Off the Chart: A Business of Medicine Podcast

Medical Economics
  • 5.0 (9)
  • BUSINESS
  • UPDATED WEEKLY

Off the Chart: A Business of Medicine Podcast features lively and informative conversations with health care experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. New episodes release every Monday and Thursday morning. Brought to you by Medical Economics and Physicians Practice. Off the Chart: A Business of Medicine Podcast Staff Hosts: Keith Reynolds, Austin Littrell Contributors: Chris Mazzolini, Todd Shryock, Richard Payerchin, Keith Reynolds, Austin Littrell Inquiries: Please email Hosts Keith Reynolds (kreynolds@mjhlifesciences.com) or Austin Littrell (alittrell@mjhlifesciences.com) with feedback, questions, guest suggestions and more.

  1. Health care's reset, with Shannon Sims, M.D., Ph.D., and Matthew Bates, M.P.H.

    2H AGO

    Health care's reset, with Shannon Sims, M.D., Ph.D., and Matthew Bates, M.P.H.

    Rising patient acuity. Aging demographics. Tight margins. Artificial intelligence (AI) moving from buzzword to workflow tool. Medical Economics sat down with Shannon Sims, M.D., Ph.D., FAMIA, chief product officer at Vizient, and Matthew Bates, M.P.H., managing director at Kaufman Hall, to talk about Vizient's 2026 State of the Industry Report and what it calls a "reset" moment for U.S. health care. Sims and Bates explain how AI is already reducing documentation burdens through ambient listening and revenue cycle automation, why access has overtaken staffing as the defining operational challenge and how advanced practice providers (APPs) are reshaping team-based care as physician shortages persist. Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EDT: https://registration.physicianspractice.com Music Credits:Cherry Blossom Memories by Cephas - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.com Editor's note: Episode timestamps and transcript produced using AI tools.0:00 — Cold open Can AI help return the joy to medicine — and improve the economics of practice? 0:34 — Intro and Practice Academy 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

    24 min
  2. Site-neutral payment and independent practice, with Christopher M. Whaley, Ph.D.

    3D AGO

    Site-neutral payment and independent practice, with Christopher M. Whaley, Ph.D.

    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

    26 min
  3. The state of health care in 2026, with Richard Anderson, M.D., FACP, CEO of The Doctors Company and TDC Group

    FEB 12

    The state of health care in 2026, with Richard Anderson, M.D., FACP, CEO of The Doctors Company and TDC Group

    The health care system is changing quickly, and the legal and regulatory systems that govern it are struggling to keep up. Medical Economics Associate Editor Austin Littrell sat down with Richard Anderson, M.D., CEO of The Doctors Company and TDC Group, to talk about the organization’s annual predictions report, Healthcare on the Horizon: Predictions for U.S. Healthcare Through 2026.Anderson explains why artificial intelligence may soon become part of the standard of care — and why clinician trust, legal precedent and liability exposure will determine how quickly that happens. He outlines the paradox physicians face when deciding whether to follow AI recommendations, the growing impact of nuclear verdicts and social inflation in malpractice litigation and the widening access gaps as rural hospitals close and reimbursement pressures mount. Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EDT: https://registration.physicianspractice.com Music Credits:Cloud Garden by Cephas - stock.adobe.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

    38 min
  4. When patients ask AI first, with Amber Maraccini, Ph.D., M.A., of Medallia

    FEB 9

    When patients ask AI first, with Amber Maraccini, Ph.D., M.A., of Medallia

    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.

    20 min
  5. Policy uncertainty in 2026, with Anders Gilberg of MGMA

    FEB 5

    Policy uncertainty in 2026, with Anders Gilberg of MGMA

    Government funding deadlines, expiring coverage subsidies and temporary policy fixes are creating real-world disruptions for physician practices — often with little warning. Keith Reynolds, managing editor of Physicians Practice, sat down with Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association (MGMA), to talk about how recent federal policy decisions are landing inside medical groups. Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EDT: https://registration.physicianspractice.com Music Credits:Retro Rhythm by BJBeats - stock.adobe.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.

    25 min
  6. Attending to patients and ourselves, with Melissa Lucarelli, M.D., FAAFP, and Ronald M. Epstein, M.D., FAAHPM

    FEB 2

    Attending to patients and ourselves, with Melissa Lucarelli, M.D., FAAFP, and Ronald M. Epstein, M.D., FAAHPM

    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.

    49 min
  7. The biggest risks for physicians in 2026, with Peter Reilly of HUB International

    JAN 29

    The biggest risks for physicians in 2026, with Peter Reilly of HUB International

    In 2026, physicians are facing a familiar mix of pressure — reimbursement uncertainty, rising labor and supply costs, staffing shortages and growing exposure to legal and cyber risk. Medical Economics Managing Editor Todd Shryock caught up with Peter Reilly, North American health care practice leader at HUB International, to talk about what those risks look like in practice, and which ones physicians can no longer afford to ignore. Reilly explains why reimbursement instability is unlikely to ease in the near term, why rural hospitals and critical access facilities remain especially vulnerable, and how burnout and disengagement continue to affect retention. He also breaks down what’s happening in the medical professional liability market, including the rise of “nuclear” and “thermonuclear” jury verdicts and what that means for rates moving into 2026. He shares practical guidance on planning, mitigation and why proactive steps matter more than ever in an increasingly unpredictable health care environment. Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EST: https://registration.physicianspractice.com Music Credits:Neon Rainfall by Cephas - stock.adobe.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.

    27 min
  8. The staffing squeeze, with Rihan Javid, D.O., J.D., of Edge

    JAN 26

    The staffing squeeze, with Rihan Javid, D.O., J.D., of Edge

    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.

    14 min
See All (166)

Ratings & Reviews

5
out of 5
9 Ratings

About

Off the Chart: A Business of Medicine Podcast features lively and informative conversations with health care experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. New episodes release every Monday and Thursday morning. Brought to you by Medical Economics and Physicians Practice. Off the Chart: A Business of Medicine Podcast Staff Hosts: Keith Reynolds, Austin Littrell Contributors: Chris Mazzolini, Todd Shryock, Richard Payerchin, Keith Reynolds, Austin Littrell Inquiries: Please email Hosts Keith Reynolds (kreynolds@mjhlifesciences.com) or Austin Littrell (alittrell@mjhlifesciences.com) with feedback, questions, guest suggestions and more.

Information