Off the Chart: A Business of Medicine Podcast

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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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=0e7f653cd1Music Credits:Groovy 90s Hip Hop Acid Jazz by Musinova - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comMusic Credits:Ocean Calm by Cephas - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comMusic Credits:Coffee Shop Sketches by Buurd - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comMusic Credits:Saved by You by Cephas - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comMusic Credits:Her Name by Cephas - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comMusic Credits:Retro Disco Lounge Groove by MotifLab Music - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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 note1:42 — 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 explained16:58 — Closing thoughts17:15 — 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 careO’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.comMusic Credits:Chasing the Moonlight by Cephas - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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 note1:42 — 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 Minute14:09 — 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.comMusic Credits:CALM CHILL RELAXED SMOOTH JAZZ (OWE YOU) by Tasty Tunes - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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 note1:56 — 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 Minute17:57 — 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 costs30:12 — 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.comMusic Credits:Cherry Blossom Memories by Cephas - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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 note2:01 — Introducing Vizient and Kaufman Hall2:12 — 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 Minute13:52 — 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.comMusic Credits:Empty Spaces by Cephas - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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 — Intro1:46 — 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 Minute12:01 — 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.comMusic Credits:Cloud Garden by Cephas - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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 Minute18:38 — 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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comMusic Credits:Retro Rhythm by BJBeats - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comMusic Credits:Crystal Grind by NISO - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comMusic Credits:Neon Rainfall by Cephas - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comVarious 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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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-ageMusic Credits:After Hours by Yigit Atilla  - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comRelaxing Lounge by Classy Call me Man - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.0000000000001365CDC report:"Ultra-processed Food Consumption in Youth and Adults: United States, August 2021–August 2023"https://www.cdc.gov/nchs/products/databriefs/db536.htmMusic Credits:Midnight Jazz by Alexey Anisimov - stock.adobe.comRelaxing Lounge by Classy Call me Man - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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 Communication on 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-careMusic Credits:Lo Fi Warm Piano by Elonix - stock.adobe.comRelaxing Lounge by Classy Call me Man - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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"Music Credits:Tempting Conversations by Frequently Asked Music/MusicRevolution - stock.adobe.comRelaxing Lounge by Classy Call me Man - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.Music Credits:Ambient Jazz by AurbanniAudio - stock.adobe.comRelaxing Lounge by Classy Call me Man - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor'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.