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Francisco Lopez-Jimenez, M.D., M.S., MBA, and Kyla M. Lara-Breitinger, M.D., M.S., are preventive cardiologists at Mayo Clinic and co-authors, with the late Amir Lerman, M.D., of the “Mayo Clinic Guide to a Healthy, Happy Heart.” More than 30 Mayo Clinic clinicians who see patients regularly contributed to the book. Earlier this year, Medical Economics Senior Editor Richard Payerchin sat down with Lopez-Jimenez and Lara-Breitinger. They explain how primary care physicians can steer patients who want one quick fix toward small changes that last. They also explain why the most useful goals are behaviors a patient controls, like eating less salt, instead of a blood pressure number. They also discuss normal weight obesity and the limits of body mass index (BMI), advanced lipid markers, how to bring patients’ home blood pressure readings into care and what primary care physicians should weigh before prescribing glucagon-like peptide-1 (GLP-1) drugs without a specialist on hand. Proceeds from book sales support the Mayo Clinic Cardiovascular Research Department. Don’t miss our recent episodes on Medicare’s 2027 fee schedule, MGMA’s 100th annual conference, maternity care gaps and interoperability. Music Credits:Ambient Jazz by AurbanniAudio - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor’s note: Episode timestamps and transcript produced using AI tools.0:00 – 0:48 | Cold open. Lopez-Jimenez on the question he asks patients who don’t own a blood pressure monitor: how many TVs they have. 0:48 – 2:03 | Introduction. Austin Littrell introduces the episode and the guests. 2:03 – 3:10 | Remembering Amir Lerman, M.D. Lopez-Jimenez describes his late co-author’s pioneering work on how the inner lining of the arteries functions. 3:10 – 4:48 | Behind the book. Lara-Breitinger on the more than 30 contributors across Mayo Clinic campuses, and Lopez-Jimenez on why every one of them sees patients. 4:48 – 7:50 | Beyond the quick fix. Lopez-Jimenez says the biggest benefit comes from going from doing nothing to doing something, and Lara-Breitinger explains why delayed gratification makes heart health a hard sell. 7:50 – 12:25 | Goals patients can control. Simple goals that are easy to track, asking patients about their biggest source of stress and why eating less salt is a better patient goal than a blood pressure number. 12:25 – 16:52 | Advanced markers and body fat. Lara-Breitinger on adding high-sensitivity C-reactive protein, lipoprotein(a) and apolipoprotein B to a lipid panel, and Lopez-Jimenez on making risk testing easier for patients to get. 16:52 – 17:45 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 17:45 – 22:18 | Talking about weight. Normal weight obesity, raising weight with tact and sensitivity, metabolically healthy patients with a higher BMI and why measuring waist circumference is hard in a 15- to 30-minute visit. 22:18 – 28:25 | Home blood pressure data. Lopez-Jimenez on getting home readings into the electronic health record without burying physicians, why some devices aren’t reliable and why diagnosis should happen at home. Lara-Breitinger on why patients need to hear that blood pressure is a big deal. 28:25 – 31:35 | GLP-1s without a specialist. Lara-Breitinger on the patients who clearly qualify, the harder cases at a BMI of 25 or 26 and the cost barrier for patients paying full price. 31:35 – 35:57 | One thing to change. Lopez-Jimenez’s four tenets of prevention, and Lara-Breitinger on asking patients what brings them joy and lowering low-density lipoprotein cholesterol. 35:57 – End | Outro. Payerchin thanks the guests and Littrell wraps the episode.

If the proposed 2027 Medicare physician fee schedule is finalized, real Medicare payment rates will be 35% below 2016 levels, according to Jonathan Ketcham, Ph.D., Earl and Gladys Davis Distinguished Research Professor in Business and professor of economics at Arizona State University. Ahead of the final rule, guest interviewer Cameron J. Sabet, M.S., MBA, M.A., a medical student at Georgetown University, sat down separately with Ketcham; Michael Chernew, Ph.D., Leonard D. Schaeffer Professor of Health Care Policy at Harvard Medical School and former chair of the Medicare Payment Advisory Commission (MedPAC); Miranda Yaver, Ph.D., assistant professor at the University of Pittsburgh; and David O. Meltzer, M.D., Ph.D., Fanny L. Pritzker Professor of Medicine and chief of the Section of Hospital Medicine at the University of Chicago. Medical Economics Senior Editor Richard Payerchin connects the interviews. Chernew explains why he doesn’t call the 2027 conversion factor drop a cut and why MedPAC still recommended paying above current law. Yaver says a proposed pay cut for evaluation and management visits on the same day as a procedure could mean more trips, copays and parking fees for older patients. Meltzer makes the case for hybrid payment models, and Ketcham says he would sunset the fee schedule altogether. Register for the Physicians Practice Practice Academy Series: Protecting Your Practice’s Revenue, a virtual event on Thursday, Oct. 29, from 12 to 4 p.m. ET: https://registration.physicianspractice.com/990031Music Credits: Distant Memories by Buurd - stock.adobe.com A Textbook Example by Skip Peck - stock.adobe.com Editor’s note: Episode timestamps and transcript produced using AI tools.0:00 – 0:57 | Cold open. Ketcham, Chernew, Yaver and Meltzer on payment rates, fairness, rationing and hybrid payment models. 0:57 – 2:22 | Introduction. Austin Littrell introduces the episode and the experts and previews the Physicians Practice Practice Academy on Oct. 29. 2:22 – 3:26 | Is it really a cut? Chernew says the 2027 conversion factor drop is the same as it would have been under current law once a temporary increase expired. 3:26 – 5:18 | 35% below 2016. Ketcham says real Medicare rates have fallen sharply since 2016, commercial rates have tracked along and the result has pushed physicians toward consolidation. 5:18 – 7:36 | When pay cuts become an access problem. Yaver notes 98% of non-pediatric physicians accept traditional Medicare, and Chernew explains why MedPAC found access adequate but still recommended paying more. 7:36 – 9:00 | The same-day visit cut. Yaver says a proposed cut to visits billed on the same day as a procedure could spread care across more appointments for older patients. 9:00 – 12:06 | Is Medicare paying for the wrong things? Meltzer on risk selection, the limits of pay for performance and how advanced primary care management fees helped his program’s primary care break even. 12:06 – 12:58 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 12:58 – 14:39 | Fairness vs. economics. Chernew argues physician pay comes down to what it costs to get the services we want, not what feels fair. 14:39 – 15:57 | Does the fee schedule favor bigger practices? Ketcham says administrative and legal barriers, not medicine itself, push practices to grow, and the 2027 changes continue that momentum. 15:57 – 17:31 | Paying for prior authorization work. Yaver on the Wasteful and Inappropriate Service Reduction (WISeR) Model pilot, nearly 53 million Medicare Advantage prior authorization requests in 2024 and one practice’s five-person prior authorization staff. 17:31 – 18:23 | Sunset the fee schedule. Ketcham, back in academia after working in the White House, says he would get the government out of setting physician prices. 18:23 – 19:42 | Do alternative payment models work? Chernew says they only have to be better than fee-for-service and urges small practices to look at conveners. 19:42 – 20:56 | A fixed payment per patient? Meltzer warns flat per-patient payments invite avoiding sicker patients and says hybrid models matter. 20:56 – 22:37 | The most important change. Yaver warns that well-intentioned policies, like prior authorization, can backfire and make care costlier. 22:37 – End | Outro. Littrell thanks the experts and wraps the episode.

The Medical Group Management Association (MGMA) held its 100th annual conference Sept. 27-30 in San Antonio, and the Medical Economics and Physicians Practice teams were in attendance. This episode brings back the conversations that stood out. Medicare's proposed 2027 fee schedule would cut the conversion factor again and pay half for a second service billed the same day. Medicare Advantage plans are downcoding claims, and payers are denying them faster than practices can appeal. Staff turnover, patient wait times and AI round out the recap. You'll hear from MGMA's Anders Gilberg, Madison Hynes, Andrew Swanson and acting CEO Akash Madiah, along with Kem Tolliver of Medical Revenue Cycle Specialists, Taya Gordon of Atlas & Perpetua Healthcare Consulting, Doral Jacobsen of Prosper Beyond, Rachel Brace of BackPocket Talent, Dale Patterson, M.D., of Beacon Medical Group, former NFL long snapper Jon Dorenbos, Julia Rosen of MGMA and health care attorney Tatiana Melnik. Want more on payer contracts? Doral Jacobsen leads the payer contracting session at the free Physicians Practice Practice Academy on Thursday, Oct. 29, from 12 to 4 p.m. ET. Register here: https://registration.physicianspractice.com/990031/home Music Credits:Jazz Warm Lo-Fi by Nadezhda Pilitskaia - stock.adobe.com Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.0:00 – 1:06 | Cold open. Kem Tolliver and Anders Gilberg on MGMA's centennial, and Doral Jacobsen on how much health care spending goes to administrative waste. 1:06 – 2:06 | Introduction. Austin Littrell previews the episode, recorded on site in San Antonio by the Medical Economics and Physicians Practice teams. 2:06 – 3:20 | 100 years of MGMA. From a 1926 meeting of 32 clinic managers to the association's largest conference since the pandemic, with acting CEO Akash Madiah on what he heard in the hallways and a look at the opening keynote from former INXS singer Ciaran Gribbin. 3:20 – 8:04 | What Washington has planned for 2027. A proposed 1.68% conversion factor cut, the same-day payment cut practices are fighting, the end of MIPS, the Ambulatory Specialty Model and the Jan. 1 electronic prior authorization deadline, with Anders Gilberg, Taya Gordon and Kem Tolliver. 8:04 – 11:43 | What happens to claims after they go out the door. Medicare Advantage growth and MGMA's draft bill to ban automatic downcoding, with Madison Hynes on why downcoding is so hard to track, Taya Gordon on denials piling up in accounts receivable and Doral Jacobsen on write-offs that should have been paid. 11:43 – 14:11 | Revenue practices have already earned. Rising costs, David Gans on productivity, Barbara Ireland's vaccine coding recovery, Andrew Swanson's one number to benchmark and Doral Jacobsen on doing the homework before a payer negotiation. 14:11 – 18:05 | Who's leaving, and what it costs. Staff turnover data, Rachel Brace on what replacing an employee costs compared with a retention bonus, Andrew Swanson on longer patient wait times and Kem Tolliver on why billers quit. 18:05 – 21:38 | Physicians who stay. Physician pay rising as visits fall, Andrew Swanson on why not to panic yet, Monique Delgado on physician-designed pay, Dale Patterson, M.D., on renter and owner physicians and Jon Dorenbos' advice for burned-out physicians. 21:38 – 24:28 | Where AI fits. Seema Verma on data strategy, Julia Rosen on starting with tools practices already own, Tatiana Melnik on AI scribe consent and Andrew Swanson on whether AI is replacing staff. 24:28 – 26:25 | One thing to do Monday. Akash Madiah's two tips for administrators, and Kem Tolliver on being surrounded by people who understand the work. 26:25 – End | Outro.

Forty-seven percent of chief information officers (CIOs) named cost as their top barrier to interoperability in a survey CliniComp conducted with the College of Healthcare Information Management Executives (CHIME) Foundation, according to Sandra Johnson, senior vice president of client services at CliniComp. She says the barrier has shifted from technology and standards to cost and vendor unwillingness. Medical Economics Managing Editor Todd Shryock sat down with Johnson, whose company CliniComp makes electronic health record (EHR) systems for hospitals and health systems. Johnson says data stuck in disconnected systems leaves physicians treating patients with only half the chart, which carries a clinical cost as well as a financial one. She credits vendor consolidation, policy and government incentives with connecting more systems and says the next step is making that data usable at the point of care. She argues health systems need to treat interoperability as core infrastructure instead of bolting new tools onto old systems. She also discusses whether data blocking is still a problem, how patient identity matching fits in and why artificial intelligence (AI) running on siloed data works from partial information. Every CIO in the survey said AI running on interoperable systems was important to their organization, she says. Register for the Physicians Practice Practice Academy Series: Protecting Your Practice’s Revenue, a virtual event on Thursday, Oct. 29, from 12 to 4 p.m. ET. Don’t miss our recent episodes on AI in hiring, practice revenue, direct primary care and unanswered patient calls. Music Credits: Rooftops by Buurd - stock.adobe.com A Textbook Example by Skip Peck - stock.adobe.comEditor’s note: Episode timestamps and transcript produced using AI tools.0:00 – 0:33 | Cold open. Johnson on why siloed data leaves physicians treating patients with half the chart. 0:33 – 1:50 | Introduction. Austin Littrell introduces the episode and the guest and previews the Oct. 29 Practice Academy. 1:50 – 3:03 | Cost is now the barrier. Johnson says 47% of CIOs in the CHIME survey named cost as their top barrier, making interoperability a business problem more than a technical one. 3:03 – 3:53 | Treating patients with half the chart. Siloed data carries a clinical and human cost as well as a financial one. 3:53 – 5:14 | How interoperability got this far. Vendor consolidation, policy and government incentives connected more systems, and the next step is making that data usable at the point of care. 5:14 – 6:13 | Treating interoperability as infrastructure. Johnson says bolting tools onto existing systems doesn’t build interoperability, and health systems need a core foundation that can scale. 6:13 – 7:00 | Is data blocking still a problem? Johnson calls it a market failure that every part of the industry has to help fix. 7:00 – 7:59 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 7:59 – 8:42 | Patient identity matching. Johnson says normalizing data across systems is the key to a complete view of the patient. 8:42 – 9:38 | Where AI fits. Every CIO surveyed said AI running on interoperable systems matters, but AI built on siloed data sees only part of the patient. 9:38 – 10:32 | Who’s the bottleneck? Johnson says no single stakeholder is to blame and CIOs want industry consortiums where EHR vendors and health systems share ownership of the problem. 10:32 – 11:31 | Interoperability in five years. Johnson describes a complete view of every patient at the point of care, with technology helping clinicians instead of getting in their way. 11:31 – 12:24 | What doctors should do now. Johnson urges physicians to tell their IT teams where fragmented data slows down clinical decisions. 12:24 – End | Outro. Littrell reminds listeners about the Oct. 29 Practice Academy and wraps the episode.

A single job posting can draw 1,000 applicants in a week, according to Dina Taylor, chief evangelist at HireVue. She says no hiring team has the time to read all of those resumes. Medical Economics Managing Editor Todd Shryock sat down with Taylor, whose company HireVue makes artificial intelligence (AI) hiring software, including video interviewing and candidate assessments. Taylor says AI has made it easy for job seekers to write resumes and cover letters and to apply to many jobs in a short time, and the strongest candidates get buried in that volume. She describes using AI to summarize and rank every applicant for a hiring manager, with a human making the final decision. She also describes using it to evaluate skills and behaviors, such as empathy, that a resume can’t show. She also explains how the interview changes when the hiring team already knows a candidate and why she says better-matched hires stay longer. She names the mistake she sees most often in health care hiring: being afraid to start. Register for the Physicians Practice Practice Academy Series: Protecting Your Practice’s Revenue, a virtual event on Thursday, Oct. 29, from 12 to 4 p.m. ET. Music Credits: Healing Breeze by Cephas - stock.adobe.com A Textbook Example by Skip Peck - stock.adobe.comEditor’s note: Episode timestamps and transcript produced using AI tools.0:00 – 0:31 | Cold open. Taylor on why no hiring team can read 1,000 resumes in a week. 0:31 – 2:01 | Introduction. Austin Littrell introduces the episode and the guest and previews the Oct. 29 Practice Academy. 2:01 – 3:30 | Why staffing is so hard right now. Taylor says unfilled shifts directly affect patient care, and health care roles require specific skills even as application volume keeps growing. 3:30 – 5:03 | How AI changed job applications. AI makes it easy to write a resume and cover letter and apply to many jobs at once, and the volume buries the strongest candidates. 5:03 – 6:50 | Using AI to sort the pile. Taylor says AI should make the hiring team’s work easier, with a human checking what it finds. 6:50 – 8:15 | What the hiring manager sees. In place of a top-20 list, AI summarizes and ranks every applicant so each one still gets considered. 8:15 – 9:07 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 9:07 – 10:54 | Looking past the resume. Taylor says AI-polished resumes can look identical, so skills, behaviors and cultural fit carry more weight. 10:54 – 11:47 | How the interview changes. The interview becomes a conversation to confirm what the hiring team already knows about a candidate. 11:47 – 12:32 | Better matches, longer tenure. Taylor says well-matched hires stay longer, earn higher patient satisfaction scores and move up faster. 12:32 – 13:19 | The biggest hiring mistake. Being afraid to start because health care has always hired the same way. 13:19 – 14:22 | Hiring in five years. Taylor expects more focus on skills and behaviors than on job titles, and more people entering health care from other careers. 14:22 – 14:53 | Final advice. Lean into innovation and don’t be afraid to try. 14:53 – [END] | Outro. Littrell recaps the conversation, reminds listeners about the Oct. 29 Practice Academy and wraps the episode.

Akash Madiah has seen the Medical Group Management Association (MGMA) from both sides. He used its data to redo physician compensation plans while working in practice finance, and he now leads the association as acting CEO in its centennial year. Following MGMA’s 2026 annual conference in San Antonio, he sat down with Physicians Practice Managing Editor Keith Reynolds to talk about what practices are calling MGMA about most, what administrators should do this quarter as Medicare pay stays flat and costs keep rising, and what the association’s first member pulse survey says it still needs to fix. He closes with two things any practice leader can start on Monday. Register for the Physicians Practice Practice Academy Series: Protecting Your Practice’s Revenue, a virtual event on Thursday, Oct. 29, from 12 to 4 p.m. ET: https://registration.physicianspractice.com/990031/Music Credits: Coffee Shop Sketches by Buurd - stock.adobe.com A Textbook Example by Skip Peck - stock.adobe.com Editor’s note: Episode timestamps and transcript produced using AI tools.0:00 – 0:32 | Cold open Madiah on finding the revenue a practice is already losing before chasing new revenue. 0:32 – 1:44 | Introduction Austin Littrell introduces the episode and the guest and previews the Physicians Practice Practice Academy on Oct. 29. 1:44 – 3:13 | What practices are calling MGMA about Medicare cuts and prior authorization top the list, echoing the town hall Anders Gilberg led at the conference. 3:13 – 4:11 | From data user to association leader Madiah describes using MGMA data to redo physician compensation plans and why he judges every offering by how members will use it “on Monday morning.” 4:11 – 5:54 | What he heard in the hallways Reimbursement and administrative burden dominated the conversation in San Antonio, along with members asking how to get involved and volunteer. 5:54 – 7:44 | What MGMA still needs to get right MGMA’s first member pulse survey found trust is strong, but members want easier access through digital tools, education and local engagement. 7:44 – 9:12 | What administrators should do this quarter Know your numbers, collect what you’ve already earned before adding volume, invest in retention and benchmark against peers. 9:12 – 10:08 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 10:08 – 13:23 | Preparing for MGMA’s second century Madiah outlines three priorities: evolving MGMA’s data products, engaging members from early-career staff to veterans, and building the association’s voice as an industry leader. 13:23 – 15:12 | Two things to start on Monday Pick the one metric that matters most to your organization and review it every week, then schedule one conversation with a peer outside your organization. 15:12 – 16:21 | Closing thoughts Madiah reflects on MGMA’s role in taking work off physicians’ plates so they can focus on patients. 16:31 – [END] | Outro Littrell thanks listeners and reminds them about the Oct. 29 Practice Academy.

Health care organizations often promote their top clinicians into leadership roles with little preparation for the business side of the job, according to Kate Atchley, Ph.D., professor of practice at the Haslam College of Business at the University of Tennessee, Knoxville. A brilliant cardiologist, she says, isn’t automatically ready to handle capital allocation, payer economics or change management. Megan Manzano, senior custom content specialist at Physicians Practice, sat down with Atchley, who directs Haslam’s Executive Master of Business Administration (MBA) in Healthcare Leadership and Physician Executive MBA programs. Atchley says the biggest change in health care leadership over the last decade is how interconnected the problems have become. That leaves leaders choosing between two legitimate priorities, such as clinician autonomy and standardization or patient access and clinician workload. She names the five skills she sees as essential for physician leaders: systems thinking, business fluency, leading through influence, change leadership and curiosity. She also explains how organizations can build leaders earlier by giving promising staff gradually harder assignments and exposure to other parts of the organization, and offers her advice for physicians who want a bigger voice in how their organizations are run: “get out of your lane.” This special report is sponsored by the Haslam College of Business at the University of Tennessee, Knoxville. Music Credits: Cup of Coffee by Ionics - stock.adobe.com Editor’s note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.0:00 – 1:19 | Introduction. Austin Littrell introduces the special report and the guest. 1:19 – 2:21 | Meet Kate Atchley, Ph.D. Megan Manzano welcomes Atchley and lays out the pressures facing health care leaders, from reimbursement to workforce shortages. 2:21 – 3:25 | What’s changed in a decade. Atchley says health care’s problems are now so interconnected that leaders can’t pull one lever without moving three or four others. 3:25 – 5:07 | Why clinical expertise isn’t enough. Expertise in one domain is necessary but not sufficient for leading across many. 5:07 – 6:58 | Choosing between two valid priorities. Clinician autonomy vs. standardization, and patient access vs. clinician workload. 6:58 – 10:23 | Five skills physician leaders need. Systems thinking, business fluency, leading through influence, change leadership and curiosity. 10:23 – 11:49 | Building a leadership pipeline. Spotting potential leaders early and giving them gradually harder assignments before they step into the role. 11:49 – 14:01 | Get out of your lane. Atchley’s advice for emerging leaders: learn enough finance, operations and strategy to understand the trade-offs. 14:01 – [END] | Closing thoughts and outro. Manzano thanks Atchley, and Austin Littrell wraps the episode.

Direct primary care physicians charge an average of about $98 a month for a membership, and those who consider their practices full care for roughly 400 to 700 patients, according to a national survey led by Kenneth Qiu, M.D. Qiu says most of the practices that responded have a single physician, and a third of those have no staff at all. Medical Economics Senior Editor Richard Payerchin sat down with Qiu, a family physician who founded EuDoc in the Richmond, Virginia, area straight out of residency and led the Direct Primary Care Alliance’s “State of Direct Primary Care” report. Qiu says the community’s rule of thumb is that 1% to 5% of a physician’s fee-for-service patients will follow them into a new practice. Physicians starting from scratch often moonlight while their panels grow. Qiu says that work generally requires being opted into Medicare, which means billing Medicare for any Medicare patient they see. Many choose not to see those patients, which he says slows practice growth and limits access for beneficiaries. He also discusses repealing certificate-of-need laws, letting patients apply cash prices toward their deductibles, how his model differs from concierge medicine, why many practices stop growing around five physicians and how academic medicine still looks down on primary care. Music Credits: Midnight Serenade by MORRIX Holyhold - stock.adobe.com A Textbook Example by Skip Peck - stock.adobe.com Editor’s note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.0:00 – 0:32 | Cold open. Qiu on how his model differs from concierge medicine. 0:32 – 1:23 | Introduction. Austin Littrell introduces the episode and the guest. 1:23 – 2:55 | Meet Kenneth Qiu, M.D. Qiu describes opening his practice straight out of residency and first learning about the model as a fourth-year medical student. 2:55 – 4:48 | Why the alliance ran the survey. Figures on pricing and panel size had circulated by word of mouth with no hard data behind them. 4:48 – 6:57 | Reaching physicians outside organized medicine. How the committee pushed the survey through every network it could find. 6:57 – 10:07 | What the survey found. Practices in 49 states, average pricing near $98, full panels of roughly 400 to 700 patients and a large share of solo practices. 10:07 – 12:02 | How many practices are out there. Qiu explains where the estimate of about 3,600 practices nationwide comes from. 12:02 – 15:46 | Will your patients follow you? Building a panel, moonlighting while a practice grows and the Medicare billing rule that slows new practices. 15:46 – 18:46 | Removing barriers. Repealing certificate-of-need laws and letting patients apply cash prices toward their deductibles. 18:46 – 19:39 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 19:39 – 22:10 | Not concierge medicine. Why Qiu says criticism aimed at concierge practices doesn’t fit his model. 22:10 – 25:12 | Wearing every hat. The business demands of a solo practice and why growth often stalls around five physicians. 25:12 – 27:57 | Primary care’s image problem. How academic medicine looks down on family medicine and how the alliance reaches students and residents. 27:57 – 30:42 | The next generation. Qiu credits the survey’s collaborators and explains why physicians starting out of residency may push the model further. 30:42 – [END] | Closing thoughts and outro. Austin Littrell thanks listeners and wraps the episode.

Amol Nirgudkar, CPA, CGMA, estimates that 25% to 30% of calls to health care offices go unanswered during business hours. He says patients who reach voicemail rarely leave a message. They call the next practice in their search results. Medical Economics Managing Editor Todd Shryock sat down with Nirgudkar, co-founder and CEO of Patient Prism, which uses artificial intelligence (AI) to analyze patient calls to practices. Nirgudkar explains why access has become patients' top frustration and how unanswered calls waste money practices spend on search and social media ads. He suggests using AI voice agents for overflow, weekend and after-hours calls. He puts AI receptionist services at $500 to $800 a month, sometimes $1,000, against per-visit revenue he says can run from $250 to $5,000 depending on specialty. He also advises physicians to fix one broken process at a time and says the harder problem with AI is getting staff to use it. Music Credits: Sky Drifter by Cephas - stock.adobe.com A 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. Nirgudkar grades today's AI voice agents. 0:25 – 1:19 | Introduction. Austin Littrell introduces the episode and the guest. 1:19 – 3:00 | Access is the problem. Nirgudkar says patients want to be seen when they need care, and the first hurdle is whether anyone answers the phone. 3:00 – 4:43 | What missed calls cost practices. Nirgudkar estimates 25% to 30% of calls go unanswered during business hours and says some voicemails are never returned. Unanswered calls also waste a practice's ad spending. 4:43 – 5:33 | Where patients go instead. Callers move on to the next physician in their Google or chatbot search results. 5:33 – 7:55 | Why the front desk is still a bottleneck. Clinician shortages, low pay for front office roles, staff trained as order takers and rising labor costs since the COVID-19 pandemic. 7:55 – 8:48 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 8:48 – 10:26 | Where AI voice agents fit today. Online scheduling handles simple bookings. Nirgudkar says voice agents are a good first step for overflow, weekend and after-hours calls. 10:26 – 12:31 | The return on investment. Nirgudkar compares monthly service costs with per-visit revenue and explains why most callers never leave a voicemail. 12:31 – 13:30 | Supporting staff, not replacing them. AI takes on routine work so front office teams can spend more time with patients at check-in and checkout. 13:30 – 15:30 | Will patients talk to AI? Low-acuity scheduling for existing patients works well, but insurance and coverage questions can still frustrate callers. 15:30 – 17:50 | Pick one problem and fix it. Chatbots, text agents, radiology AI and revenue cycle tools. Nirgudkar says the bigger challenge is getting staff to use what a practice buys. 17:50 – [END] | Closing thoughts and outro. Austin Littrell thanks listeners and wraps the episode.

In a June survey from reputation management company rater8, 55% of adults said they had walked away from at least one physician because of something they read online. When one of those reviews is fake or false, Michael Pelagalli, J.D., says HIPAA leaves physicians with very little they can say in a public reply, and federal regulators have fined practices that said too much. Medical Economics Associate Editor Austin Littrell sat down with Pelagalli, a partner at Minc Law, a Cleveland firm that works exclusively on internet defamation and online reputation matters. Pelagalli explains the difference between a defamatory review and a protected opinion. He covers what a practice should document and flag the moment a false review appears and how his firm uses John Doe lawsuits and subpoenas to unmask anonymous reviewers. He also describes a case in which dozens of fake reviews traced back to a family physician in the next county over. And he discusses the RESPOND Act, an advocacy campaign to amend HIPAA so physicians could reply in proportion to what a patient has already disclosed. Music Credits: Groovy 90s Hip Hop Acid Jazz by Musinova - stock.adobe.com A Textbook Example by Skip Peck - stock.adobe.comEditor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.0:00 – 0:28 | Cold open. Pelagalli on the family physician who woke up to dozens of fake reviews overnight. 0:28 – 1:52 | Introduction. Austin Littrell introduces the episode and the guest. 1:52 – 4:09 | Meet Michael Pelagalli. Pelagalli describes Minc Law's focus on online defamation, harassment and extortion. He explains how his early career defending physicians in malpractice cases led to the health care side of his practice. 4:09 – 6:13 | Opinion vs. fact. A rude physician or a long wait is opinion. Pelagalli explains why a claim that a surgeon was intoxicated in the operating room is a statement of fact that records can disprove. 6:13 – 10:16 | When a review crosses the line. Why reviews from real patients are harder to pursue than reviews from people who never were patients. Pelagalli describes a physician who took a patient's repeated accusations, which investigators had cleared, all the way to trial and won. 10:16 – 14:19 | The first step after a false review appears. Document it, check it against patient records and flag reviews from nonpatients to the platform repeatedly. Pelagalli explains when to call a lawyer before responding at all. 14:19 – 15:12 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 15:12 – 18:21 | How much a physician can say in reply. A generic invitation to talk privately is allowed. Confirming that the reviewer was ever a patient is not, even if the patient already said so. 18:21 – 21:24 | The RESPOND Act. Pelagalli on an advocacy effort to amend HIPAA so physicians could answer in proportion to what a patient has disclosed, and why litigation shouldn't be the only option. 21:24 – 26:43 | Unmasking an anonymous reviewer. How John Doe lawsuits, platform subpoenas, basic subscriber information and IP addresses lead to a name. Pelagalli explains what the letter to the unmasked reviewer says. 26:43 – 29:33 | When the reviewer is a competitor. The family physician from the next county over, and why a competitor opens the door to unfair competition, tortious interference and Lanham Act claims. 29:33 – 31:18 | Act promptly. Pelagalli says reaching the patient privately within a couple of days or a week makes removal far more likely than letting reviews pile up. 31:18 – End | Closing thoughts and outro. Littrell thanks Pelagalli and wraps the episode.

D2 Solutions' survey, "Patient Access Barriers 2026," found that 21% of patients delayed starting a prescribed medication because of confusion or access problems, and 47% said a lack of transparency left them anxious and uncertain. Dean Erhardt says the prior authorization rejections behind many of those delays are largely administrative rather than clinical, and they often come back with no reason given. Medical Economics Senior Editor Richard Payerchin sat down with Erhardt, president and CEO of D2 Solutions, a health care consulting and technology company that works with drug manufacturers, pharmacies and payers on market access and patient support. Erhardt explains how errors as small as a mismatched ZIP code get submissions thrown out, why guidance from payer call centers changes from one call to the next and what patients still don't know about manufacturer copay and affordability programs. He also weighs labor against technology costs for smaller practices, makes the case for upskilling staff around artificial intelligence (AI) and describes how primary care physicians could reach patients in health care deserts by setting aside time for telehealth. Music Credits: Her Name by Cephas - stock.adobe.com A Textbook Example by Skip Peck - stock.adobe.comEditor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.0:00 – 0:40 | Cold open. Erhardt on what a newly diagnosed patient hears from everyone involved in getting a medication approved. 0:40 – 1:44 | Introduction. Austin Littrell introduces the episode and the guest. 1:44 – 3:47 | Meet Dean Erhardt. Erhardt describes D2 Solutions' start in consulting in 2008 and his earlier career on the payer, distributor and pharmacy benefit manager (PBM) sides of the industry. 3:47 – 5:34 | Why prior authorizations stall. Denials often come back with no reason given. Erhardt says delays of days are an infrastructure problem, and some manufacturers see products held up for as long as three to four weeks. 5:34 – 7:38 | Catching errors before they're submitted. Payer call center guidance varies from one call to the next. Erhardt explains how matching each payer's requirements for a given product and flagging errors as small as a mismatched ZIP code prevent rejections. 7:38 – 10:16 | What patients go through. Erhardt describes patients fielding conflicting calls from the physician's office, the pharmacy and the payer, practices needing as many as nine calls to reach them and patients who never learn about copay and affordability programs. 10:16 – 12:08 | Options for smaller practices. Erhardt weighs labor against technology costs, points to staff turnover as a hidden expense and says training on a new platform should take about 15 minutes. 12:08 – 13:01 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 13:01 – 16:08 | Can technology offset the workforce shortage? Erhardt expects dramatic shortages by 2030 and says people nearing retirement now are more comfortable with technology than the generation before them. He points to digital therapeutics and wearables as part of care delivery. 16:08 – 18:03 | Upskilling staff around AI. Erhardt's horse-and-buggy case for training, and why a couple of classes a year can keep a practice's skills from falling behind the technology. 18:03 – 20:56 | What comes after AI scribes. Virtual consults that put a distant physician in a rural exam room, AI call centers and why Erhardt thinks patients are 12 to 24 months from being comfortable with AI agents. 20:56 – 22:40 | A volatile year for drug access. Erhardt points to PBM reform, revamped manufacturer contracts, growing lists of non-covered drugs and the risk of a race to the bottom on biosimilar prices. 22:40 – 24:26 | Behind the "ask your doctor" ads. Erhardt describes enrolling patients in manufacturer programs straight from TV ads and screening them before they reach a physician. He estimates about 30% of patients don't have a primary care physician. 24:26 – 25:54 | Direct-to-patient models and primary care. Erhardt says patients will drive the shift toward virtual care based on convenience, and that they'll decide how they want to receive care. 25:54 – 27:46 | Investing in primary care. Health care deserts, physicians 75 miles away and the case for setting aside telehealth time for patients who can't take hours off work. 27:46 – 28:54 | What the survey says about access. Erhardt on the patient who learns they have a disease that costs $250,000 a year to treat and doesn't know what to do next. 28:54 – End | Closing thoughts and outro. Payerchin thanks Erhardt, and Littrell wraps the episode.

Nearly two decades into the push toward value-based care, Dan D'Orazio says the industry isn't much further along than it was when the effort began. He says value-based programs are still pegged to fee-for-service, and the fee-for-service revenue hospitals collect routinely outweighs the penalties meant to move them off it. Medical Economics Managing Editor Todd Shryock sat down with D'Orazio, CEO of Sage Growth Partners, a Baltimore-based health care strategy and marketing firm. D'Orazio explains why remote monitoring of implantable cardiac devices stalled long after the technology was ready. He also explains why he doesn't expect artificial intelligence (AI) to fix incentives that were never a technology problem, and what capitation and Maryland's global hospital budgets can and can't do outside an integrated system. He makes the case that physician-led accountable care organizations are one of the few places value-based care is working, and explains why he expects incremental gains at best from here. Music Credits: Sleepy Sunday by Buurd - stock.adobe.com A Textbook Example by Skip Peck - stock.adobe.comEditor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.0:00 – 0:12 | Cold open. D'Orazio on where value-based care is headed. 0:12 – 1:12 | Introduction. Austin Littrell introduces the episode and the guest. 1:12 – 2:41 | Where value-based care actually stands. Todd Shryock welcomes D'Orazio, who says the industry isn't much further along than it was in 2008 and 2009, and not for lack of effort. He weighs 10 to 20 years of value-based care against 80 years of fee-for-service. 2:41 – 5:45 | Why the shift stalled. Value-based programs are still pegged to fee-for-service, and the incentives to stay put outweigh the penalties. D'Orazio uses remote monitoring of implantable cardiac devices to show that the barrier was never the technology. It was the workflows, liability, staffing and alert fatigue around it. 5:45 – 9:28 | Penalties vs. revenue. D'Orazio says readmission penalties are small next to what hospitals still collect under fee-for-service, and that most of what drives a patient's health sits outside a physician's control. 9:28 – 14:23 | Why payers and the government keep pushing it. Costs keep rising and employers are bearing them. D'Orazio says even online scheduling runs into directory data, interoperability and physician templates. He adds that short commercial plan tenure undercuts the long-term incentive value-based care depends on. 14:23 – 15:17 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 15:17 – 18:32 | Can AI solve it? AI is only as strong as the data beneath it. D'Orazio sees real gains in administrative automation but says AI won't change fee-for-service, incentives or patient behavior. 18:32 – 21:41 | Capitation's comeback. Integrated systems like Kaiser Permanente and Geisinger can make it work. D'Orazio walks through the underwriting, data and care coordination capitation demands, and why several health systems have exited the health plan business. 21:41 – 23:55 | The Maryland model. Maryland pays its hospitals through global budgets, an approach D'Orazio says is returning through a CMS model. He explains how it changed hospital behavior and why commercial insurers and employers can't easily replicate it. 23:55 – 27:45 | Where health care is headed. D'Orazio expects incremental gains at best. He points to physician-led accountable care organizations outperforming hospital-led ones and calls for a rebirth of independent physician leadership. He names end-of-life spending and prior authorization as problems that won't unwind easily. 27:45 – End | Closing thoughts and outro. Shryock thanks D'Orazio, and Littrell wraps the episode.

In a Buzz Health survey of prescribers, 54% said patients often or very often fail to start therapy because of cost, but only 17% said prescription abandonment is highly visible in their workflows. Joseph Kleiman, president of Buzz Health, says the gap comes down to connectivity: prescriber, pharmacy and health plan systems that still don't share data. Medical Economics Managing Editor Todd Shryock sat down with Kleiman to talk through the survey, which included prescribers and electronic health record (EHR) workflow leaders. Nearly all prescribers in the survey said seeing insurance and discount prices side by side in the EHR would be extremely or very valuable, and when cash or discount pricing was available at the point of prescribing, it was chosen most often. Kleiman explains why that doesn't necessarily make insurance the worse deal, what it costs patients and practices when price comparisons happen after the visit, and what he would tell the primary care physician who has stopped trying and tells patients to search for a coupon. He also weighs in on the role artificial intelligence (AI) could play and whether federal attention on price transparency is moving things in the right direction. Music Credits: Ocean Calm by Cephas - stock.adobe.com A Textbook Example by Skip Peck - stock.adobe.comEditor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.0:00 – 0:15 | Cold open. Kleiman on cash prices and surprises at the pharmacy counter. 0:15 – 1:14 | Introduction. Austin Littrell introduces the episode and the guest. 1:14 – 2:23 | Why patients don't start therapy. Todd Shryock welcomes Kleiman, whose company's survey found 54% of prescribers say patients often or very often fail to start therapy because of cost. Kleiman says the problem persists because prescriber, health plan and pharmacy systems still don't share data. 2:23 – 3:15 | Closing the feedback loop. Only 17% of prescribers said prescription abandonment is highly visible in their workflows. Kleiman says fixing that takes systems that deliver results in one centralized location, and that it hasn't been a priority rather than something anyone opposes. 3:15 – 4:04 | Pricing inside the EHR. Nearly all prescribers said side-by-side insurance and discount pricing in the EHR would be valuable. Kleiman says nothing is standing in the way, and the technology can already deliver real-time pricing at the point of prescribing. 4:04 – 5:12 | Cash price vs. insurance. When cash or discount pricing is shown at the point of prescribing, it gets picked most often. Kleiman says insurance isn't necessarily the worse option, but prior authorization and deductibles create friction that surfaces at the pharmacy. 5:12 – 6:10 | The cost of sorting out prices after the visit. When price comparisons fall to staff or patients after the appointment, Kleiman says the uncertainty leads to abandoned prescriptions. 6:10 – 7:04 | Primary care's role in affordability. Kleiman says primary care physicians want an active role, and connecting pharmacy, prescriber and health plan will let them play a bigger part in the prescription journey. 7:04 – 7:56 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas. 7:56 – 8:46 | A message for health systems and administrators. Kleiman says the technology is there and isn't difficult to implement, and that better adherence helps costs for practices and health plans. 8:46 – 9:40 | For the physician who's given up. Kleiman on patients quoted one price who find another at the pharmacy, and his message that solutions now exist through the EHR and health plans. 9:40 – 10:33 | Where AI fits. Kleiman says AI can play a big part, but data sharing must be permitted and the work done carefully in a heavily regulated industry. 10:33 – 11:21 | Are things getting better? Kleiman points to CMS and legislative action on price transparency and says the remaining work is tying systems to a single source of truth. 11:21 – 12:00 | Final thoughts. Kleiman urges pharmacies, prescribers and health plans not to push pricing transparency aside. 12:00 – End | Outro. Littrell wraps the episode and points listeners to Medical Economics and Physicians Practice coverage of the MGMA Annual Conference in San Antonio, Sept. 27-30.

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.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 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

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.comEditor'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.