Off the Chart: A Business of Medicine Podcast

Medical Economics
  • 5.0 (9)
  • Business
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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. 1d ago

    What's really keeping practices independent, with Aaron Ledbetter of Veradigm

    Independent practices know technology is what keeps them independent. They just don't trust the technology they have. Veradigm surveyed 360 leaders at independent ambulatory practices, including 210 physicians, and found 79% call technology essential to staying independent while only 64% are confident their current tools can deliver. Aaron Ledbetter, solutions and growth strategist at Veradigm, joins the show to explain what sits inside that gap: denied claims that take one to two weeks to surface, payer contracts multiplying faster than the staff to manage them and a labor market where physicians are the hardest position to both recruit and retain. He also makes the case that the electronic health record is about to stop being a system of record and start being a system of work. Medical Economics and Veradigm are hosting a live virtual event on the same subject, "The State of the Independent Practice in 2026," on Wednesday, Aug. 26 at 2 p.m. EDT: https://globalmeet.webcasts.com/starthere.jsp?ei=1770655&tp_key=bf8dd29613&sti=mjhpopup&utm_source=mkt_layer&utm_medium=popup&utm_campaign=ME+State+of+Independent+Practice+8.26&utm_content=news%7Ctopics%2Ftechnology%7Ctopics%2Findustry-trends%7Ctopics%2Fvalue-based-care%7Ctopics%2Fpractice-management 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 artificial intelligence (AI) tools. 0:00 – 0:32 | Cold open. Ledbetter previews the episode's central claim: the electronic health record is about to stop recording what happened and start doing the work. 0:32 – 1:33 | Introduction. Austin Littrell introduces the episode, the guest and the Aug. 26 Medical Economics and Veradigm virtual event. 1:33 – 2:27 | Meet Aaron Ledbetter. Ledbetter describes Veradigm's clinical and revenue cycle work with independent practices, and his own path through value-based care consulting in Washington, D.C., direct work with CMS and CMMI on model design and payer contract negotiation for roughly 1,600 clinicians at a New England ACO. 2:27 – 4:16 | The confidence gap. Seventy-nine percent of practice leaders call technology essential to staying independent; 64% trust the tools they have. Ledbetter attributes the gap to tools aging out mid-adoption, an arms race with payer technology and the administrative weight of a growing book of payer contracts. 4:16 – 5:52 | Why practices walk away from acquisition talks. Twenty-six percent of practices surveyed reached serious acquisition negotiations before deciding to stay independent. Ledbetter says strain gets them to the table, whether administrative, operational or financial, and what pulls them back is the belief they can still solve it with better tools. 5:52 – 7:06 | Why a denial takes two weeks to surface. Ledbetter calls it a symptom of a lagging operating model, with detection, root cause analysis and resolution scattered across different people and different systems. Fifty-eight percent of practices run a hybrid revenue cycle split between internal staff and outside vendors. 7:06 – 8:17 | Denial drivers across the whole revenue cycle. Eligibility errors, missing data and coding mismatches all trace back to information that wasn't captured, was captured incorrectly or didn't surface early enough. Ledbetter argues against fixing one stage in isolation. 8:17 – 9:08 | P2 Management Minute. Keith Reynolds shares practice management tactics and invites listeners to submit their own. 9:08 – 10:56 | Scale doesn't insulate. Eighty-two percent of practices reported increased financial pressure and 60% called that increase significant. Larger practices feel it as volatility driven by payer complexity, solo practices feel it as a staffing problem, and Ledbetter argues both are expressions of a shrinking margin for error. 10:56 – 12:31 | What's different about AI this time. Ledbetter grants that physicians are right to be skeptical and names app fatigue as a real problem, then makes the case that ambient documentation and background automation of prior authorization, reporting and denial follow-up move the electronic health record from a system of record to a system of work. 12:31 – 14:03 | The administrative barrier to value-based care. Nearly half of respondents named administrative requirements the top barrier to value-based care participation, ahead of clinical complexity and financial risk. Drawing on his ACO contracting experience, Ledbetter describes tracking the differences between arrangements as work that takes a small army, and argues technology should automate quality measure tracking and surface care gaps before the visit. 14:03 – 15:34 | Automation as a recruiting advantage. Physicians ranked hardest to both recruit and retain. Independent practices can't match a guaranteed employed paycheck, but Ledbetter argues automating documentation, denials and prior authorization buys the work-life balance that decides where a physician lands. 15:34 – 17:30 | Running independence as an operating model. For practices with little or no administrative staff, Ledbetter says the answer isn't hiring but choosing technology that surfaces the right signals in days instead of months. He also expects more independent practice associations banding together for leverage with vendors and payers. 17:30 – 19:02 | The inflection point. Health care has spent years throwing people at manual problems and adding complexity in the process. Ledbetter's closing case is that this is the first moment technology can look at the entire system of work at once. 19:02 – [runtime] | Closing thoughts and outro. Littrell thanks Ledbetter, points listeners to the full Q&A and the report, and reminds the audience about the Aug. 26 virtual event.

    What's really keeping practices independent, with Aaron Ledbetter of Veradigm

  2. 5d ago

    Cutting the PBM out of your patient's GLP-1, with Jay Bregman of Andel

    GLP-1s broke the traditional pharmacy benefit, and a growing number of employers are responding by buying brand drugs straight from the manufacturer and cutting the insurer and pharmacy benefit manager out of the transaction entirely. Jay Bregman, founder and CEO of Andel, joins Medical Economics Associate Editor Austin Littrell to explain how the model works from the prescriber's side: the script still starts with the patient's own physician, still travels over Surescripts and still reports back into the chart. What changes is everything after that, including a fixed employer contribution in place of a prior authorization. Bregman also addresses the part that matters clinically, which is what happens to a patient's negotiated price when they leave the job or the employer stops contributing, and where a benefit built on employment leaves the patients it doesn't cover. 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 artificial intelligence (AI) tools. 0:00 – 0:31 | Cold open Bregman on why coverage on paper rarely means access in practice, and why even an approval may not survive the next plan year. 0:31 – 1:40 | Introduction Austin Littrell introduces the episode and Jay Bregman, and frames direct-to-employer purchasing as one of several channels now routing around the pharmacy benefit. 1:40 – 2:06 | Meet Jay Bregman Bregman describes Andel as a cooperative marketplace connecting plans, drug manufacturers and members on a single network. 2:06 – 3:37 | What direct-to-employer purchasing actually is Andel acquires rights to brand drugs from the manufacturer at a discount, which Bregman says it earns by removing utilization management, prior authorization, formularies and rebates. Employers pay a cash contribution, from $100 per fill up to the full cost, and carve the drug out of the traditional plan. 3:37 – 5:06 | Why GLP-1s became the entry point Bregman argues utilization broke conventional coverage for this class, calling GLP-1s the wildfires and hurricanes of pharmacy, and says the carve-outs being built for them are scaffolding for other drugs. 5:06 – 6:15 | From prescription to doorstep Patients keep their own physician, the script goes to Andel's non-dispensing pharmacy over Surescripts, and eligibility, payment and shipping run automatically. No telehealth requirement, no limited network. 6:15 – 7:26 | Where the treating physician fits Bregman's case that the model re-empowers the prescriber, and his argument that the administrative layer it removes was never adding clinical value. 7:26 – 8:16 | Does anything change at the point of prescribing Andel built its own pharmacy, NPI and Surescripts integration so it appears in any EMR. By Bregman's account, a physician sends the script exactly as they would to any retail pharmacy. 8:16 – 9:07 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 9:07 – 10:06 | Does the fill land in the chart Because the order travels through Surescripts, it reports back like any other prescription. Bregman says a free data exchange API also lets plans reconcile out-of-pocket spending and accumulators, which he frames as the dividing line from direct-to-consumer channels. 10:06 – 11:20 | Cost and experience versus the pharmacy benefit Bregman claims fewer than 2% of members get access even when a plan covers GLP-1s, and argues a predictable monthly out-of-pocket beats an approval that may not hold next year. 11:20 – 12:49 | What happens when the job ends The access cliff. Bregman says COBRA may let some plans continue the benefit and that portability between employers is on the roadmap, but acknowledges that for certain drugs the negotiated price disappears once the employer contribution stops. 12:49 – 13:42 | Where Medicare fits None of Andel's products are designed for Medicare. Bregman points to the commercial market as the company's focus and to the patients government programs don't reach. 13:42 – 14:37 | What Bregman wants physicians to know His pitch to prescribers: the platform treats the prescriber's decision as final and doesn't challenge it with prior authorization or utilization management. 14:37 – 15:19 | Beyond GLP-1s Bregman says the first non-GLP-1 agreement is signed and more drugs are expected on the platform within six months, and asks prescribers for direct feedback. 15:19 – 16:47 | Closing thoughts and outro Littrell thanks Bregman and wraps the episode.

    Cutting the PBM out of your patient's GLP-1, with Jay Bregman of Andel

  3. Aug 10

    Most practices cut the wrong thing first, with Shawntea Gordon of Atlas & Perpetua Healthcare Consulting

    Practice costs are climbing on every line at once: staffing, medical supplies and a technology stack that has grown at some organizations from two or three main systems to as many as 15. Reimbursement has not moved with any of it, and when the math gets that tight the reflex is to start cutting. Physicians Practice Managing Editor Keith Reynolds sat down with Shawntea Gordon, CEO of Atlas & Perpetua Healthcare Consulting, to explain why that reflex is where most practices go wrong. A cut made without data behind it is a guess, Gordon argues, and the wrong guess costs more than it saves. She and Reynolds get into the leaks she finds most often, how to tell which benchmarks are actually worth trusting, why staffing reductions so frequently backfire and the recurring expense that has been quietly billing practices since the paper era. Music Credits: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 artificial intelligence (AI) tools.0:00 – 0:23 | Cold open. Gordon on the practices that call staffing their biggest cost and then find out they were understaffed all along. 0:23 – 1:30 | Introduction. Austin Littrell introduces the episode, the guest and the gap between what practices spend and what they collect. 1:30 – 2:22 | Why the pressure feels different now. Gordon points to the widening spread between costs and reimbursement, plus staff shortages and a technology stack that has grown at some organizations from two or three main systems to as many as 15. 2:22 – 3:19 | Where the money leaks. Front desk data entry, coordination of benefits, uncaptured patient responsibility, undocumented in-office services, unappealed denials and downcoding. The one she sees most: unmanaged denials and claims sitting in accounts receivable. 3:19 – 4:01 | The first step if you have never benchmarked. Start with your own history. Pull 12 months of invoices, check what you ordered against what you paid, then look at alternatives and group purchasing contracts. 4:01 – 5:12 | Which benchmarks are worth trusting. Gordon on separating established associations from organizations that only claim to be validated, and why an apples-to-apples comparison starts with an honest read of your own size, location, service mix and payer mix. 5:12 – 6:16 | The right-sizing test before any staffing cut. Pull your administrative and clinical support ratios against validated benchmarks first. Groups convinced staffing is their biggest cost are often already understaffed, with burnout capping what they can collect. 6:16 – 7:20 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 7:20 – 7:58 | The contract nobody rereads. Practices that moved from paper to electronic and left shredding services on the same rotation, paying monthly minimums against bins that never fill. 7:58 – 9:35 | Cutting costs without creating new risk. The four questions Gordon runs before any systemic change, and the practice that switched medical supply vendors and lost access to a surgical item that was chronically backordered. 9:35 – 10:59 | Building a framework that holds. A holistic review, a 90-day improvement plan, then the same monthly block of time converted into continuous improvement. Gordon makes the case for 1% a month over an annual look back. 10:59 – 11:32 | One thing to do Monday morning. Run a monthly report comparing the CPT codes billed against the codes reimbursed. Every variance is a possible downcode. 11:32 – [END] | Closing thoughts and outro. Reynolds thanks Gordon, and Littrell wraps the episode.

    Most practices cut the wrong thing first, with Shawntea Gordon of Atlas & Perpetua Healthcare Consulting

  4. Aug 6

    Insurance was never meant to be a first-dollar payer, with Joanne Frederick

    Joanne Frederick, CEO of Government Market Strategies, has spent more than 30 years working inside Medicare, Medicaid, Tricare and VA health programs, and she opens with the one most physicians know least. Tricare covers 9.4 million service members, families and retirees, and pays at a discount off Medicare rates that plenty of practices already say don't cover their costs. From there Frederick makes a broader argument: that insurance was never designed to sit between a patient and a physician for routine care, and that the administrative layer built around that arrangement now consumes an estimated 15% to 30% of every health care dollar. She and Medical Economics senior editor Richard Payerchin work through what a cash-based system would look like at the practice level, where artificial intelligence genuinely helps, and the one piece she thinks direct primary care is still missing. Music Credits:Her Name by Cephas - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.0:00 – 0:25 | Cold open. Frederick on a system built around fixing a problem that may have been smaller than the fix. 0:25 – 1:44 | Introduction. Austin Littrell introduces the episode, the guest and the Tricare reimbursement problem at the center of it. 1:44 – 3:00 | Meet Joanne Frederick. Richard Payerchin introduces the guest, who has worked in public sector health programs since the late 1980s and founded her first firm in 1992. 3:00 – 4:46 | What Tricare is. The program covers roughly 9.4 million service members, families and retirees, about 400,000 of them overseas, and picks up the care military treatment facilities cannot deliver. 4:46 – 6:29 | Where beneficiaries are, and the readiness mission. Frederick on the density around large installations and the twin goals of a ready medical force and a medically ready force. 6:29 – 7:45 | Paid below Medicare rates. Tricare reimburses at a discount off Medicare, sometimes a steep one, in a market where physicians already say Medicare does not cover their costs. 7:45 – 10:36 | What the rest of health care could borrow. Frederick argues readiness is the idea worth exporting, and calls the physician the most valuable player on the field of our lives. 10:36 – 13:53 | Defining a cash-based system. Insurance was never intended to be a first-dollar payer, Frederick says, and administrative costs run an estimated 15% to 30% of health care spending. 13:53 – 14:45 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 14:45 – 18:00 | Prior authorization and the case insurers make. Payerchin puts the industry's value argument to Frederick, who questions what is gained when a request cycles back and forth two or three times and gets approved anyway. 18:00 – 22:18 | Where artificial intelligence actually helps. Frederick calls today's note-taking applications the tip of the iceberg and makes the case for navigation tools, with the caveat that nothing replaces the physician-patient relationship. 22:18 – 25:18 | Direct primary care and the missing piece. Frederick, a direct primary care member herself, asks whether physicians have the panel time to serve as health coaches, and floats an annual health improvement plan as the wraparound. 25:18 – 26:50 | A message to primary care physicians. Frederick on the administrative burden the system places on primary care, and an open invitation for ideas on how to reduce it. 26:50 – 27:40 | Outro. Littrell thanks the guest and wraps the episode.

    Insurance was never meant to be a first-dollar payer, with Joanne Frederick

  5. Aug 3

    The patient access blind spot, with Mindy Fortson of Experian Health

    Nearly half of the health care organizations in Experian Health's 2026 State of Patient Access Survey say patient access improved over the past year. Among patients, fewer than one in five agree. Medical Economics Managing Editor Todd Shryock sat down with Mindy Fortson, chief operating officer of Experian Health, to work out what's behind that split, why 73% of respondents on the practice side say patients delay or forfeit care when they can't get a cost estimate up front, and how much of the prior authorization burden a practice can realistically fix on its own. Fortson also gets into the survey's most counterintuitive finding: after years of pushing patients toward portals and mobile billing, paper is coming back. Read Experian Health's 2026 State of Patient Access Survey here.Music Credits: Sleepy Sunday by Buurd - stock.adobe.com A Textbook Example by Skip Peck - stock.adobe.com Editor's note: Episode timestamps and transcript produced using AI tools. 0:00 – 0:26 | Cold open. Fortson names the survey finding that unsettled her most and explains why she reads it as a public health problem rather than a billing one. 0:26 – 1:39 | Introduction. Austin Littrell introduces the episode, the guest and the perception gap at the center of the survey. 1:39 – 1:53 | Meet Mindy Fortson. Todd Shryock introduces the guest and the 2026 State of Patient Access Survey. 1:53 – 3:04 | Why practices and patients score access differently. Forty-six percent of organizations say access improved. Eighteen percent of patients agree. Fortson traces the split to two groups measuring different outcomes: staffing and digital adoption on one side, affordability and speed on the other. 3:04 – 4:07 | Prior authorization and what a practice can actually fix. Thirty-six percent of patients reported authorization difficulties. Fortson puts most of the burden on payer and policy reform, since requirements are plan specific and carry heavy clinical review. 4:07 – 5:43 | Insurance verification delays. Nearly three in 10 patients hit one. Fortson frames these as administrative rather than clinical problems and points to front-end coverage discovery, eligibility checks and MBI lookups as the automation targets. 5:43 – 7:42 | The cost estimate problem. Seventy-three percent on the practice side say patients delay or forfeit care without an up-front estimate. The bright spot: surprise billing complaints have fallen considerably where estimate tools are in place. 7:42 – 8:55 | Why training deficits keep surfacing. Thirty-nine percent cite training gaps. Every payer is different and every encounter is different, which makes front-end registration a heavy manual lift. 8:55 – 9:46 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 9:46 – 11:28 | Where automation and AI pay off first. Twenty-eight percent report adopting AI, a figure the survey didn't measure at all last year. Fortson expects AI to move out of pilots and into general infrastructure within one to two years. 11:28 – 12:46 | Ninety-three percent say patients struggle to pay. Fortson on Medicaid uncertainty, regulatory ambiguity and employers shifting costs onto employees. 12:46 – 14:33 | Access to practitioners, four years running. Still the top patient-reported challenge. Scheduling and portal tools help, but a meaningful share of patients either lack a smartphone or won't navigate a portal. 14:33 – 15:41 | The paper billing surprise. Snail mail metrics jumped this year against the mobile trend. Fortson points to regulatory and HIPAA notices that default to mail, plus cybercrime anxiety about entering personal information online. 15:41 – 17:17 | The metric to watch next year. Speed to access shows up as both a top frustration and a top success, depending entirely on whether the practice has adopted the tools. 17:17 – 18:35 | Closing thoughts and outro. Littrell points listeners to the survey in the show notes and wraps the episode.

    The patient access blind spot, with Mindy Fortson of Experian Health

  6. Jul 30

    A primary care physician's guide to cyclosporiasis, with Molly O'Shea, M.D.

    Cyclosporiasis presents like a lot of other summer illnesses, but it runs six weeks untreated and the routine ova and parasite panel will not find it unless you ask your lab specifically. Molly O'Shea, M.D., has owned an independent pediatric practice in Michigan for more than 30 years, putting her at the center of the largest cyclospora outbreak on record in the United States. She talks with Medical Economics Senior Editor Richard Payerchin about how the infection presents, what to order and how to have that conversation with the lab, when to treat on symptoms alone, and what to tell patients arriving with questions about ivermectin and cleanses. She also explains why she believes reported case counts substantially understate what is happening in the community. CDC tracking: https://www.cdc.gov/cyclosporiasis/index.htmlFDA recall: https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/taylor-fresh-foods-recalls-iceberg-lettuce-central-mexico-because-possible-health-risk Music Credits:Palm Trees in Cyan Glow by KBH Production - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor's note: Episode timestamps and transcript produced using AI tools.0:00 – 0:12 | Cold open O'Shea previews the episode's central premise: the reported case counts are almost certainly an undercount. 0:12 – 1:36 | Introduction Austin Littrell introduces the episode, the guest and the scale of the outbreak. 1:36 – 2:00 | Meet Molly O'Shea, M.D. Richard Payerchin introduces the guest and opens at the beginning. 2:00 – 5:11 | What cyclospora is, and how to make produce safer A parasitic infection contracted from contaminated fresh produce, not spread person to person. O'Shea walks through washing technique, a vinegar solution for raspberries and cilantro, and why she still wants patients eating fruits and vegetables. 5:11 – 6:26 | Does buying local help? Not automatically. You still don't know the irrigation system or the equipment that brought it to market. 6:26 – 8:20 | What it looks like in the office Bloating, cramping and long duration. How to separate it from Giardia, enteroviruses and norovirus, and why her practice tells families to wait three or four days before coming in. 8:20 – 9:21 | Why the routine stool panel misses it Detection requires a special stain, and it will not be run unless it is ordered. Talk to your lab about what to send and in what container. 9:21 – 11:43 | The two-week incubation problem Why the exposure history is nearly impossible to reconstruct, why dose matters, and why she tells parents to stop trying to trace it. 11:43 – 13:40 | Treatment Bactrim for about a week. False negatives after long symptom duration, and when to treat on symptoms alone. 13:40 – 15:20 | Hospitalization, and how badly cases are undercounted Who gets sick enough to be admitted, and why dehydration is the complication to watch. 15:20 – 16:11 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 16:11 – 17:04 | What to say about ivermectin The best available evidence supports Bactrim. Ivermectin has not been studied well enough to place in either the treatment or prevention category. 17:04 – 19:29 | Cleanses and other things patients found online The body is already doing what a cleanse claims to do, and the added physiologic stress isn't warranted. 19:29 – 22:00 | Reassuring worried patients without ordering the test Listen, acknowledge the worry, then give a plan and say exactly where the test fits in it. 22:00 – 24:55 | The federal surveillance gap What changed in July 2025, what states still require, and why O'Shea says the national response has been disjointed. 24:55 – 26:05 | This isn't only a Michigan problem Why Michigan's counts are high and other states' may not be. 26:05 – 28:07 | What a fast federal response would look like An HHS proclamation, a coordinated information effort and an emergency response team. 28:07 – 32:13 | Fragmented care, Medicaid and who never gets diagnosed Coverage losses, high deductibles and a shift away from prevention. 32:13 – 34:00 | Closing thoughts and outro Littrell points listeners to current case counts and the recall notice, and wraps the episode.

    A primary care physician's guide to cyclosporiasis, with Molly O'Shea, M.D.

  7. Jul 27

    Another year of Medicare cuts, with Anders Gilberg of MGMA

    CMS has released its proposed 2027 Medicare Physician Fee Schedule, and once again it carries a conversion factor cut: 1.68% for physicians outside an alternative payment model and 1.19% for those inside one, as the 2.5% congressional patch expires. Physicians Practice Managing Editor Keith Reynolds sits down with Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association, to sort out what the rule actually does. They dig into the budget neutrality rules that force CMS to cut one specialty to pay another, the agency's push to move away from the AMA's valuation process without new data to justify it, the sunset of traditional MIPS into MIPS Value Pathways and what that reporting burden means for multispecialty groups, and a sleeper change to modifier 25 that could hit same-day billing hard.  Public comments on the proposed rule are due Sept. 14. 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 Cold open: Anders Gilberg on why these are real cuts, not cuts to the growth rate 0:17 Introduction 1:39 Keith Reynolds welcomes Anders Gilberg 2:11 The recurring themes in the proposed 2027 fee schedule 3:56 Five years of cuts, and what MGMA members are feeling 5:38 Congress's game of chicken and the new Patients First Act 6:58 Budget neutrality and robbing Peter to pay Paul 8:09 CMS's 20-year-old cost data and the move away from the AMA process 10:34 The end of traditional MIPS, and why MVPs are "MIPS on steroids" 13:20 P2 Management Minute 14:35 What small and rural practices should do now 16:13 The sleeper provision: modifier 25 and same-day billing 18:13 Comments are due Sept. 14, but will CMS budge? 20:20 The next fiscal cliff and the year-end lame duck session 22:29 Outro

    Another year of Medicare cuts, with Anders Gilberg of MGMA

  8. Jul 23

    Better care, shorter careers for women physicians, with Lisa Rotenstein, M.D., MBA, M.Sc.

    Female physicians spend more time with patients, write longer notes and field more messages, and research suggests their patients do better for it. They also leave clinical practice at a median age of 49, compared with 64 for male physicians. Lisa Rotenstein, M.D., MBA, M.Sc., a primary care physician at the University of California, San Francisco and director of the Center for Physician Experience and Practice Excellence, is the corresponding author of a new study in the Journal of General Internal Medicine examining physician attrition by sex, age and specialty. She joins Medical Economics Senior Editor Richard Payerchin to explain what's behind that 15-year gap, why it holds in rural and urban settings alike, and which fixes could actually keep women physicians at the bedside, from time-based billing to ambient documentation to giving physicians back control over their own workflow. 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 Cold open. Rotenstein previews the episode's central paradox: the practice patterns that serve patients well may be making the job unsustainable. 0:17 Introduction. Austin Littrell introduces the episode, the guest and the study's headline finding. 1:32 Meet Lisa Rotenstein. Rotenstein introduces her work directing the Center for Physician Experience and Practice Excellence and outlines what the study set out to measure. 2:58 What a 1.55 hazard ratio actually means. Female primary care physicians are among the likeliest to leave, and Rotenstein explains how the study defined leaving: no Medicare billing for three consecutive years. 5:17 The 15-year gap. Median attrition age is 49 for women and 64 for men. Rotenstein describes the bimodal pattern in the data and why the first decade and a half of practice is the critical window. 7:53 Rural and urban alike. The sex-based attrition gap holds regardless of setting, with particular consequences for access in rural communities. 9:02 What the payment model rewards. Female physicians generate 80 cents of revenue for every dollar earned by male primary care physicians, even while spending more time with patients. Rotenstein makes the case for time-based billing and value-based payment. 11:22 P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 12:13 The math health systems are missing. Physician turnover runs $500,000 to $1 million per physician, but Rotenstein says the near-term cost of retention is what keeps the conversation from happening. 14:35 What to tell medical students. More than half of matriculating medical students are women, and Rotenstein argues the profession has to show them clinical medicine is a sustainable path. 16:17 Can AI keep women physicians in practice? A Physicians Foundation-funded study found burnout reductions tied to AI scribes across two health systems. Rotenstein says prior authorization and paperwork are the next frontier. 18:35 Control, not ownership. Clinician-owned practices show lower burnout, but Rotenstein says the real variable is agency, and systems can give some of it back. 21:03 What she wants physicians to take away. The profession is losing decades of expertise from a highly trained workforce. 21:55 Closing thoughts and outro.

    Better care, shorter careers for women physicians, with Lisa Rotenstein, M.D., MBA, M.Sc.
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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.

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