company has integrated based payments at its CenterWell Senior Primary Care facilities to improve outcomes and reduce costs.
Jaime Bland, DNP, RN, CEO of CyncHealth, explains how doctors in Nebraska and Iowa now are able to exchange certain types of social health data on their states' HIEs, and what it could mean for improving patient outcomes.
Sanjay Rajagopalan, M.D., the Herman K. Hellerstein, MD, chair in cardiovascular research at University Hospitals, Cleveland, discusses the evidence linking pollution to cardiovascular disease and strategies doctors can use for disease prevention.
The Information Blocking Rule, which took effect in April 2021, was supposed to make it easier for Americans to get access to their health data. But many still find the process time-consuming and expensive. Deven McGraw, co-founder of the health data platform Ciitizen, sits down with Medical Economics to explain why, and why it matters to doctors.
How can medical practices reduce the chance of employees resisting, or successfully suing over, vaccine mandates? Health care attorney Michelle Greenberg explains.
Shawn Purifoy, MD, a family doctor in rural Arkansas, says hearing the facts from trusted sources is key to dispelling patients' fears about vaccination.
Samuel Edwards, M.D., discusses his recent study in Health Affairs of why burnout levels differ among primary care practices and what practices can do to reduce burnout among doctors and staff.
Micky Tripathi, the new National Coordinator for Health Information Technology, discusses his office's role in addressing the COVID-19 pandemic, improving EHR interoperability, and more.
Tim Sullivan, Pharm.D., director of pharmacy market solutions for UnitedHealth Group, describes the EHR-embedded tool UnitedHealth has developed to ease the prior authorization process for prescription medications.
Dr. Gidi Stein, cofounder of the Israeli company MedAware, talks about the growing potential of artificial intelligence in medicine, and how it can be used to help avoid diagnostic and prescribing errors.
Health care attorney Jonathan Levitt explains pharmacy benefit managers (PBMs) and how they have come to play a major role in drug pricing and availability.
Leon McDougle, MD, president of the National Medical Association, explains why Black Americans have been especially hard-hit by the COVID pandemic, and what policy changes the nation needs to improve health care for Blacks and other traditionally underserved communities.
If telehealth is here to stay, it could bring major financial and operational changes for medical practices. Ron Holder, COO of the Medical Group Management Association, offers advice on how practices can prepare for what may lie ahead.
Josh Claman, the CEO of Rimidi, discusses how remote monitoring devices can provide doctors with important patient health data while also creating a new revenue stream for practices.
Where can a practice go when it needs to borrow money to expand? How should it decide whether to buy or lease a new piece of equipment? What are the pros and cons of venture capital? We explore these and other practice financing questions with Julianne Andrews, MBA, CFP, co-founder of Atlanta Financial Associates.
On November 10 the Supreme Court will hear arguments in a case challenging the constitutionality of the Affordable Care Act. What would it mean for health care if the Court overturns the law? In the second of two episodes addressing that question, Jacqueline Fincher, MD, discusses the impact from her perspective as a practicing internist and president of the American College of Physicians.
On November 10 the Supreme Court will hear arguments in a case challenging the constitutionality of the Affordable Care Act. What would it mean for health care if the Court overturns the law? In the first of two Off the Chart episodes addressing that question, Christine Eibner, Ph.D., an analyst with the Rand Corp. discusses the health policy implications of ending the ACA.
Former CMS Administrator and FDA Commissioner Mark McClellan outlines his vision for primary care medicine in a post-COVID world.
According to a recent survey, more than 40% of working-age Americans, including many with employer-sponsored health insurance, can't afford the care they need. These "underinsured" represent a growing challenge for health care policymakers, insurance companies and providers. In this episode of Off the Chart with Medical Economics, Dr. Sara Collins, vice president of The Commonwealth Fund and lead author of the study, discusses the roots of underinsurance and what can be done to address it.
Travis Singleton, a vice president with the physician recruitment firm Merritt Hawkins, discusses the job market for doctors and how it's being affected by the COVID-19 pandemic.
Joel Greenwald, MD, president of Greenwald Wealth Management, discusses the options available to physicians looking to build a retirement nest egg.
Rebecca Etz, PhD, co-director of the Larry A. Green Center, discusses the challenges primary care practices face during the COVID-19 pandemic and how to overcome them.