Off the Chart: A Business of Medicine Podcast

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Jun 2026

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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.

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June 15, 2026Episode 15923 min

S1 Ep159: The new front door to health care, with Andrea Giamalva, M.D., FAAFP, of Experity

Urgent care was never designed to be the front door to American health care, but that's increasingly what it has become. As the country faces a projected shortage of as many as 80,000 primary care physicians by 2037 and nearly 40% of Gen Z patients go without a primary care physician at all, more Americans are turning to urgent care as their first and often only point of contact with the health care system. Medical Economics Associate Editor Austin Littrell speaks with Andrea Giamalva, M.D., FAAFP, chief medical officer at Experity, about what urgent care is actually handling today, where its relationship with primary care breaks down and why she believes AI-enabled technology may finally help clinicians get the right patient to the right place at the right time. The conversation covers the generational shift away from primary care, the payer and cultural barriers that complicate care-gap closure, the growing role of advanced practice providers and how tools like AI scribes could bring humanity back to the exam room.Music Credits:Coffee Shop Sketches by Buurd - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor's note: Episode timestamps and transcript produced using AI tools.0:00 – 0:24 | Sponsor message Copic medical liability insurance.0:24 – 0:51 | Cold open Giamalva previews the episode's central theme: the national shortage of primary care has turned urgent care into the front door to health care for many Americans.0:51 – 1:44 | Introduction Austin Littrell introduces the episode and guest, previewing the data behind the primary care shortage and the case for using technology to get the right patient to the right place at the right time.1:44 – 2:20 | Meet Andrea Giamalva Giamalva introduces herself as a family medicine physician and chief medical officer at Experity, the leading platform for on-demand health.2:20 – 4:28 | How urgent care became the front door From its 1970s origins to today, urgent care has grown from a cough-and-cold clinic into a multichannel digital front door offering employer-paid services, weight loss therapy, hormone therapy and mental health care.4:28 – 7:15 | Choice or access? The generational data Roughly 10% of baby boomers lack a primary care physician, rising to nearly 40% of Gen Z. Giamalva ties the generational shift, projected shortages of up to 80,000 primary care physicians by 2037 and health care deserts to the "Amazon-Uber-DoorDash" expectations now shaping patient behavior.7:15 – 9:49 | Right patient, right place, right time Giamalva argues the hardest problem in health care is matching patients to the appropriate setting, and that technology could let urgent care safely handle straightforward cases while primary care focuses on complex, time-intensive ones.9:49 – 11:28 | Reducing burden without adding fragmentation With one study finding it would take 27 hours a day for a primary care physician to manage their full panel, Giamalva says clear communication across the patient journey and better tools at the point of care are what let urgent care act as a partner rather than a competitor.11:28 – 14:02 | Treating patients like customers Giamalva makes the case that patient experience directly affects outcomes, and describes tools like Care Agent and AI scribes that aim to keep patients informed and bring human interaction back to the visit.14:02 – 14:53 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.14:53 – 17:55 | What primary care can learn from urgent care Urgent care's scheduling flexibility and retail DNA give it a head start on on-demand care. Giamalva says primary care could adopt a more hybrid, risk-stratified approach that routes patients to telehealth, urgent care or a full primary care visit based on need.17:55 – 19:43 | The expanding role of advanced practice providers As APPs take on larger roles in both settings, Giamalva calls for team-based models, clear expectations and proper training so urgent care teams can manage common chronic conditions like diabetes, hypertension and thyroid disease.19:43 – 22:01 | Closing the primary care gap Giamalva walks through what it takes for urgent care to help patients without an established primary care relationship, including patient willingness, payer contracts that can prohibit preventive care and the cultural shift required of clinical teams.22:01 – 22:53 | The case for AI-enabled technology In her closing thoughts, Giamalva argues AI-enabled technology is more than a fad and could finally reverse the administrative burden that has chipped away at the patient-provider relationship.22:53 – End | Outro Littrell thanks Giamalva and wraps the episode.

June 11, 2026Episode 15835 min

S1 Ep158: Cash-only practice, with John C. Cianca, M.D., FAAPMR, president of the American Academy of Physical Medicine and Rehabilitation

The consolidation of outpatient medicine has swept many independent physicians into larger systems, private equity arrangements or hospital employment. John C. Cianca, M.D., FAAPMR, a physiatrist in Houston, Texas, and president of the American Academy of Physical Medicine and Rehabilitation, went the other way. More than two decades ago, he left his Baylor-affiliated medical college to build a true solo, cash-only practice — no front desk, no MAs, no prior authorizations, no step therapy requirements.Medical Economics Senior Editor Richard Payerchin talks with Cianca about why he made that move, what it cost him early on and what it freed him to do for patients. They also cover what primary care physicians consistently misunderstand about physical medicine and rehabilitation, how AAPMR became an early leader in documenting and advocating for long COVID patients, and how AI is already reshaping medical education in ways that may make traditional professional society programming obsolete.Music Credits:CALM CHILL RELAXED SMOOTH JAZZ (OWE YOU) by Tasty Tunes - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor's note: Episode timestamps and transcript produced using AI tools.0:00 – 0:26 | Sponsor message Copic medical liability insurance.0:26 – 0:58 | Cold open Dr. Cianca on the consolidation churn pulling outpatient practices into larger, less autonomous systems — and why he went the other direction.0:58 – 1:55 | Introduction Austin Littrell introduces the episode, the guest and the key topics.1:55 – 2:43 | Meet Dr. John Cianca Dr. Cianca introduces himself: private practitioner in Houston, adjunct faculty at Baylor College of Medicine and UT Medical Sciences, and president of AAPMR. His practice is a solo, cash-only outpatient musculoskeletal clinic.2:43 – 4:43 | The biggest challenge facing PM&R Physical medicine and rehabilitation is a broad specialty spanning acute catastrophic injuries to day-to-day musculoskeletal care. The persistent external challenge: rehabilitation is still treated as an afterthought in care delivery, when earlier involvement produces faster, more efficient outcomes.4:43 – 9:10 | PM&R's place in the primary care landscape Many early misconceptions about physiatry have cleared, but it's still not the first call for non-operative musculoskeletal problems — orthopedics tends to get the referral. Dr. Cianca makes the case for physiatry as a long-arc specialty rather than an incident response, and traces the field's evolution from hospital-based rehabilitation to outpatient care.9:10 – 12:34 | AAPMR and long COVID Drawing on the specialty's history managing post-polio rehabilitation, AAPMR recognized early that post-COVID conditions would require sustained attention. Dr. Cianca says access to long COVID care has become harder over time, not easier, as the health care system's urgency has faded and the broader public has moved on.12:34 – 15:11 | The pressures on independent practice Administrative burden, consolidation and private equity have pushed many small practices into larger systems. Dr. Cianca describes the churn that has reshaped outpatient medicine and explains why he deliberately went the other direction — and why he was fortunate to start when he did.15:11 – 19:03 | Why Dr. Cianca went cash-only Twenty-two years ago, Dr. Cianca left his medical college affiliation to build a solo, insurance-free practice. His motivation wasn't money — he says he earns less than most colleagues — it was time: time to speak with patients, teach them and change their course rather than treat volume. He acknowledges the financial difficulty of the early years and cautions that the model is genuinely hard to build.19:03 – 23:10 | The practical reality of a cash-only solo practice No front desk, no MAs, no PAs — and no chasing approvals or unpaid claims. Dr. Cianca explains what it means to deliver care without having to justify clinical decisions to someone who may not fully understand what they're approving. On step therapy: it's not a savings, it's just a delay.23:10 – 24:01 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.24:01 – 26:25 | Remote therapeutic monitoring and technology in PM&R Dr. Cianca describes how the specialty has long used implantable technology for spasticity and pain management and explains how PM&R's practically oriented culture has made it an early and consistent adopter of new tools — including outpatient microsurgical techniques that send patients home the same day.26:25 – 29:24 | AI and the future of PM&R AI may be the biggest change Dr. Cianca has seen in his career, and it's already reshaping medical education. Residents are turning to AI for literature synthesis instead of reading primary articles, and professional societies are trying to figure out how to stay relevant without being made obsolete.29:24 – 32:04 | PM&R and the "Make America Healthy Again" initiative Dr. Cianca's view: physiatry has been doing this work all along. The specialty's whole-person, function-first approach to care predates the policy framing. A colleague recently put it simply: "You've already been doing this anyway."32:04 – 34:16 | A message to primary care physicians and outro Primary care is physiatry's gateway, and Dr. Cianca's message to PCPs: for non-operative musculoskeletal problems, physiatrists offer something orthopedics doesn't — long-term partnership across a spectrum of time, not just an incident response. Payerchin wraps the interview; Littrell closes the episode.

June 8, 2026Episode 15717 min

S1 Ep157: From spreadsheets to strategy, with Melinda Mastel, MBA, MS, of the Medical College of Wisconsin

Strategic thinking is often treated as an executive skill — something reserved for leadership retreats and long-range planning sessions. Melinda Mastel, MBA, MS, FHFMA, CMPE, PMP, a financial advisor at the Medical College of Wisconsin, argues it belongs on every finance professional's desk on a normal Tuesday. Physicians Practice Managing Editor Keith Reynolds speaks with Mastel about what actually drives budget misses in medical groups, why the culprit is almost never the numbers themselves, and how small changes in the way financial data is tracked and presented can produce bigger operational shifts than most practice leaders expect. They also cover what a minimum viable product approach looks like in a health care finance context, why scope creep is the quiet killer of practice improvement projects, how to align cross-functional teams that can't agree on what the problem actually is, and why curiosity is the skill that most reliably turns an early-career finance professional into a trusted advisor. Mastel closes with two concrete tips practice leaders can implement immediately: challenge your assumptions about what can and can't change, and expand who you're hearing from.Music Credits:Retro Disco Lounge Groove by MotifLab Music - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor's note: Episode timestamps and transcript produced using AI tools.0:00 – 0:24 | Sponsor message Copic medical liability insurance.0:24 – 0:48 | Cold open Mastel on why launching a new program at 50% or 20% of the ideal scope isn't failure — it's strategy.0:48 – 1:39 | Introduction Austin Littrell introduces the episode and Melinda Mastel.1:39 – 2:42 | The first question to ask when someone brings you a budget problem Stop at the numbers themselves and ask what changed. Workflow shifts, staffing changes, documentation drift and altered coding standards all show up in the data before they show up anywhere else.2:42 – 3:26 | The most common reason medical groups miss budget Hidden operational shifts — small, undocumented changes in how time is spent or how effort is deployed — drift practice finances away from projections without ever triggering a formal review.3:26 – 4:37 | What strategic thinking actually looks like on a Tuesday Strategic thinking is not an executive skill — it is a set of questions anyone can apply to anything on their desk. Do we agree on the actual problem? Who is affected downstream? What decisions upstream are landing here? Mastel argues the practice of asking those questions consistently is what separates finance professionals who execute from those who are sought out for advice.4:37 – 6:13 | When reframing data changes a decision A growing subspecialty program at the Medical College of Wisconsin was tracked in aggregate with several other programs, making it nearly impossible to evaluate performance. Separating it in the accounting structure — a simple change — gave senior leaders clear metrics and produced more intentional investment decisions almost immediately.6:13 – 8:54 | Launching something new on a tight budget: the blind spot We underestimate uncertainty and over-commit to the ideal version from day one. Mastel makes the case for a minimum viable product approach: launch at 50% or 20%, test it, gather feedback and preserve contingency for the things you cannot control. On the revenue side, she points to sponsored funding, organizational partnerships and philanthropic sources as underused options in academic medicine and beyond.8:54 – 9:58 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.9:58 – 11:47 | The project management tools that actually matter in health care Two principles from formal project management apply directly to practice finance work: stakeholder management — bringing the right people, including end users and cross-functional contributors, into the conversation at the right time — and scope clarity, because projects that don't define what they are not tackling tend to drift and lose momentum.11:47 – 13:03 | Aligning a cross-functional team that can't agree on the problem When urgency is high and definitions differ, the instinct is to move fast. Mastel argues for the opposite: slow down, document the shared definition of the problem before moving to solutions, and come back to it when decisions downstream get contested. That investment upfront eliminates far more rework than it costs.13:03 – 14:33 | The skill that turns a finance professional into a trusted advisor Curiosity — not technical fluency, not communication skills, not change management frameworks, though all of those matter. Asking questions when there is extra time at the end of a meeting, understanding what pressures sit outside your own role and building a reputation for caring about causes rather than just executing tasks is what moves someone from analyst to thought partner.14:33 – 16:33 | Two tips for practice leaders Challenge your assumptions about what is fixed. Some things genuinely cannot change quickly, but others can — and they won't unless someone asks the question. Then expand who you're hearing from. Office hours, rounding, an open-door policy — anything that gets the same voices out of the same room and brings in the perspective of people on the front lines.16:33 – 16:51 | Closing remarks Keith Reynolds thanks Mastel and wraps the interview.16:51 – end | Outro Austin Littrell closes the episode.

June 4, 2026Episode 15634 min

S1 Ep156: Why where you live may matter more than how you're treated, with experts from the Physicians Foundation

Social drivers of health (SDOH) — food security, housing stability, transportation, utilities access and interpersonal safety — account for roughly 80% of what determines whether a patient stays healthy or gets sick. Yet most of the health care system is still organized around the 20%: treating illness after it arrives. Medical Economics Senior Editor Richard Payerchin speaks with Dhruv Khullar, M.D., M.P.P., a practicing physician and associate professor of health policy and economics at Weill Cornell Medical College who directs the Physicians Foundation Center for the Study of Physician Practice and Leadership, and Paul C. Harrington, former executive vice president of the Vermont Medical Society and a board member of the Physicians Foundation. They discuss why a patient's zip code can predict life expectancy more reliably than the care they receive, why SDOH screening falls short when the community resources to act on it aren't there, and the moral injury clinicians feel when they identify a need they cannot meet.Music Credits:Morning Coffee by Keyframe Audio - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor's note: Episode timestamps and transcript produced using AI tools.0:00 – 0:27 | Sponsor message Copic medical liability insurance.0:25 – 0:52 | Cold open Dr. Khullar on the moral injury clinicians feel when they can identify a patient's social need but cannot meet it.0:52 – 1:44 | Introduction Austin Littrell introduces the episode and both guests.1:44 – 5:06 | Meet Paul Harrington Harrington introduces himself as a former Vermont legislator, U.S. Senate health policy director and longtime Physicians Foundation board member, and explains how a foundation-commissioned study by Dr. Buzz Cooper reframed health care spending as a demand-side problem — and drew the foundation into SDOH.5:06 – 9:02 | SDOH is not a rural problem or an urban problem Palm Beach County data shows a 16-year life expectancy gap between two zip codes 10 miles apart. Harrington argues that access to food, transportation, safe housing and economic opportunity — not geography — determines whether a patient thrives.9:02 – 11:36 | What works on the ground Three examples from the foundation's grant program: a Rush University cardiology program that places residents in food shelves to understand what their patients face outside the clinic; a Wichita, Kansas initiative embedding SDOH screening into electronic medical records and tracking whether identified needs are actually being addressed; and North Carolina's Medicaid managed care model, which improved health outcomes by adding food vouchers, housing support and transportation to the care contract.11:36 – 12:27 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.12:27 – 13:46 | Meet Dr. Dhruv Khullar Dr. Khullar introduces himself as a practicing physician and health services researcher at Weill Cornell Medicine, where he directs the Physicians Foundation Center for the Study of Physician Practice and Leadership. The center focuses on incentives in health care, value-based payment, consolidation, physician well-being and the social needs of patients.13:46 – 16:18 | The science behind SDOH SDOH is not a new idea or a trend — the evidence that social and community factors shape health outcomes, by some measures more than the care delivered in clinics and hospitals, is well established. The open challenge is not validation but intervention: once a social need is identified, what actually works to address it?16:18 – 18:17 | The five core drivers of health Food security, housing stability, transportation access, utilities access and interpersonal safety. Dr. Khullar identifies food insecurity as the broadest challenge facing the most patients and unstable housing as the most individually devastating.18:17 – 20:17 | The screening gap Community resource partnerships work — when they exist. The problem is that many communities lack those resources, leaving screening without the infrastructure to act on it. Going forward, the priority is aligning payment and policy to incentivize health systems to meet social needs, not just clinical ones.20:17 – 21:46 | The SDOH billing codes and why physicians aren't using them The Physicians Foundation was instrumental in establishing billing codes that allow physicians to document patients' social needs. Adoption has been slow because awareness remains low — and because adequate reimbursement is still needed to create a durable incentive to use them.21:46 – 23:25 | How to talk about SDOH with patients Empathy first. Dr. Khullar describes building the kind of trust that makes patients comfortable disclosing a housing or food problem — and argues that doing so matters not just for patient outcomes but for the sustainability of the workforce, which bears real moral weight when needs go unmet.23:25 – 25:28 | Reaching beyond the clinic Dr. Khullar's three-part framework: identify who needs help through relationship-building and, carefully, AI-assisted screening; build durable relationships with community organizations over years and decades; and push for adequate public funding of social services, because screening and referrals can only go so far without a functioning safety net behind them.25:28 – 27:10 | The case for investing upstream Both primary care and social services carry the same logic — large upfront investment, enormous long-term return. Dr. Khullar argues the case is both financial and moral: the political and social will to act is the only thing missing.27:10 – 29:57 | State policy and how physicians can get involved States are laboratories for SDOH policy, and Harrington argues that elected officials actively want physician input. Working through state medical societies is the most direct path — legislators seek out physicians during recesses, and when physicians show up, they are heard.29:57 – 31:15 | Dr. Khullar's message to primary care physicians Primary care is harder year over year, and unless health care financing, administrative burden and social support infrastructure change substantially, the workforce is at risk. Dr. Khullar calls this one of the most important issues in health care reform.31:15 – 33:21 | Paul Harrington's message to primary care physicians Primary care physicians are the bedrock of American health care — underappreciated and underfunded. Harrington closes with a direct thank-you, a tribute to rural physicians embedded in the fabric of their communities and the Physicians Foundation's commitment to make the work of addressing social drivers of health easier, not harder, for the physicians doing it every day.33:21 – 33:42 | Closing thoughts and outro Payerchin thanks both guests and wraps the interview portion of the episode.

June 1, 2026Episode 15533 min

S1 Ep155: What doctors don't know about their own finances, with Michael Jerkins, M.D., M.Ed., and Jillian Vestal, J.D., of Panacea Financial

Physicians are among the highest earners in the American workforce. They're also among the most financially stressed. Panacea Financial's 2026 survey, "The Financial Lives of Doctors," puts numbers to that tension. Financial confidence rises from just 2.33 out of 5 in medical school to 3.27 among practicing physicians. More than half of respondents said they would not choose medicine again, or weren't sure, if federal student loans were capped at $200,000 (which they will be next month). Nearly two-thirds cited tax complexity as a top career challenge. Medical Economics Associate Editor Austin Littrell speaks with Michael Jerkins, M.D., M.Ed., president and co-founder of Panacea Financial, and Jillian Vestal, J.D., head of legal services at Panacea Legal, about what's driving those numbers. The conversation covers what physicians consistently miss when reading their own contracts, how student debt shapes nearly every major financial decision a doctor makes, the tax traps hiding in signing bonuses and relocation reimbursements, and what the financial services industry keeps getting wrong about physicians as clients.Read the report: https://panaceafinancial.com/survey-2026/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 – 0:26 | Sponsor message Copic medical liability insurance.0:26 – 0:42 | Cold open Dr. Jerkins previews the episode's core tension: being a doctor is still the coolest job you can have — but there will be a financial point where people reconsider.0:42 – 1:57 | Introduction Austin Littrell introduces the episode and the guests and previews the key findings from Panacea's 2026 survey, "The Financial Lives of Doctors."1:57 – 3:41 | Meet the guests Dr. Jerkins describes his path from financially struggling MedPeds physician to co-founding Panacea Financial. Vestal explains her background in health system contract work and what drew her to Panacea Legal.3:41 – 6:08 | Would doctors choose medicine again? 53% of survey respondents said they wouldn't choose medicine, or weren't sure, if student loans were capped at $200,000. Dr. Jerkins puts the number in context: record medical school enrollment suggests demand remains strong, but the cap could quietly shift who enters the profession and where they end up practicing.6:08 – 11:39 | The contract knowledge gap 49% of respondents said understanding their own compensation is a top challenge — but Vestal argues the real number is higher, because many physicians don't know what they don't know. Two contracts with identical salary numbers can look very different once call obligations, productivity incentives and bonus structures are factored in.11:39 – 12:50 | Why earning more doesn't mean feeling more confident Financial confidence barely moves from training to practice — not because doctors are irresponsible, but because clinical and administrative demands leave little bandwidth for learning to navigate tax strategy, long-term planning and retirement savings.12:50 – 17:22 | Student debt and contract negotiations 46% of doctors don't fully understand their repayment, forgiveness or refinancing options — and that knowledge gap follows them into employment negotiations. Vestal walks through how signing bonuses structured as loans, student loan assistance clauses and termination language can each carry significant financial consequences that most physicians never see coming.17:22 – 18:21 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.18:21 – 21:24 | Balancing loans with life goals 70% of respondents struggle to balance loan repayment with other financial goals, including 37% already in practice. Dr. Jerkins explains why the period right after training is when physicians are most at risk of financial mistakes — and why a student loan strategy needs to come before the nice house.21:24 – 25:23 | The tax complexity problem Tax complexity was the most cited career challenge at 67%, split nearly evenly between trainees and practicing physicians. Vestal breaks down how signing bonuses structured as loans, relocation reimbursements and state-to-state tax bracket shifts create unexpected W-2 surprises in a physician's first year of practice. Dr. Jerkins adds the growing 1099 locums trap.25:23 – 28:31 | What the financial services industry gets wrong about doctors Physicians aren't careless — they're busy and uninformed. Dr. Jerkins argues the industry misreads physician risk, ignores their schedules and fails to account for the income gaps that happen between training and practice.28:31 – 32:27 | The single most important thing to do right now Educate yourself, don't trust appearances and find a fiduciary advisor with physician-specific experience. Vestal adds: even if you've already signed your contract and have no plans to leave, get it reviewed — one doctor recovered $40,000 she never knew she was owed.32:27 – 33:20 | Closing thoughts and outro Littrell thanks the guests, directs listeners to Panacea's 2026 survey in the show notes and wraps the episode.

May 28, 2026Episode 15423 min

S1 Ep154: The time is now for physician-owned hospitals, with Carlos Cardenas, M.D., president of Physician-Led Healthcare for America

For the first time, CMS isn't asking whether physician-owned hospitals should be part of Medicare's care delivery models — it's asking how. Carlos Cardenas, M.D., a practicing gastroenterologist, founder and chairman of DHR Health in Texas' Rio Grande Valley, and president of Physician-Led Healthcare for America, joins Medical Economics Senior Editor Richard Payerchin to explain why that distinction matters. They cover how Section 6001 of the ACA froze competition in hospital markets, what the data actually shows about cost and quality at physician-led facilities, how to address the overutilization criticism, the patchwork of state and federal rules governing physician ownership, and what it will take to move the needle in Congress.CMS has published its proposed 2027 Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS), including a request for information about participation of physician-owned hospitals in Medicare’s new Transforming Episode Accountability Model (TEAM). Public comments on the CMS request for information are due June 9. The IPPS is a 576-page document, but the relevant section can be found by searching for: “Hospital with Physician Ownership Request for Information”.Music Credits:Chasing the moment 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 — Sponsor message Copic medical liability insurance.0:27 — Cold open: Dr. Cardenas on CMS's shift in framing physician-owned hospitals 0:52 — Intro: Austin Littrell previews the episode and the June 9 CMS public comment deadline 1:55 — Guest introduction: Dr. Cardenas and Physician-Led Healthcare for America 3:11 — The "landmark moment": What the CMS request for information actually signals 3:49 — How the ACA's Section 6001 restricted physician-owned hospitals and froze competition 4:31 — The economic environment for medical practice over the last 15 years 7:26 — Why CMS's request for information is a meaningful seat at the table 9:49 — P2 Management Minute: Keith Reynolds 10:37 — A 2023 study showing Medicare could have saved $1B+ if care had been delivered at physician-owned hospitals 12:34 — Addressing the overutilization criticism 13:34 — Cherry-picking patients: Is it real? 15:15 — Reconciling state corporate-practice-of-medicine laws with federal limits on physician hospital ownership 18:07 — What it will take to get Congress to act on physician ownership legislation 20:02 — If the Medicare inpatient rule produces no change, what comes next? 21:28 — A message to primary care physicians 22:22 — Outro and CMS public comment reminder

May 25, 2026Episode 15330 min

S1 Ep153: Leadership lessons, with Leon Moores, M.D.

Happy Memorial Day, Off the Chart listeners! In today's episode, Leon Moores, M.D., a pediatric neurosurgeon, experienced health care executive and author of "All Physicians Lead: Redefining Physician Leadership for Better Patient Outcomes," joins Medical Economics Associate Editor Austin Littrell to answer the question: What does it mean to lead when you don't have all the answers? Moores argues that every physician is already exercising leadership every day, whether they recognize it or not, and that the clinical skills physicians already have are a better leadership template than most realize. He explains why projecting false confidence is more damaging than acknowledging what you don't know, how the COVID-19 pandemic's overconfident messaging left lasting scars on public trust, and what it actually looks like to be a stabilizing force rather than a cheerleader or a panic merchant. He also walks through the most common mistake physician leaders make under stress, dismissing the people around them while rushing to the next thing, and closes with one piece of advice any leader can act on this week: listen better.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 AI tools.0:00 – 0:24 | Sponsor message Copic medical liability insurance.0:24 – 0:42 | Cold open Dr. Moores previews the episode's core argument: by any fundamental definition of leadership, every physician is already doing it every day.0:42 – 1:42 | Introduction Austin Littrell wishes listeners a happy Memorial Day and introduces the episode and Dr. Moores.1:42 – 2:26 | Meet Dr. Leon Moores Dr. Moores introduces himself: nearly 37 years as a pediatric neurosurgeon, experience leading large health care organizations and a longtime student and teacher of leadership.2:26 – 5:54 | How uncertainty affects medical teams Dr. Moores contextualizes today's uncertainty against the COVID-19 pandemic and argues that leaders need to recognize that personal pressures don't stay at the door when people come to work.5:54 – 8:19 | What teams need from their leaders Be honest about what you don't know, say so upfront and tell your team that your recommendations may change as you learn more. Leaders are affected by uncertainty too, and self-awareness is the prerequisite for self-management.8:19 – 10:59 | Every physician is already a leader By the basic definition of leadership, influencing behavior to achieve a desired result, every physician is leading every day. The clinical framework physicians already use maps almost exactly onto effective leadership practice.10:59 – 13:33 | Calm vs. honest: finding the balance Using the Apollo 13 analogy, Dr. Moores explains the difference between being a credible stabilizing force and being either a robot or a cheerleader. Acknowledge the problem, don't panic and don't pretend everything is fine when it isn't.13:33 – 14:22 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.14:22 – 16:43 | How to deliver difficult news without losing trust Show some humanity. Let your team know you're affected too. The Wizard of Oz leadership approach, telling everyone it's fine while standing behind the curtain, destroys credibility. Being honest builds the psychological safety that allows people to raise their hand when something is wrong.16:43 – 18:51 | Seeing stress in team members who don't speak up Dr. Moores' advice: ask. Repeatedly. Create an environment where it's genuinely okay to say you're having a tough day, and people will eventually use it.18:51 – 23:23 | Building trust before a crisis hits Trust is a bank account built over time through small, consistent actions: celebrating questions, welcoming challenges and pausing to actually listen. Dr. Moores describes an OR team with 123 combined years of experience and explains what you lose when even one of them doesn't feel safe to speak up.23:23 – 26:06 | The most common leadership mistake under stress Dismissiveness, brushing off a question because you're moving too fast to stop. It's rarely intentional, but it persists. Stopping for 60 seconds to make eye contact and engage does more for team trust than most leaders realize.26:06 – 28:32 | The one thing to do differently this week Listen better. Put the phone away, turn to face the person, sit down if they're sitting and don't mentally move on to the next thing while they're still talking.28:32 – 30:30 | Closing thoughts and outro Dr. Moores closes with a reminder about acknowledging uncertainty honestly and the years it will take to rebuild societal trust in medicine. Littrell thanks listeners and wraps the episode.

May 21, 2026Episode 15225 min

S1 Ep152: The secret to winning payer negotiations, with Doral Jacobson, MBA, FACMPE, of Prosper Beyond VBC

Most practices feel defeated going into payer negotiations before they even start. In this episode of Off the Chart: A Business of Medicine Podcast, Doral Jacobson, MBA, FACMPE, CEO of Prosper Beyond VBC, joins Physicians Practice Managing Editor Keith Reynolds to explain why, and what to do about it. Jacobson walks through the three things that undermine practices before a single word is spoken: no strategy, no clarity on how their contracts are actually performing and a poor track record that creates fear of rejection. She explains how to use price transparency data without getting trapped in a numbers debate, which contract terms beyond the headline rate move the needle most — including escalators, unilateral amendment protections and termination clauses — and what questions to ask payers early to find out how much leverage you actually have. The conversation also covers how negotiation strategy differs across primary care, specialty, behavioral health, ambulatory surgery and FQHC settings, and closes with a bottom line that Jacobson says applies to every practice regardless of size: payers have nothing without a network, and you have more power than you think.Music Credits:RELAXED CHILL JAZZ LOUNGE (OVER THE RIVER) by Tasty Tunes - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor's note: Episode timestamps and transcript produced using AI tools.0:00 – 0:24 | Sponsor message Copic medical liability insurance.0:24 – 0:43 | Cold open Jacobson previews the episode's core message: payers have nothing without a network, and practices win negotiations every day because payers do need them.0:43 – 1:42 | Introduction Austin Littrell introduces the episode and previews the conversation with Jacobson.1:42 – 4:09 | Why practices feel defeated before they start Jacobson traces practice anxiety in payer negotiations to three sources: a poor track record that creates assumptions about how talks will go, no short- or long-term strategy, and a lack of clarity about how their own contracts are actually performing. She uses a Florida client example to show how not knowing your own contract landscape can lead you to nearly terminate your second-best deal.4:09 – 7:13 | How to use price transparency data without getting trapped Jacobson argues transparency data is limited — it captures a rate in time but misses edits, administrative burden, payment policy erosion and value-based revenue. The real question to ask isn't how you compare to competitors, but what it would cost a payer to acquire your practice instead.7:13 – 8:53 | The contract terms that move the needle beyond the headline rate Jacobson's top undervalued terms: multi-year deals with escalators to keep pace with inflation, administrative burden relief written into proposals, unilateral amendment protections so payers can't change rates without consent, and a 90-day without-cause termination clause.8:53 – 10:20 | The questions worth asking payers early Three questions Jacobson recommends: what would happen to total cost of care if this practice were acquired by a health system; what can we do together to protect against contract termination; and would there be a network adequacy issue if we were no longer in network.10:20 – 13:40 | How to sequence your asks and set the right cadence Jacobson's framework: do a full contract audit first, establish short- and long-term goals, lead with your value proposition before your proposal, and plan for negotiations to take longer than expected — sometimes 14 months. Best-performing clients are always negotiating because costs are always rising.13:40 – 14:43 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.14:43 – 18:20 | What a strong case actually looks like in the room Jacobson's dream scenario: competitive rates with other payers being actively fixed, a strong market position the payer can't afford to lose, good quality ratings, a clear value proposition and an engaged clinician who can tell the story. A quarterly relationship with the payer that has nothing to do with rates is also a significant advantage.18:20 – 21:21 | How strategy differs by practice type Primary care's power is the referral. Nephrology's is HCC coding. Rural specialists have access leverage. Ambulatory surgery centers save money every time they avoid an inpatient admission. FQHCs lead with adequacy and prevention. Behavioral health needs to watch rate multipliers by credential level. The pitfalls are largely the same across all of them.21:21 – 23:54 | Repeatable moves that work across markets Jacobson's framework: a one-page visual value proposition, a complete contract language review, proactive strategy before any payer "love letter" arrives and a tenacious follow-up cadence that assumes everything will take longer than it should.23:54 – 24:46 | One tip to implement this week and outro Jacobson's closing advice: start now. Pick one contract and work on it. You miss 100% of the swings you don't take. Littrell thanks listeners and wraps the episode.

May 18, 2026Episode 15132 min

S1 Ep151: Make the right thing the easy thing, with David Carmouche, M.D., of Lumeris

Primary care is facing a collision of two trends: a growing patient population with more chronic disease, and a workforce that will be short 85,000 to 90,000 physicians within a decade. In this episode, David Carmouche, M.D., executive vice president and chief medical and commercial officer at Lumeris — and a newly appointed member of the HHS Healthcare Advisory Committee — joins Medical Economics Senior Editor Richard Payerchin to discuss what AI can realistically do about that. Music Credits:Higher Self by Cephas - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor's note: Episode timestamps and transcript produced using AI tools.0:00 – 0:25 | Sponsor message Copic medical liability insurance.0:25 – 0:42 | Cold open Dr. Carmouche previews the episode's closing message: as physicians, we're meant to be lifelong learners — and this is an exciting time to shape how AI gets deployed in health care.0:42 – 1:49 | Introduction Austin Littrell introduces the episode and previews the conversation with Dr. Carmouche.1:49 – 5:16 | Dr. Carmouche's background Richard Payerchin invites Dr. Carmouche to introduce himself. He traces a career that moved from independent primary care practice to Blue Cross Blue Shield of Louisiana, Ochsner Health, Walmart Health and now Lumeris — 30 years of experience across payer, provider and retail health settings.5:16 – 8:16 | The tipping point — and what AI is actually for Dr. Carmouche describes the collision driving the primary care crisis: unprecedented patient need meeting a shrinking workforce. He argues AI's role is to extend the human workforce and reduce cognitive load — summarized in his core design principle: make the right thing the easy thing.8:16 – 11:29 | Value-based care's promise and execution failures Dr. Carmouche explains Medicare's two main value-based care models — ACOs and Medicare Advantage — and why the concept is right but the execution has consistently missed the mark. Most physicians feel managed to the wrong things: care gaps, AWVs and risk codes rather than keeping patients healthy.11:29 – 15:10 | What AI-enabled continuous care could look like Dr. Carmouche lays out a vision of AI as a continuous presence between office visits — monitoring patients using EHR, pharmacy, HIE and consumer data, alerting physicians when someone is going off track and adjusting visit frequency based on real-time patient status rather than arbitrary scheduling.15:10 – 15:56 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.15:56 – 21:42 | Repatriating specialty care back to primary care Richard raises the growing burden of chronic disease management falling to primary care. Dr. Carmouche addresses the specialty referral problem directly — including a health system where 30% of cardiology appointments are filled with hypertension patients — and describes how AI-enabled clinical decision support could help primary care physicians manage more complex conditions and reduce unnecessary specialist referrals.21:42 – 23:53 | The Wolters Kluwer partnership and automated clinical decision support Dr. Carmouche describes a partnership with Wolters Kluwer and UpToDate to automate the connection between patient data and evidence-based guidance — presenting clinicians with personalized, guideline-directed treatment recommendations at the point of care without requiring them to manually query the tool.23:53 – 28:05 | Who pays for the technology — and can everyone access it? Dr. Carmouche addresses the cost and access challenges around remote monitoring devices, distinguishing between high-tech connected options and low-tech alternatives like a $39 Omron blood pressure cuff paired with AI text communication. The key challenge isn't the device — it's closing the loop back to a prescribing clinician.28:05 – 31:02 | Advice for physicians still on the sidelines Dr. Carmouche says skepticism is okay — but burying your head in the sand is not. He encourages even the most reluctant physicians to read about AI, explore free online primers and stay curious, while also urging caution about placing AI directly between physician and patient without requiring proof points first.31:02 – 32:22 | Closing remarks and outro Payerchin wraps the interview. Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.

May 14, 2026Episode 15021 min

S1 Ep150: Shadow AI: It's already in your practice, with Asha Palmer, J.D., of Skillsoft

If you haven't given your staff a sanctioned artificial intelligence (AI) tool, chances are they've already found one on their own. In this episode, Asha Palmer, senior vice president of compliance solutions at Skillsoft, joins Medical Economics Associate Editor Austin Littrell to break down the real risks of shadow AI in clinical settings — not just the data privacy concerns most practices already know about, but the harder-to-catch problem of inaccurate outputs that no one is monitoring. Palmer explains why banning AI entirely isn't a sustainable strategy, walks through what a simple, practical governance plan looks like for a smaller practice, and makes the case that the conversation with clinicians has to come before the policy does. She also covers what to ask vendors before any AI tool goes live, what to do when you discover staff are already using tools you didn't approve and why visibility — not prohibition — is the most important thing practice leaders can give themselves right now.Music Credits:Ocean Calm by Cephas - stock.adobe.comA Textbook Example by Skip Peck - stock.adobe.comEditor's note: Episode timestamps and transcript produced using AI tools.0:00 – 0:27 | Sponsor message Copic medical liability insurance.0:27 – 0:50 | Cold open Palmer previews the episode's central argument: banning AI is not a sustainable strategy — staff will use it on their phones whether you sanction it or not.0:50 – 1:42 | Introduction Austin Littrell introduces the episode and previews the conversation with Palmer.1:42 – 3:03 | Meet Asha Palmer and Skillsoft Palmer introduces herself — a lawyer turned compliance professional now in tech — and describes Skillsoft as a learning company focused on defensible, scalable compliance programs.3:03 – 5:03 | What is shadow AI and why does it matter Palmer reframes the conversation by starting with the opportunity AI creates for clinicians — efficiency, cognitive support, a thought partner — before explaining why unmonitored use creates serious data input and output risks that organizations can't see or control.5:03 – 6:20 | Why clinicians keep reaching for unsanctioned tools The number one reason: the organization hasn't sanctioned anything. When there's no approved path, people create their own — and banning AI entirely makes shadow use more likely, not less.6:20 – 9:16 | What a governance plan actually looks like for a small practice Palmer's practical framework: establish use cases in three buckets — how people are already using AI, how they want to use it and how the organization wants them to. Then map risks to those cases, identify controls and build in ongoing testing and monitoring.9:16 – 11:00 | The risks practices are underestimating It's not patient data exposure — most clinicians understand that risk. The bigger concern is inaccurate or inconsistent outputs: hallucinations, wrong conclusions drawn from real data, recommendations that don't align with the organization's care model.11:00 – 11:56 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.11:56 – 13:59 | AI is not just an IT problem Palmer argues that AI has to be viewed as a multidisciplinary issue — IT procures and monitors, compliance ensures safe use, and practice leaders need to see AI through the lens of business opportunity and growth, not just risk management.13:59 – 16:09 | What compliance infrastructure needs to be in place before any AI goes live Palmer's core recommendation: rigorous third-party due diligence. Ask vendors tough questions about where your data goes, how models are trained, whether they test for bias and accuracy, and what their own governance structure looks like.16:09 – 18:38 | What to do when you discover shadow AI use Palmer's answer isn't to fire anyone — it's to ask why. What are clinicians not getting that they feel they need? Shadow use is a signal, not just a violation. She also makes the case for a clear, readable acceptable use policy as a foundational step before any AI goes live.18:38 – 20:30 | Closing advice for practice leaders Palmer closes with a direct message: visibility is everything. Sanctioning a tool gives you the data, the use cases and the control you need. Letting staff use AI in the shadows means losing control of your data, your people and eventually your practice.20:30 – 21:39 | Outro Littrell thanks Palmer and wraps the episode.