Off the Chart: A Business of Medicine Podcast

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.

Off the Chart: A Business of Medicine Podcast is a business podcast hosted by Medical Economics, with 226 episodes on record and a Required Pod Score of 80. PitchCentric scores this show on Booking Probability, Listen Score, and live audience signals refreshed every 24 hours.

Medical Economics hosts Off the Chart: A Business of Medicine Podcast, a business show with 226 episodes published.

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  Episode #187

  S1 Ep187: Medicare's plan to pay half for same-day care, with Anders Gilberg of MGMA

  Sep 21, 202622 minS1

  Public comments on Medicare's proposed 2027 physician fee schedule closed Sept. 14 with a provision on the table that would pay 50% for one of two services when a patient gets an office visit and a procedure on the same day. Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association (MGMA), joins Physicians Practice Managing Editor Keith Reynolds to explain what that would look like in the exam room, why budget neutrality rules keep pitting specialties against one another and what the bipartisan Patients First Act would change. They also cover the mandatory Ambulatory Specialty Model that starts Jan. 1 with its participant list still unpublished, what else is sitting in the lame-duck pile and the AI policies Gilberg says every practice should have in writing. The final 2027 fee schedule is expected on or about Nov. 1. Music Credits: Cozy Evening Coffee Time by BJBeats - stock.adobe.com A Textbook Example by Skip Peck - stock.adobe.com Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools. 0:00 – 0:23 | Cold open Anders Gilberg on patients being asked to come back the next day for a procedure. 0:23 – 1:29 | Introduction Austin Littrell previews the episode and MGMA's centennial Annual Conference in San Antonio, Sept. 27-30. 1:29 – 1:59 | Meet Anders Gilberg Keith Reynolds welcomes Gilberg back on the day public comments closed on the proposed 2027 fee schedule. 1:59 – 4:41 | The one change MGMA wants Another conversion factor cut is in the rule, but Gilberg says the change CMS can make on its own is dropping a proposal to pay half for one of two services billed the same day. He walks through a dermatology example and the Same Day Care Coalition's opposition. 4:41 – 5:56 | The Patients First Act The bipartisan doctors caucus bill would tie annual fee schedule updates to the Medicare Economic Index, rework budget neutrality and reform quality reporting. 5:56 – 8:06 | Why CMS can't fix budget neutrality alone The $20 million trigger is written into law. Gilberg points to a 2024 add-on code whose use was overestimated by roughly $1 billion, a cut physicians never got back. 8:06 – 9:19 | The quiet part: practice expense Practice expense values cover overhead, and Gilberg explains why keeping the lights on, paying staff and buying supplies makes this an administrator's issue. 9:19 – 11:10 | The Ambulatory Specialty Model starts Jan. 1 Gilberg says practices aren't ready because the participant list still hasn't been published, and notification is expected to run through a portal each physician checks individually. 11:10 – 12:13 | P2 Management Minute Keith Reynolds shares practice management tactics and invites listeners to send in their own, then turns to the lame-duck session. 12:13 – 13:45 | Will Congress fix the cut? Gilberg on why modest cuts are harder to fight than big ones, drawing on his experience with the SGR years. 13:45 – 15:38 | What else is in the lame-duck pile The work geographic price index floor and the expiring alternative payment model incentive bonus, plus why a retroactive fix in the new year is the outcome nobody wants. 15:38 – 18:51 | AI guardrails inside the practice Governance, written policies on what gets typed into tools like ChatGPT, HIPAA and malpractice exposure under laws already on the books, and keeping the human element in the physician-patient relationship. 18:51 – 19:39 | What to watch next The final rule is expected on or about Nov. 1, and Gilberg says practices won't know until the 11th hour whether the same-day cut survived. 19:39 – 20:36 | San Antonio Keith and Gilberg on the MGMA Annual Conference. 20:36 – end | Outro

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  Episode #186

  S1 Ep186: When physicians know the right care and can't give it, with Rebecca Schoon of Pacific University

  Sep 17, 202630 minS1

  In a national survey of more than 1,200 practicing physicians, 47% said they often or always lacked the time to give patients optimal care, and 27% said they had already left a job because of moral distress. Rebecca Schoon, Ph.D., one of the authors of the Physicians for a National Health Program report behind those numbers, says the patients her team heard from in Oregon could see what was happening to their doctors and did not blame them for it. Medical Economics Senior Editor Richard Payerchin sat down with Schoon, an associate professor of public health at Pacific University and a board member of Health Care for All Oregon , a nonprofit that advocates for universal health care. Schoon helped lead the report's Oregon case study. Schoon walks through the acquisitions of Oregon practices by Optum, Amazon and private equity firms, the noncompete clauses and visit quotas she says drove physicians out of the Eugene area, and the 2025 state law that restricts corporate control of medical practices. She also explains how moral injury reaches physicians in independent practice through prior authorization, denials and paperwork. Then she turns to Oregon's effort to design a statewide universal health care plan and to what patients told researchers about longer waits and the toll of fighting their insurers. The full report, "Moral Injury in Medicine: The Human Costs of Practicing in a Profit-Driven System," is available from Physicians for a National Health Program, and the Universal Health Plan Governance Board posts its meetings and materials online. This conversation was recorded before the board voted in August to push the deadline for its plan from Sept. 15 to Dec. 1. Music Credits: Cup of Coffee by Ionics - stock.adobe.com A Textbook Example by Skip Peck - stock.adobe.com Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools. 0:00 – 0:29 | Cold open . Schoon on what patients in Oregon's focus groups said about their physicians. 0:29 – 1:52 | Introduction . Austin Littrell introduces the episode and the guest, with an update on the Universal Health Plan Governance Board's deadline. 1:52 – 3:12 | Meet Rebecca Schoon . Richard Payerchin welcomes Schoon, who teaches health policy and health systems at Pacific University and works on policy reform with Health Care for All Oregon. 3:12 – 5:38 | How the study came together . Physicians for a National Health Program paired a national physician survey and focus groups with an Oregon case study and patient focus groups run by Health Care for All Oregon, with funding from the Robert Wood Johnson Foundation. Schoon defines moral injury as the tension between clinicians' ethical obligations and the for-profit constraints of the current system. 5:38 – 8:24 | Financialization comes to Oregon . Optum's acquisitions of Oregon Medical Group in Eugene and The Corvallis Clinic, the physician resignations and two-year noncompete clauses that followed, and deals by Amazon and private equity firms for clinics in Portland, Bend and Redmond. 8:24 – 12:22 | How Oregon pushed back . Oregon's corporate practice of medicine ban dates to a 1947 state Supreme Court ruling, but corporate owners found ways around it, most recently through management services organizations. Schoon describes how Health Care for All Oregon worked with state Rep. Ben Bowman (D-Oregon) on the 2025 law that has been called the strictest in the nation, which also limits noncompete clauses. 12:22 – 15:04 | Moral injury in independent practice . Physicians in corporate settings are bound by limits set by management services organizations. In independent practices, Schoon says moral injury comes more from prior authorization, denials, step therapy and paperwork. 15:04 – 15:56 | P2 Management Minute . Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 15:56 – 19:39 | Oregon's path to universal health care . A 2019 legislative task force, the 2022 ballot measure that added access to health care to the state constitution as a fundamental right and the nine-member Universal Health Plan Governance Board designing the plan. The board has since moved its September deadline to Dec. 1. 19:39 – 23:05 | Paying for it . Draft options include income, payroll and corporate taxes. Schoon argues most Oregonians would save compared with what they pay in premiums, deductibles and copays. She contrasts billing in countries with universal health care, which she says takes seconds, with the months an American practice can spend chasing a single payment. 23:05 – 28:15 | What patients told researchers . Appointments limited to one health issue, longer waits after specialists left the Eugene area, repeated denials that took a psychological toll and patients who sympathized with doctors whose hands were tied. 28:15 – End | Closing thoughts and outro . Payerchin thanks Schoon, and Littrell wraps the episode.

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  Episode #185

  S1 Ep185: Who gets paid when the AI does the work? with Caroline Pearson of the Peterson Health Technology Institute

  Sep 14, 202614 minS1

  A clinical artificial intelligence (AI) tool costs little to run and can be billed many times over, while fee-for-service rates are set on the clinician time and effort a service is expected to take. Caroline Pearson says that math is why AI could push health care costs up rather than down, and that remote patient monitoring already shows what it looks like. Medical Economics Managing Editor Todd Shryock sat down with Pearson, executive director of the Peterson Health Technology Institute, a nonprofit that evaluates the clinical and economic value of emerging health technologies. Pearson draws the line between assistive AI, which a supervising physician deploys, oversees and bills for, and autonomous AI, which delivers some care on its own. She explains why liability for an autonomous prescribing tool currently runs through the physician's malpractice insurance and what would have to change to move it to the vendor, how Medicare's new Access Model lets technology companies get paid with no physician in the mix, why accountable care organizations (ACOs) have been slower to adopt AI than their incentives would suggest, and what she means when she says technology doesn't need a living wage. Music Credits: Paper Cranes by Buurd - stock.adobe.com A Textbook Example by Skip Peck - stock.adobe.com Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools. 0:00 – 0:27 | Cold open . Pearson on why technology doesn't need a living wage. 0:27 – 1:35 | Introduction . Austin Littrell introduces the episode and the guest. 1:35 – 1:55 | Meet Caroline Pearson . Todd Shryock introduces Pearson and the Peterson Health Technology Institute's report on paying for clinical AI. 1:55 – 2:24 | The takeaway for physicians . The potential is real, the incentives to adopt are not, and the payment models available now risk raising health care costs. 2:24 – 3:37 | Why fee for service inflates the bill . Rates are set on clinician time and effort, but the marginal cost of running a tool is low and it can be billed many times over. Pearson points to remote patient monitoring as a live example. 3:37 – 4:18 | More patients, or more revenue per visit? Seeing more patients would stretch the workforce further. The concern is revenue per visit rising without more patients seen or better outcomes in those visits. 4:18 – 5:47 | Assistive AI vs. autonomous AI . Assistive tools are deployed, overseen and billed by the supervising physician. Autonomous tools deliver facets of care on their own, with medication prescribing and hypertension titration as the nearest examples. 5:47 – 6:38 | P2 Management Minute . Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 6:38 – 7:47 | Getting paid to review the algorithm . Remote patient monitoring codes already pay physicians to review AI analysis of patient data. Pearson on setting the right value for oversight payments and keeping clinicians cognitively sharp as they use the tools more. 7:47 – 8:39 | Who is liable when it goes wrong . Prescribing tools generally operate under the physician's malpractice insurance, which makes it the physician's liability. Pearson on the push to move that to the vendor and the legal infrastructure that doesn't exist yet. 8:39 – 10:20 | Cutting the physician out of the payment . Medicare's Access Model pays technology companies directly for chronic care management, and Doctronic is piloting prescribing in Utah. Pearson on preserving the physician's role and setting a payment level that reflects what the technology actually costs. 10:20 – 11:25 | Why ACOs haven't bought in . Risk-based models need evidence of better outcomes and lower total cost rather than a revenue play, and Pearson says the evidence available has not been compelling enough. 11:25 – 12:26 | Change management is the other half . Redesigning workflows and rethinking how clinicians spend their time, at the system level and the individual level. 12:26 – End | Closing thoughts and outro . Shryock thanks Pearson, and Littrell wraps the episode.

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  Episode #184

  S1 Ep184: Why banning corporate medicine won't save independent practice, with Wayne Winegarden, Ph.D., of the Pacific Research Institute

  Sep 10, 202624 minS1

  Thirty-three states now restrict the corporate practice of medicine to some degree, and lawmakers in several more are moving to tighten those limits. Wayne Winegarden, Ph.D., says the crackdown is aimed at the wrong target. Medicare physician payments rose 12% between 2000 and 2022 while the cost of running a practice climbed nearly 48%. Medical Economics Associate Editor Austin Littrell sat down with Winegarden, a senior fellow in business and economics at the Pacific Research Institute and director of the institute's Center for Medical Economics and Innovation. Winegarden argues that inflation functions as a tax on independent practice, and that state bans on management services organizations land almost entirely on independent physicians because hospitals are typically exempt. He explains why he considers California's Senate Bill 351 a better model than Oregon's Senate Bill 951, what separates an MSO partnership that preserves independence from an acquisition with the paperwork rearranged, what the early evidence shows about prices after an MSO deal, and why he thinks independent practice survives the next decade even as the warning siren gets louder. Winegarden's policy brief, "How Government Policy Is Consolidating the Practice of Medicine," is available from the Pacific Research Institute. Music Credits: Distant Memories by Buurd - stock.adobe.com A Textbook Example by Skip Peck - stock.adobe.com Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools. 0:00 – 0:32 | Cold open . Winegarden on inflation as a tax on independent practice. 0:32 – 1:51 | Introduction . Austin Littrell introduces the episode and the guest. 1:51 – 3:07 | Another year of the payment gap . CMS has proposed a 2027 physician pay cut alongside a raise for hospital outpatient departments. Winegarden on the accumulation of frustration, the financial difficulty of managing it and the psychological question of whether it ever gets better. 3:07 – 4:52 | The counterfactual . If Medicare payment had tracked inflation since 2001, how much consolidation never happens. Winegarden says the exact number isn't knowable, but that removing a major driver removes its influence, and that the problem is government policy putting a finger on the scale rather than consolidation itself. 4:52 – 7:30 | Site-neutral payment and the inflation tax . Why site-neutral passes on cost savings alone, why indexing physician pay to inflation is the harder sell, and the penny-wise, pound-foolish math of what it costs to keep practices open. 7:30 – 9:58 | What counts as an independent practice . The traditional definition is a doctor-owned or controlled practice. Winegarden calls MSOs a hybrid and argues that the experimentation is the point. 9:58 – 12:32 | Partnership or acquisition . Control over decision-making is the dividing line. Winegarden on the bean counter in Pennsylvania writing rules for a patient in Oregon, and what an MSO has to deliver to be worth the affiliation. 12:32 – 13:24 | P2 Management Minute . Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 13:24 – 15:05 | What happens to prices after an MSO deal . Better collections and firmer practice finances, prices still below hospital rates, and why not enough time has passed to know where the competition leads. 15:05 – 16:53 | Oregon's law gets its first test . An independent group used the law to fight off an out-of-state staffing firm. Winegarden says the case doesn't complicate his argument, and that Oregon's overly strict law is the reason the conflict looks the way it does. 16:53 – 18:07 | Why not extend the rules to hospitals . Binding hospitals with the same restrictions reduces competition. Winegarden wants more ideas in the market, not fewer. 18:07 – 20:06 | What a practice should ask before signing . Quality of life, compensation, how physicians spend their time and the risk they bear. Winegarden says there is still no evidence that fully independent practice is an inefficient way to deliver care. 20:06 – 22:19 | Does independent practice survive the decade . Winegarden says yes, and that if it doesn't, Medicare reimbursement and regulatory burden will be the cause rather than a better model winning. 22:19 – End | Closing thoughts and outro . Littrell thanks Winegarden and wraps the episode.

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  Episode #183

  S1 Ep183: The first thing to do after a medical error, with Anthony Orsini, D.O.

  Sep 7, 202629 minS1

  Fewer than half of physicians know the exact steps to take when a medical error occurs, according to a survey cited by Anthony Orsini, D.O. That gap, he argues, is where malpractice claims begin. Orsini, a neonatologist, founder of The Orsini Way and a member of the Medical Economics editorial advisory board, joins Medical Economics Managing Editor Todd Shryock to walk through the mistakes physicians make most often in a disclosure conversation: staying silent, getting defensive instead of transparent, retreating into medical jargon and letting body language contradict every empathetic word in the room. He explains why speculating about a cause before the review is finished is the worst move a physician can make, what the University of Michigan's shift away from deny-and-defend did to claims and liability costs, and why even a harmless error has to be disclosed. Don't miss the first episode of Conversations that Matter , with Anthony Orsini, D.O.: https://www.medicaleconomics.com/view/do-you-struggle-with-difficult-patient-conversations- Music Credits: Ambient Jazz by AurbanniAudio - stock.adobe.com A Textbook Example by Skip Peck - stock.adobe.com Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools. 0:00 – 0:26 | Cold open Orsini on why the most empathetic words in the world fail when a physician's posture contradicts them. 0:26 – 2:00 | Introduction Austin Littrell introduces the episode, the guest and the debut of Orsini's new Medical Economics series. 2:00 – 2:35 | Meet Dr. Anthony Orsini Todd Shryock introduces Orsini and The Orsini Way. 2:35 – 7:27 | The most common disclosure mistakes Failing to disclose at all, getting defensive rather than transparent, retreating into medical jargon and ignoring nonverbal communication. Orsini cites a study finding fewer than half of physicians know the steps to take after an error. 7:27 – 9:59 | Why speculating is the worst thing you can do The brain reads nonverbal cues before words, an angry family is a normal response, and naming a cause before the review is finished routinely turns out to be wrong. 9:59 – 13:33 | What families actually want to hear Orsini says 39 states now have full or partial apology laws, and that in role-play training physicians more often over-claim fault than dodge it. A morphine dosing example shows why errors are almost always a process breakdown. 13:33 – 15:28 | The data behind transparency Orsini walks through the University of Michigan findings on claims, liability costs and time to resolution after the system moved away from deny-and-defend. 15:28 – 18:02 | Can body language be taught? Videotaped role play, the "long sitter" posture, and why a relaxed stance that builds rapport in a routine visit destroys credibility in a disclosure. 18:02 – 18:55 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 18:55 – 21:56 | Does every error get disclosed? Yes, Orsini says, and he tells the story of a minor morphine overdose a hospital chose not to report, and what happened when the mother found out anyway. 21:56 – 24:22 | Who should deliver the news Why the physician should lead the disclosure rather than risk management or legal counsel, and how the pre-disclosure meeting should work. 24:22 – 27:11 | Be prepared before it happens Why physicians avoid training for medical errors, what resources exist for practices outside a hospital system, and Orsini's closing message. 27:11 – 27:28 | Closing thoughts and outro

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