Off the Chart: A Business of Medicine Podcast

Susan Dentzer, president and CEO of America's Physician Groups, joins the show to talk Medicare reform and the specific proposals included in America's Physician Group's latest report, "Medicare Done Right."

Download the full report: https://www.apg.org/wp-content/uploads/2025/04/Medicare-Done-Right-Final-4.1.25.pdf

Music Credits:
PARIS DINNER by Bopper Beats - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
COCKTAIL by Mythical Audio - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

Introduction and Episode Overview (00:00:00) Austin introduces the episode, guest Susan Dentzer, and the focus on Medicare reform and accountability.

Biggest Issue with Medicare and Key Fix (00:01:18) Susan discusses the main problem with Medicare and the report’s top recommendation: increasing accountability in both Medicare arms.

Accountable Relationships in Practice (00:02:25) Explains what it means for every beneficiary to have an accountable relationship with a healthcare professional, especially for small practices.

Importance of Care Coordination and Outcomes (00:03:47) Highlights the value of primary care teams, care coordination, and minimizing unnecessary hospital use for better outcomes.

Problems with MIPS and MACRA (00:04:16) Critique of the current MIPS/MACRA system, why it hasn’t worked, and the need for system-level reforms.

Restoring and Expanding Incentives (00:06:24) Calls for restoring and expanding advanced alternative payment model bonuses to better reward clinicians in accountable models.

Challenges for Small and Independent Practices (00:07:28) Addresses the risks and complexities of two-sided ACOs for small practices and suggests partnership solutions.

How At-Risk MA Arrangements Save Money (00:10:04) Explains how Medicare Advantage at-risk models achieve better outcomes and could save $22 billion if replicated in traditional Medicare.

Improving Medicare Advantage: Prior Authorization and Star Ratings (00:14:00) Discusses the popularity of MA, issues with prior authorization and star ratings, and visions for improvement.

Dental, Vision, and Hearing Coverage in Accountable Models (00:17:10) Proposal to offer extra benefits to traditional Medicare patients who join accountable care models and how it could work.

Top Medicare Policy Change for 2025 (00:20:51) Susan’s pick for the most impactful policy change: updating the Medicare physician fee schedule to reflect practice cost inflation.

Clarifying Medicare Advantage Misconceptions (00:23:31) Emphasizes the diversity within MA, the benefits of delegated risk models, and the importance of understanding risk adjustment.

Conclusion and Report Access (00:26:37) Wrap-up, thanks to Susan, and information on where to find the full report and subscribe to the podcast.

Isaac Park, CEO of Keebler Health, joins the show to talk agentic AI and how it can be used in health care.

Music Credits:
Saxophonia by Offenbach Project - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
COCKTAIL by Mythical Audio - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

Introduction and Pace of AI Change (00:00:00) Discussion on the unprecedented speed and velocity of technological change, especially with AI.

Podcast Introduction and Guest Overview (00:00:26) Host introduces the podcast, the episode’s topic, and the guest, Isaac Park.

Defining Agent AI vs. Large Language Models (00:01:09) Explains what agent AI is, how it differs from large language models, and its core capabilities.

Agent AI Use Cases and Healthcare Applications (00:02:43) Describes agent AI’s potential to mimic human workflows and its analogy to customer service bots.

Appropriate Use Cases in Healthcare (00:04:31) Agent AI’s current use in low-clinical, high-administrative tasks like scheduling and EHR management.

Limitations and Human-in-the-Loop Necessity (00:06:09) Discusses why agent AI shouldn’t be used alone in high-stakes clinical decisions; need for human oversight.

Agent AI as a Tool for Physicians (00:07:16) Frames agent AI as a tool to empower clinicians, not replace them, and parallels with other tech advances.

Impact on Clinician Performance (00:08:23) How AI tools can amplify both good and bad performance, based on user expertise.

Building and Maintaining Trust in AI (00:09:31) Addresses the importance of trust, transparency, and evidence in AI adoption among clinicians.

AI in Staffing and Documentation (00:11:32) Explores AI’s role in automating scheduling and its success in clinical documentation (ambient scribing).

Future Steps in Documentation and Efficiency (00:13:49) Considers whether agent AI can further automate tasks like billing and multi-step processes.

Complexity and Limitations of AI in Healthcare (00:14:26) Explains healthcare’s complexity, AI’s struggles with structured tasks, and why full automation is risky.

Point Solutions and Future AI Trends (00:18:27) Predicts proliferation of small, effective AI tools in healthcare, but questions full autonomy.

Prospects for Artificial General Intelligence (AGI) (00:20:13) Discusses fluctuating industry opinions on AGI and the rapid pace of AI development.

Closing Remarks and Outro (00:21:52) Wrap-up of the conversation, thanks to the guest, and podcast subscription information.

Paul Berggreen, M.D., president of the American Independent Medical Practice Association (AIMPA), joins the show to talk about the current state of private practice, as well as the findings of the American Medical Association's (AMA's) Physician Practice Benchmark Survey.

Find the AMA survey here: https://www.ama-assn.org/about/ama-research/physician-practice-benchmark-survey
Download the survey here: https://www.ama-assn.org/system/files/2024-prp-pp-characteristics.pdf

Music Credits:
SMOOTH GROOVY BACKGROUND RNB by Resolute Audio - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
COCKTAIL by Mythical Audio - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

Introduction to Private Practice Medicine (00:00:00) Dr. Berggreen discusses the entrepreneurial nature of private practice and its importance compared to institutional employment models.

Podcast and Guest Introduction (00:00:29) Host introduces the podcast, episode context, and the main speakers.

AMA Physician Practice Benchmark Survey Overview (00:01:10) Discussion about the AMA survey, its methodology, and its relevance to physician employment trends.

Trends in Private Practice and Survey Data Limitations (00:02:09) Analysis of the declining percentage of physicians in private practice and issues with survey methodologies.

Factors Driving Decline in Private Practice (00:04:41) Exploration of inadequate payment rates, rising costs, and regulatory burdens affecting independent practices.

Impact of Payment and Regulatory Challenges (00:05:05) Detailed explanation of payment stagnation, rising costs, and regulatory complexity for independent physicians.

Physician Ownership and Autonomy (00:09:07) Discussion on the importance of physician ownership, autonomy, and its impact on burnout and patient care.

Loss of Autonomy in Large Systems (00:10:19) Real-world examples of how loss of autonomy affects physicians and patient referrals in large organizations.

Technology, AI, and Independent Practice (00:13:53) Consideration of how AI and technology may help or hinder independent practices, including cost and adoption.

AI Tools in Practice: Benefits and Costs (00:14:27) Specific examples of AI tools for documentation, their benefits, and financial implications for small practices.

Specialty Breakdown in Independent Practice (00:18:03) Review of AMA survey findings by specialty, with insights into which specialties remain more independent.

Private Equity and MSO Models in Healthcare (00:20:20) Discussion of private equity’s role, MSO models, and their impact on cost, quality, and physician autonomy.

Avalere Study on Practice Models and Costs (00:22:25) Summary of a study comparing cost and quality outcomes across different practice models, including private equity.

Independent Practice and National Health Initiatives (00:27:26) Role of independent practice in improving national health, access, and chronic disease management.

Innovation and Physician Shortage (00:30:36) Discussion on physician shortages, the need for innovation, and the importance of extending physicians’ careers.

Inclusivity of AIMPA Membership (00:32:08) Clarification that AIMPA welcomes all specialties, including internal and family medicine.

Episode Closing Remarks (00:32:37) Farewell, thanks, and information on subscribing to the podcast and newsletters.

Brian McKillop, president of AMN Healthcare's locum tenens division, joins the show to talk projections, causes and solutions for the U.S. physician shortage.

Find AMN Healthcare's latest report, "The Physician Shortage: Projections, Causes, and Solutions," here:

🔗 https://online.flippingbook.com/view/787974745/

Music Credits:
MUCHOS BESOS by Bopper Beats - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
COCKTAIL by Mythical Audio - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

Introduction and Episode Overview (00:00:25) Host introduces the podcast, guests, and main topic: the physician shortage and AMN Healthcare’s latest report.

Projections of Physician Shortage (00:01:25) Discussion of recent projections and statistics on the physician shortage through 2036.

Implications for Patients and Doctors (00:02:23) Exploring what the shortage means for health care delivery, supply and demand, and patient care.

Seven P’s: Contributing Factors to the Shortage (00:02:46) Breakdown of the seven main factors driving the physician shortage, including population growth, aging, burnout and pipeline issues.

Underserved Communities and Access Disparities (00:05:58) Addressing the shortage’s impact on underserved areas and strategies to improve access to care.

Filling Gaps: Advanced Practice Providers and International Physicians (00:07:48) How nurse practitioners, PAs and international medical graduates help fill physician gaps, especially in rural areas.

Burnout: Causes and Solutions (00:09:06) Discussion of physician burnout, its causes, and both micro and macro solutions to improve retention.

Aging Population and Physician Retirement Cliff (00:11:43) Impact of an aging population and workforce on physician supply and patient care needs.

Medical Residency Caps and Funding (00:12:36) How residency slot caps and funding mechanisms affect the pipeline of new physicians.

Changing Practice Models: Employment and Flexibility (00:15:03) Shift from independent practice to employment, rise of telemedicine and the importance of flexible work models.

Short-Term Solutions to the Physician Shortage (00:17:21) Immediate actions to address the shortage, including international medical graduates and retention strategies.

About AMN Healthcare and Resources (00:19:01) Overview of AMN Healthcare’s services and resources available for physicians and health care organizations.

Closing Remarks and Credits (00:20:06) Thanking the guest, encouraging subscriptions and providing production credits.

Ericka L. Adler, J.D., a shareholder and manager of the health care group at Roetzel & Andress, joins the show to discuss the hidden risks of prescribing GLP-1 medications — like semaglutide and tirzepatide — that physicians need to know, from ensuring informed consent to navigating long-term safety data.

Music Credits:
After Hours by Yigit Atilla - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
COCKTAIL by Mythical Audio - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

**Introduction and Overview (00:00:00)**
Brief mention of compliance issues and the evolving legal landscape for prescribing GLP-1 drugs.

**Podcast Introduction (00:00:29)**
Host introduces the episode, speakers, and main topics: legal risks, informed consent, and safety data for GLP-1 drugs.

**Guest Introduction (00:01:05)**
Introduction of EricKa Adler and the focus on GLP-1 drug risks.

**Liability Risks for Prescribing GLP-1 Drugs (00:01:19)**
Discussion of primary legal risks, compliance with state and federal laws, and proper office setup.

**Off-Label Use Legal Concerns (00:02:49)**
Explains legal concerns with off-label prescribing and how to mitigate risks through documentation and informed consent.

**Informed Consent Specifics for GLP-1 Drugs (00:05:53)**
Importance of tailored, robust informed consent forms for GLP-1 drugs, especially for off-label use.

**Compounded Versions and Legal Risks (00:07:57)**
Legal risks of prescribing compounded GLP-1 drugs, including contamination, misbranding, and advertising issues.

**Insurance Denials and Prior Authorizations (00:11:26)**
Challenges with insurance coverage, prior authorizations, and evolving insurer policies for GLP-1 prescriptions.

**Telemedicine and Prescribing GLP-1 Drugs (00:14:10)**
Legal risks and compliance requirements for prescribing GLP-1 drugs via telemedicine, including licensure and administration rules.

**Long-Term Safety and Liability Concerns (00:16:59)**
Emerging liability concerns regarding long-term safety and adverse effects, and the importance of malpractice coverage.

**Financial Relationships with Pharmaceutical Companies (00:20:10)**
Legal and ethical concerns for physicians with financial ties to GLP-1 drug manufacturers, including anti-kickback laws.

**Regulatory Changes and Evolving Landscape (00:21:40)**
Recent and anticipated legal or regulatory changes, state vs. federal oversight, and the need for ongoing compliance.

**Conclusion and Closing Remarks (00:25:02)**
Thanking the guest, closing the episode, and providing subscription information.

Thomas E. Price, M.D., an orthopedic surgeon and the 23rd secretary of the U.S. Department of Health and Human Services (HHS), joins the show with an idea to address the health care workforce shortage: legal, employment-based immigration.

According to a recent Staffing Stream article, "An overlooked answer to the US healthcare crisis: Skilled immigration," by Ron Hoppe, there are:

Is immigration policy reform the long-awaited solution to the health care workforce shortage in the U.S.?

Music Credits:
Ambient Jazz by AurbanniAudio - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
COCKTAIL by Mythical Audio - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

Introduction to the Episode (00:00:00)
Overview of the podcast's focus on health care workforce challenges and immigration policy.

Background on Workforce Shortage (00:01:03)
Discussion on the long-standing health care workforce shortage and barriers to solving it.

Immigrant Contribution to Healthcare (00:02:30)
Highlighting the significant role of immigrant health care workers in the U.S. system.

Policy Changes for Workforce Solutions (00:04:33)
Exploration of federal and state policy changes needed to address healthcare workforce shortages.

Visa Backlogs for Clinicians (00:05:45)
Examination of the visa backlog issue preventing qualified international clinicians from practicing.

Challenges in Graduate Medical Education (00:06:04)
Discussion about limitations on residency slots affecting physician training and immigration.

Lack of Attention to Immigration Issues (00:07:28)
Analysis of why skilled immigration in health care isn't a priority in national policy discussions.

Role of Physicians in Advocacy (00:08:42)
Importance of communication and advocacy by physicians and medical organizations for policy change.

Alignment of Immigration and Border Security (00:10:36)
Agreement that immigration reform can coexist with border security priorities in health care.

Broad Scope of Healthcare Shortages (00:11:54)
Emphasis on the extensive range of health care worker shortages beyond just physicians and nurses.

Mark Daly, chief technology officer of Digital Diagnostics, joins the show to unpack artificial intelligence (AI) diagnostic tools, and what must be done to maintain both patient and physician trust.

Be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know.

Music Credits:
Feel Good Flow by Droppin Q - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
COCKTAIL by Mythical Audio - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

Introduction to AI in Medicine (00:00:20)
Overview of the podcast and speakers discussing AI's role in diagnostics.

AI Transforming Diagnostics (00:01:11)
Mark Daly talks about AI's impact on image interpretation in medicine.

Concerns About AI Replacing Human Judgment (00:02:43)
Discussion on AI as a tool to assist physicians rather than replace them.

Regulatory Challenges for AI Diagnostics (00:04:04)
Exploration of the regulatory hurdles AI diagnostics face and their implications.

Ensuring Transparency and Trust in AI (00:06:25)
Importance of building trust and transparency with physicians regarding AI tools.

Patient Perception of AI Tools (00:08:38)
Discussion on how patients respond to AI in decision-making processes.

Reducing Physician Burnout with AI (00:11:43)
AI's potential to alleviate physician workload and reduce burnout.

Rapid Adoption in Medical Specialties (00:13:10)
Identifying specialties likely to adopt AI diagnostics quickly.

Equitable Access to AI Advancements (00:15:24)
Addressing the need for all patients, especially underserved populations, to benefit from AI.

AI's Potential in Mobile Clinics (00:17:02)
Discussion on AI's role in increasing access to healthcare through mobile clinics.

Funding AI Tools in Healthcare (00:17:43)
Exploration of the financial implications of integrating AI tools in the healthcare system.

Building Trust in AI Systems (00:18:21)
Importance of data collaboration and validation to enhance trust in AI diagnostic tools.

Vision for AI in Diagnostics (00:20:37)
Future prospects of low-cost, high-value diagnostic tests and their implications for patient care.

Leveraging Big Data for Rare Diseases (00:22:04)
Using AI to analyze large datasets for insights into rare diseases and unique patient populations.

Enhancing Patient Outcomes with AI (00:23:25)
AI's potential to improve patient outcomes while reducing costs in medical diagnostics.

Closing Remarks and Future Innovations (00:24:16)
Excitement about future AI innovations and their impact on patient care and outcomes.

Jeffrey A. Singer, M.D., a general surgeon and senior fellow at the Cato Institute, joins the show to talk about patient autonomy — which also happens to be the subject of his new book, "Your Body, Your Health Care."

For more from Singer, read his article in Medical Economics, or find a copy of his book here.

Be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know.

Music Credits:
Midnight Serenade by MORRIX Holyhold - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
COCKTAIL by Mythical Audio - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

Introduction to Patient Autonomy (00:00:00)
Discussion on the importance of respecting patient autonomy in healthcare.

Podcast Introduction (00:00:25)
Austin Littrell introduces the podcast and the guest, Jeffrey A. Singer, M.D.

Dr. Singer's Background (00:01:01)
Richard Payton introduces Dr. Singer and his credentials.

Origin of the Book (00:01:23)
Dr. Singer explains the inspiration behind his book "Your Body, Your Healthcare."

Linking Policy Areas (00:02:20)
Discussion on the overarching principle of autonomy in healthcare policy.

Informed Consent Evolution (00:03:58)
Dr. Singer highlights the shift towards informed consent in medical practice.

Historical Case: Sloan v. Society of New York Hospital (00:06:15)
Overview of the landmark case establishing patient consent rights.

Government Interference in Autonomy (00:07:56)
Discussion on how government regulations infringe on patient autonomy.

Clinical Information Query (00:08:02)
A question regarding the need for more clinical information in patient care.

Advancements in Medicine (00:08:15)
Discussion on the impact of technology and AI on medical practice.

Importance of Doctor-Patient Communication (00:08:53)
Dr. Singer emphasizes the need for effective communication in healthcare.

Empowerment through AI (00:09:38)
Dr. Singer discusses how AI can enhance patient autonomy and healthcare access.

Scope of Practice Issues (00:10:49)
Discussion on barriers created by licensing laws for healthcare providers.

Telehealth and Patient Autonomy (00:12:57)
Exploration of how telehealth intersects with patient autonomy and informed consent.

State Licensing Barriers (00:13:17)
Dr. Singer discusses the challenges posed by state licensing for telehealth services.

Proposed Solutions for Telehealth (00:15:15)
Suggestions for reforming telehealth regulations to enhance patient access.

Physician Shortage Concerns (00:17:23)
Discussion on the growing demand for healthcare amidst a physician shortage.

Government Mandates and Vaccination (00:21:06)
Dr. Singer addresses informed consent related to vaccine mandates during the pandemic.

Public Health vs. Personal Health (00:23:38)
Distinction between public health interventions and personal health choices.

Government Intrusion in Healthcare (00:24:42)
Discussion on government regulations banning food colorings without scientific evidence, affecting consumer choices.

COVID-19 Response Critique (00:25:45)
Criticism of public health agencies for their slow response and refusal to consider alternative strategies during the pandemic.

Testing Delays and Bureaucracy (00:26:49)
Overview of delays in COVID-19 testing approvals and the paternalistic approach limiting self-testing options.

Value of Primary Care Physicians (00:28:34)
Acknowledgment of primary care physicians' importance and the challenges they face in the healthcare system.

Balancing Clinical Judgment and Autonomy (00:30:11)
Advice for medical professionals on respecting patient autonomy while managing personal biases and clinical responsibilities.

Daniel G. Aaron, MD, JD, an associate professor of law at the University of Utah's S.J. Quinney College of Law, joins the show to talk about the American Law Institute's revised legal standard for assessing medical negligence.

For more, check out Aaron's JAMA article, "A New Legal Standard for Medical Malpractice."

Be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know.

Music Credits:
Coffee Lo-Fi by Mit-Rich - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
COCKTAIL by Mythical Audio - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

Introduction to the Episode (00:00:00)
Overview of the podcast and introduction of Dr. Daniel Aaron discussing medical malpractice standards.

Background on the Legal Standard Update (00:01:02)
Dr. Aaron explains the revisions to the medical malpractice standard by the American Law Institute.

Differences in the New Standard (00:03:16)
Discussion on how the new standard differs from traditional customary practice in malpractice cases.

Implications for Clinical Decision-Making (00:06:08)
How the new standard allows physicians more flexibility in clinical decision-making based on evidence.

Guidelines and Legal Scrutiny (00:08:31)
Advice for physicians on ensuring the guidelines they follow are legitimate and evidence-based.

Examples of Negligence Under the New Framework (00:10:00)
Exploration of how customary practices could still be deemed negligent with the new standard.

Effects on Defensive Medicine (00:11:36)
Discussion on how the revised standard may influence defensive medicine behaviors among physicians.

Monitoring Legislative Changes (00:13:10)
Guidance for physicians on keeping track of legislative developments in medical malpractice law.

Actions for Primary Care Physicians (00:16:09)
Recommendations for busy physicians to stay informed about the evolving legal landscape.

Closing Remarks (00:17:10)
Dr. Aaron's final thoughts on the significance of the changes in medical malpractice law.

2025 has brought new heights for vaccine innovation — and new lows in public trust. Medical Economics and Infection Control Today convened a panel of frontline physicians, policy leaders and infectious disease experts to unpack recent policy shifts, the impact of vaccine hesitancy and how we move forward with evidence, empathy and action.

Panelists
William Schaffner, M.D., Professor of Preventive Medicine and Infectious Diseases, Vanderbilt University School of Medicine

Charles Vega, M.D., FAAFP, Clinical Professor of Family Medicine, Associate Dean for Culture and Community Education, University of California, Irvine

Georges Benjamin, M.D., FACP, Executive Director, American Public Health Association

Jen Brull, M.D., FAAFP, President, American Academy of Family Physicians

Tina Q. Tan, M.D., FIDSA, FPIDS, FAAP, President, Infectious Diseases Society of America, Professor of Pediatrics, Feinberg School of Medicine, Northwestern University

Moderator:
Heather Stoltzfus, M.P.H., R.N., CIC Research nurse program manager, Johns Hopkins University Division of Infectious Disease, Consultant, Broad Street Prevention, Editorial Adviser, Infection Control Today

Music Credits:
BARRICADE by Killer Chops - stock.adobe.com

Vaccine panelist introductions (2:14 to 4:13)

Opening thoughts on 2025’s vaccination challenges (4:14 to 10:44)

The state of vaccine innovation (10:45 to 16:22)

Vaccine politics: ‘They’ve taken apart the infrastructure to get shots in arms’ (16:23 to 20:00)

Pediatric vaccines: Rates decline, parental skepticism grows (20:01 to 23:30)

Confronting the lack of public vaccine education (23:31 to 30:05)

Addressing vaccine-skeptical patients (30:06 to 35:05)

Rebuilding confidence in vaccination (35:06 to 37:54)

The role of medical societies in vaccine advocacy (37:55 to 44:37)

Practical tips for physicians to combat misinformation (44:38 to 50:26)

Closing thoughts on vaccines in 2025 (50:27 to 56:14)