Off the Chart: A Business of Medicine Podcast

Ericka Adler, JD, of Roetzel & Andress, joins the show to discuss factors you should consider before selling your practice.

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

Music Credits:
CHILL RELAXED JAZZ (DR SMOOTH) by Tasty Tunes - 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 the speakers discussing selling a medical practice.

Importance of compliance review (00:01:05)
Discussion on the compliance review process and its significance in the sale of a medical practice.

Staff's role in compliance (00:02:27)
Exploration of how staff compliance affects the sale process and potential buyer decisions.

Billing issues in due diligence (00:03:38)
Insight into common billing issues that arise during due diligence and their implications.

Compensation arrangements and compliance (00:05:14)
Examination of how improper compensation can lead to compliance issues in medical practices.

Maintaining HIPAA compliance (00:08:20)
Strategies for ensuring HIPAA compliance during the due diligence process when selling a practice.

Impact of state laws on sales (00:10:13)
Discussion on how different state laws can complicate the sale of multi-state practices.

Common misconceptions in selling (00:13:04)
Addressing misconceptions physicians have about the sales process and buyer expectations.

Reasons sales fall through (00:14:46)
Examples of mistakes by practice owners that can lead to failed sales transactions.

Buyers' considerations beyond profitability (00:16:39)
Understanding that buyers evaluate more than just financials; they assess overall compliance and operations.

Due diligence variations by buyer type (00:17:50)
Comparison of due diligence levels between physician groups, private equity, and health systems.

Addressing unqualified staff (00:19:13)
Advice on whether to remove unqualified family members from payroll before selling.

Planning ahead for sale (00:20:38)
Emphasis on the importance of early planning and thorough preparation before selling a practice.

Conclusion and final thoughts (00:22:29)
Wrap-up of the conversation, highlighting key takeaways for physicians selling their practices.

Linda Stein Gold, MD, FAAD, discusses the late-breaking tapinarof cream 1% data from a new analysis of the ADORING-3 clinical trial. Interview recorded at the 2025 American Academy of Dermatology conference in Orlando, Florida. 

Topics discussed include:

Norman K. “Kip” Beals, MD, is executive director of primary care for Independence Health System in western Pennsylvania. He is board certified in family medicine and sports medicine. A physician practicing for 35 years, Beals has worked in independent practice and as a physician leader and chief innovation officer for health systems.

Beals joins the show to discuss the evolving landscape of health care reimbursement — and how physicians can weather the storm.

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

Music Credits:
Chill Lounge by Elonix - 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 Healthcare Reimbursement (00:00:22)
Overview of the podcast and discussion topics, including Medicare cuts and financial pressures.

Physicians' Awareness of Medicare Cuts (00:01:04)
Dr. Beals discusses how physicians typically learn about Medicare reimbursement cuts through news rather than direct communication.

Reactions to Reimbursement Cuts (00:03:12)
Physicians often feel a mix of frustration and resignation regarding ongoing cuts to reimbursements.

Burnout Among Physicians (00:04:44)
Discussion on the alarming statistic of physician burnout and its impact on healthcare practices.

Business Training in Medical Education (00:07:08)
Dr. Beals highlights the lack of business training for physicians during medical school.

Strategies for Increasing Revenue or Cutting Expenses (00:09:32)
Exploration of how physicians can approach financial challenges in their practices.

Collaboration in Healthcare (00:10:36)
Emphasis on the need for intense collaboration among healthcare providers to improve efficiency.

Lessons from the COVID-19 Pandemic (00:13:30)
Reflections on how the pandemic has forced healthcare practices to adapt and become leaner.

Innovative Approaches in Healthcare (00:15:42)
Discussion on using technology and innovative thinking to enhance healthcare delivery.

Community Needs Assessment (00:18:23)
Dr. Beals shares the importance of understanding community needs for effective healthcare solutions.

Practical Examples of Community Engagement (00:19:10)
Examples of initiatives aimed at addressing barriers to healthcare access in rural areas.

Population Health and Cost Efficiency (00:22:40)
Discussion on improving healthcare outcomes and reducing costs through efficient disease management and early problem detection.

Government Cuts and Innovation (00:23:41)
Impact of potential Medicare cuts on driving innovation and finding better healthcare solutions.

Importance of Primary Care (00:25:46)
Encouragement for patients to seek care from primary care providers for efficient and comprehensive healthcare.

Collaboration in Healthcare Leadership (00:26:59)
Advocacy for collaboration between clinical and administrative leaders to enhance patient care and community health outcomes.

Closing Remarks and Gratitude (00:27:48)
Expression of appreciation for the conversation and acknowledgment of the importance of continued dialogue.

Andrea Greco, senior vice president of health care safety at CENTEGIX, joins the podcast to discuss keeping practices safe and how failing to do so can impact patient care.

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

Music Credits:
Retro Rhythm by BJBeats - stock.adobe.com
COCKTAIL by Mythical Audio - stock.adobe.com

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

Workplace Violence is Unacceptable (00:00:00)
Discussion on the unacceptability of workplace violence in healthcare settings.

Introduction to the Episode (00:00:15)
Host Keith Reynolds introduces the episode's focus on workplace safety in healthcare.

Impact of Workplace Violence on Nurses (00:00:54)
Andrea Greco explains how workplace violence affects nurse satisfaction and patient care.

Workplace Safety and Staff Retention (00:02:25)
Discussion on the importance of workplace safety for retaining healthcare staff, especially younger workers.

Creating a Culture of Safety (00:03:00)
Strategies for fostering a culture of safety and well-being in healthcare organizations.

Situational Awareness for Incident Responders (00:05:33)
Importance of situational awareness and tools for employees to report incidents.

Barriers to Incident Reporting (00:07:42)
Exploration of barriers preventing effective incident reporting in healthcare settings.

Visitor Management Protocols (00:09:00)
Steps for primary care practices to enhance visitor management and reduce safety risks.

Prioritizing Workplace Safety (00:11:13)
Key priorities for healthcare leaders to ensure a safe workplace moving forward.

Final Thoughts on Caregiver Support (00:12:31)
Emphasis on putting caregivers first and maintaining a supportive environment.

Yashaswini Singh, PhD, MPH, a health care economist and assistant professor at Brown University's School of Public Health, joins the show to discuss her recent research article, "Growth of Private Equity and Hospital Consolidation in Primary Care and Price Implications," published in JAMA Health Forum.

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

Music Credits:
Lofi Chillout Hip Hop Beat by Joystock - 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 Primary Care Pressures (00:00:00) 
Discussion on significant pressures faced by independent primary care practices in the U.S.

Podcast Introduction (00:00:17) 
Austin Littrell introduces the episode and the speakers, including guest Yashaswini Singh, PhD, MPH.

Trends in Hospital and Private Equity Consolidation (00:01:08) 
Dr. Singh discusses consolidation trends in primary care involving hospitals and private equity.

Market Dynamics of Healthcare (00:02:39) 
Insights on how U.S. healthcare markets struggle due to inadequate competition and increasing consolidation.

Private Equity Investment Overview (00:03:48) 
Discussion on the substantial investment by private equity firms in various healthcare settings.

Methodology of Research Study (00:04:00) 
Overview of the research objectives and methodology used to analyze primary care employment trends.

Findings on Primary Care Employment (00:05:01) 
Key findings reveal a significant increase in hospital-affiliated primary care physicians from 2009 to 2022.

Impact of Pricing on Care (00:06:18) 
Analysis of how physician employment trends affect healthcare costs and patient pricing.

Explaining Price Differences (00:08:14) 
Discussion on factors contributing to price differences between hospital-affiliated and independent practices.

Regional Disparities in Consolidation (00:10:27) 
Examination of geographic variations in hospital and private equity affiliations among primary care physicians.

Evolution of Private Equity in Healthcare (00:12:16) 
Insights into the timeline and focus shifts of private equity investment in physician practices.

Future Research Directions (00:15:05) 
Discussion on the need for further research on consolidation impacts and private equity exit strategies.

Implications for Primary Care Physicians (00:17:23) 
Advice for primary care physicians on navigating the changing landscape of healthcare consolidation.

Emerging Trends in Primary Care (00:19:15) 
Recognition of additional evolving models in primary care beyond hospital and private equity affiliations.

Ferhat Dikbiyik, chief research and intelligence officer at the  cybersecurity firm Black Kite, joins the podcast to discuss cybersecurity and the evolving structure and threat of ransomware gangs.
Music Credits:
Ready for Repeat by Rolla Coasta - 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 (00:00:15)
Host Keith Reynolds introduces the podcast and the discussion on cybersecurity and ransomware gangs.

Surge in ransomware attacks (00:00:49)
Ferhat discusses the 32% increase in ransomware attacks in healthcare from 2023 to 2024.

Dynamics of ransomware ecosystem (00:01:11)
Ferhat explains shifts in the ransomware ecosystem, emphasizing the rise of affiliate-driven models.

Affiliates in ransomware (00:03:39)
Discussion on how affiliates operate within the ransomware ecosystem and their motivations.

Targeting smaller medical practices (00:06:01)
Ferhat highlights the increased risk smaller medical practices face from ransomware attacks.

Banning ransom payments (00:08:33)
Discussion on the implications of banning ransom payments for victims under pressure.

Changing negotiation tactics (00:10:01)
Ferhat notes the shift towards urgent ransom demands with little room for negotiation.

Challenges for law enforcement (00:11:53)
Ferhat explains the difficulties law enforcement faces in combating organized ransomware groups.

Geographic distribution of ransomware groups (00:12:49)
Ferhat discusses the locations of ransomware groups, primarily in Eastern Europe and Russia.

Finding targets for attacks (00:14:35)
Ferhat describes how cybercriminals identify and select small medical practices to target.

Health care as a prime target (00:15:29)
Ferhat predicts that healthcare will continue to be a significant target for cybercriminals.

Protecting small medical practices (00:16:29)
Advice on proactive measures small practices can take to safeguard against ransomware.

Phishing and vulnerabilities (00:17:56)
Ferhat discusses the prevalence of phishing as an attack method for ransomware groups.

Training employees on phishing (00:18:30)
Emphasis on the importance of training staff to recognize phishing attempts.

Final thoughts on ransomware risks (00:18:37)
Ferhat stresses the need for vigilance and proactive measures against increasing ransomware risks.

Maryal Concepcion, MD, FAAFP, the owner and CEO of Big Trees MD, joins the show to talk direct primary care with Medical Economics Editorial Director, Chris Mazzolini. Concepcion shares the story of her own personal transition from traditional, fee-for-service medicine, to starting her own direct primary care practice.

Music Credits:
A Cup Of Warm Tea by JO.BITE - stock.adobe.com
COCKTAIL by Mythical Audio - stock.adobe.com

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

Introduction to Direct Primary Care (00:00:00)  
Maryal Concepcion, MD, FAAFP, shares her vision of primary care as it relates to direct primary care (DPC).

What is Direct Primary Care? (00:01:01) 
Concepcion explains DPC and its differences from traditional fee-for-service medicine.

The Community Aspect of DPC (00:02:42) 
Discussion on the importance of community relationships in DPC and patient care.

Challenges in Traditional Medicine (00:04:41) 
Concepcion reflects on her experiences in traditional fee-for-service medicine.

Journey Through Medical Training (00:05:02) 
Overview of Concepcion's medical education and her transition to attending physician.

Experience in Fee-for-Service (00:06:39) 
Concepcion describes the limitations and frustrations in her fee-for-service practice.

Impact of Corporate Medicine (00:08:47) 
Insights on corporate practices and the challenges faced by physicians.

Creating a Podcast for Healing (00:10:47) 
Concepcion discusses starting a podcast as a way to share experiences and heal.

Describing the DPC Practice (00:13:00) 
Concepcion explains how her DPC practice operates and its patient-centered focus.

Setting Up a DPC Practice (00:17:16) 
Discussion on the steps taken to establish her DPC practice from scratch.

Marketing and Communication in DPC (00:20:07) 
Concepcion talks about the importance of marketing and patient communication in DPC.

Elevator Pitch for Patients (00:20:59) 
Overview of how Concepcion introduces DPC to patients and addresses their concerns.

Understanding Patient Needs (00:22:06) 
Discussion on the importance of listening to patients and addressing their needs in healthcare.

Transitioning to Direct Primary Care (00:23:03) 
Advice for listeners on taking the first steps toward transitioning from fee-for-service to DPC.

Resources for DPC Transition (00:23:33) 
Introduction of various resources available for those interested in starting a DPC practice.

Support and Community in DPC (00:25:13) 
Emphasis on the supportive community available to DPC practitioners across the United States.

Closing Remarks (00:26:27) 
Thanking Maryal Concepcion for her insights and contributions to the discussion.

Anders Gilberg, senior vice president for government affairs with MGMA, joins us to discuss the second Trump administration and MGMA's policy wishlist.

MGMA's advocacy agenda

Music Credits:
Cup of Coffee by Ionics - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com

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


Introduction and overview (00:00:00)
Discussion begins with a mention of Elon Musk's impact on a significant healthcare bill.

Welcome and context (00:00:17)
Keith introduces Anders Gilberg and sets the context of the conversation regarding the second Trump administration.

Current state of health care (00:01:25)
Anders discusses the unfinished business from the previous Congress and the lack of political leadership in key agencies.

Key personalities in HHS (00:02:54)
Exploration of potential new leaders in HHS and their implications for healthcare legislation.

Challenges from previous Congress (00:04:38)
Discussion on the lingering effects of changes made to evaluation and management codes affecting physician payments.

Legislative uncertainty (00:08:08)
Anders reflects on the unexpected changes to a crucial healthcare bill and its impact on physician payments.

Regrouping and future strategies (00:09:58)
Anders outlines the need for re-education and regrouping following the shifts in Congress and political landscape.

Advocacy agenda overview (00:15:12)
Anders shares key priorities for the GMA, focusing on physician payment reform and reducing regulatory burdens.

Prior authorization issues (00:16:37)
Discussion on the burdens of prior authorization and efforts to improve transparency in insurance practices.

Quality reporting concerns (00:18:05)
Anders critiques the MIPS program and the need for a more efficient way to report quality measures.

Cybersecurity in health care (00:19:20)
Highlighting the importance of addressing cybersecurity threats and the implications for healthcare operations.

Conclusion and future check-ins (00:20:35)
Anders expresses willingness to return for future discussions as the political landscape evolves.

Medical Economics Managing Editor Todd Shryock and Peter H. Reilly, North American health care practice leader and chief sales officer at HUB International, discuss the top risks that medical practices face in 2025, as detailed in HUB International's 2025 Healthcare Outlook and Insurance Market Rate Report, from malpractice insurance rates to cybersecurity to natural disasters.

Music Credits:
Backroad lounge by Christian Petermann/Jamendo - 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 (00:00:20) 
Overview of the podcast and introduction of speakers discussing healthcare risks for 2025.

Discussion on Healthcare Costs (00:02:23) 
Exploration of rising costs and decreasing reimbursements in healthcare.

Rural Hospitals and Financial Pressures (00:05:49) 
Impact of financial strain on rural hospitals and the need for awareness among physicians.

Worker Shortages and Burnout (00:08:10) 
Addressing the challenges of worker shortages and mental strain in healthcare practices.

Malpractice Insurance Trends (00:12:08) 
Overview of the medical professional liability market and its financial pressures.

Mitigating Natural Disaster Risks (00:15:21) 
Strategies for practices to prepare for natural disasters and minimize operational disruptions.

Cybersecurity Risks in Healthcare (00:19:16) 
Discussion on the increasing threat of cybercrime and the importance of data security.

Final Thoughts on Risk Management (00:23:32) 
Encouragement for practitioners to understand and proactively manage risks in their practices.

Medical Economics Senior Editor Richard Payerchin and Robert Kushner, MD, professor of medicine and medical education at Northwestern university talking about the latest advancements in treating obesity, and how physicians should approach the drugs making a splash across the industry.

Music Credits: Future Medicine by mark woollard - 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 new medications (00:00:00) 
Discussion on understanding the administration and combination of new medications for weight loss and health improvement.

Podcast introduction (00:00:20) 
Host introduces the episode featuring Richard Payerchin andRobert Kushner, MD, discussing obesity treatment advancements.

Current status of physicians (00:01:15) 
Kushner highlights physicians' increasing awareness and adoption of new obesity medications.

Effectiveness of new medications (00:02:02) 
Overview of how new medications improve weight loss and health outcomes compared to previous treatments.

Not a cure-all (00:03:38) 
Kushner clarifies that while effective, these medications are not a complete solution for obesity.

Patient questions and concerns (00:05:14) 
Common patient inquiries about candidacy for new medications and managing side effects.

Criteria for candidacy (00:06:45) 
Discussion on body mass index (BMI) criteria for patients to qualify for obesity medications.

Economic factors in treatment (00:08:34) 
Challenges regarding medication affordability and insurance coverage impacting treatment decisions.

Personal experience with medications (00:09:03) 
Kushner shares his extensive experience prescribing various obesity medications.

Treatment regimen approach (00:10:55) 
Emphasis on addressing obesity as a chronic disease with appropriate treatment strategies.

Lifestyle foundation for treatment (00:13:10) 
Importance of lifestyle changes alongside pharmacotherapy in obesity management.

Avoiding counterfeit medications (00:15:40) 
Discussion on the dangers of counterfeit drugs and the importance of sourcing legitimate medications.

Long-term study insights (00:18:30) 
Insights from a study on semaglutide and its acceptance rate among patients regarding side effects.

Future of obesity medications (00:21:18) 
Predictions on the long-term safety and efficacy of semaglutide based on recent studies.

Financial predictions for coverage (00:23:54) 
Discussion on potential changes in medication coverage and the future of obesity treatment advancements.

Introduction to new medications (00:24:36) 
Discussion on glucagon and amylin medications showing promise in obesity treatment trials.

Oral medications development (00:25:10) 
Anticipation for oral small molecule medications that mimic injectable treatments for obesity.

Medicare approvals and cost implications (00:25:42) 
Medicare's approval of semaglutide for certain patients and the need to reduce medication costs.

Future of medication pricing (00:26:29) 
Expectations for price renegotiation and the potential for generic medications to lower costs.

Importance of primary care engagement (00:26:48) 
Emphasis on primary care physicians' role in managing obesity with new medications and lifestyle changes.

Closing remarks (00:27:59) 
Gratitude expressed for the discussion and the importance of familiarity with obesity treatments.