Off the Chart: A Business of Medicine Podcast

When tariffs on medical devices and components were first announced, the initial figures were, as Casey Hite puts it, mind-blowing — potentially forcing Aeroflow Health to exit entire business lines. In this episode, Hite joins Medical Economics Managing Editor Todd Shryock to discuss how the medical device supply chain has been reshaped by tariffs, why physician practices are already feeling the squeeze on items like syringes and PPE, and how Aeroflow responded not by lobbying for relief, but by accelerating AI adoption across the organization. 

Hite walks through specific examples, from artificial intelligence (AI)-powered medical record interpretation to automated customer inquiry agents, and explains why implementing these tools wrong can be just as damaging as not implementing them at all. He also addresses how supply chain costs have risen 15% year over year, why diversifying away from single-country sourcing is now essential, and why he believes health care's default tendency to protect the status quo is its biggest obstacle in a tariff-driven world.

Music Credits:
Trusted by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

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

0:00 – 0:25 | Sponsor message Copic Insurance.

0:25 – 0:42 | Cold open Hite previews the episode's central tension: the initial tariff figures were so large they would have made entire business lines unsustainable.

0:42 – 1:31 | Introduction Austin Littrell introduces the episode and previews the conversation with Hite.

1:31 – 2:34 | Initial fears when tariffs were announced Hite says Aeroflow's primary concern was access to care — specifically, whether they could absorb the margin hit without passing costs to patients, given that more than 90% of revenue flows through third-party payers at rates locked in years in advance.

2:34 – 3:13 | Which segments were hit hardest Hite identifies soft goods — breastfeeding supplies, PPE, syringes — and device components assembled in the U.S. from overseas parts as the most vulnerable categories.

3:13 – 3:58 | How fears compared to reality Hite notes that announced tariff sizes rarely match what actually goes into effect, and that the figures initially quoted would have been existential for some of Aeroflow's business lines. The final numbers came in lower — but still significant.

3:58 – 5:33 | Real-world effects on physician practices and the industry Hite describes the squeeze on practices already operating on thin margins — higher costs for basic supplies, pressure to find savings elsewhere. He explains how Aeroflow chose to treat the crisis as a forcing function for innovation rather than simply lobbying for tariff relief.

5:33 – 7:07 | How the industry is responding — and how Aeroflow is different Most companies are focused on pushing back on tariffs directly. Aeroflow looked the other way: how can AI and technology make up the lost margins? Hite frames AI as a force multiplier — one of the rare tools that simultaneously reduces cost and improves service.

7:07 – 12:35 | AI in action at Aeroflow Hite walks through specific deployments: replacing fax-based communication with EMR data pipelines via Particle Health and Redox; using AI to extract relevant data from patient charts that can run hundreds of pages; deploying AI agents to handle email, chat and soon phone inquiries; and putting AI coding tools in developers' hands to cut workload by 20–30%. He stresses that real-time sentiment monitoring is essential to prevent AI agents from trapping customers in loops.

12:35 – 13:27 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

13:27 – 15:00 | Why most companies aren't seeing the AI gains they expected Hite says the problem isn't the tools — it's implementation. Large committee-driven rollouts move too slowly. He also shares a candid moment: the first time he used AI coding tools, it hit his ego.

15:00 – 16:50 | Tariffs as an unexpected accelerant for innovation Hite argues the counterintuitive effect of tariffs is that they've urgently accelerated AI adoption. He also warns that this same dynamic will eventually depress hiring, and that companies will need to invest in retraining their people.

16:50 – 18:02 | Who's absorbing the cost — and by how much Hite confirms that Aeroflow's cost of goods rose 15% from 2024 to 2025 — and that savings elsewhere have not come close to offsetting that increase. Manufacturers are shouldering some of the burden, but not all.

18:02 – 18:46 | Lessons learned: diversify the supply chain Hite's key takeaway for the industry: stop concentrating supply chains in a single country. Aeroflow has prioritized sourcing from multiple countries to reduce exposure to any single tariff spike.

18:46 – 21:27 | Advice for physicians and health care leaders Hite pushes back on health care's doom-and-gloom culture and its tendency to protect the status quo — citing fee-for-service as the prime example. He draws a parallel to COVID-19, arguing that tariffs, like the pandemic, have simply accelerated adoption of technology that was already available. His message: accept the new reality, rally your team and look for the opportunity.

21:27 – 22:15 | Outro Shryock closes the interview. Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.

Artificial intelligence (AI) is already driving workforce decisions at major companies, and health care practices, large and small, are not immune.

In this episode, Christopher Mayer, J.D., a specialist in employment law with the firm Frier Levitt, explains how generative AI is being used to guide layoff decisions, why practice leaders can never simply accept what an AI tool recommends, and what the legal exposure looks like when AI-influenced reductions in force create disparate impact across protected categories. Mayer also addresses the near-total absence of federal AI regulation in the employment space, why the first jury trials over AI-driven layoffs could be damaging for employers, and where litigation is likely to land next. The conversation then turns to physician non-compete agreements.

Music Credits:
Warm Hands by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

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

0:00 – 0:33 | Sponsor message Copic Insurance.

0:33 – 0:52 | Cold open Mayer delivers the episode's central warning: you can't blindly accept what an AI tool tells you to do — you have to protect yourself from liability.

0:52 – 1:37 | Introduction Austin Littrell introduces the episode and previews the conversation with Mayer.

1:37 – 5:07 | How AI is reshaping workforce decisions Mayer describes two converging forces: employers using generative AI to drive layoff decisions, and AI disrupting entire job categories across industries. He notes that health care is relatively protected from AI job displacement given its patient-facing nature — but not entirely immune, citing Verizon and Amazon as examples of AI-driven workforce reductions.

5:07 – 7:19 | AI-related layoffs in health care so far Mayer says major AI-driven health care layoffs have been limited, pointing to Revere Health in Utah — which eliminated nearly 200 jobs, roughly 7% of its workforce, largely targeting medical coders. He explains why small practices are unlikely to trigger WARN Act requirements and why their layoffs tend to stay out of the headlines.

7:19 – 9:14 | How small practices are already using AI Mayer observes that small practice owners are often early AI adopters, using it for administrative and research tasks — not as a replacement for clinical judgment, but as a practical tool for running a lean operation.

9:14 – 14:01 | The HR and employment law intersection with AI Mayer explains the core compliance risk when AI influences a reduction in force: disparate impact across protected categories. He walks through the Age Discrimination in Employment Act requirements for group layoffs, why employers must build an employee census before proceeding, and why you can never simply accept what an AI tool tells you to do.

14:01 – 16:30 | Age, discrimination and the employee census Mayer clarifies how employers can know employee ages for compliance purposes, explains what an employee census looks like in practice and describes how small practices can conduct their own disparate impact analysis before proceeding with a reduction.

16:30 – 18:25 | Federal AI regulation: largely absent Mayer says meaningful federal AI regulation in the employment space doesn't yet exist. The current administration is broadly pro-AI and not focused on regulating it. California has moved at the state level, but the federal picture remains thin.

18:25 – 22:14 | Predicting the first AI employment lawsuits Mayer forecasts that challenges to AI-driven layoffs are inevitable — and that juries will likely be unsympathetic to employers who appear to have used AI as cover for discriminatory intent. He flags AI bias in tools like Grok as an early warning sign of what's coming.

22:14 – 23:04 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

23:04 – 28:08 | The non-compete landscape for physicians Mayer traces the FTC's failed attempt at a federal non-compete ban, explains why state law now governs entirely, and walks through the spectrum: California's outright ban, Pennsylvania's new one-year cap and termination carve-out for physicians, and states like New Jersey and New York where enforceability depends heavily on geographic scope, duration and the judge.

28:08 – 31:06 | What physicians should do when presented with a non-compete Mayer's advice: don't sign without consulting an attorney. He also raises a nuance most physicians overlook — that a new employer's legal team can review an existing non-compete and potentially provide indemnification if the physician is sued by a former employer.

31:06 – 31:51 | The one thing physicians must never do Mayer warns that deceiving either a former or new employer about a non-compete — or hiding its existence — is the fastest way to create serious legal exposure.

31:51 – 32:49 | A message to primary care physicians Mayer closes with a note of optimism: don't be fearful of AI. For physicians in particular, he expects it will supplement care rather than replace it — and that over time it will be viewed as more positive than the current fear suggests.

32:49 – 34:10 | Outro Payerchin closes the interview. Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.

Health care fraud enforcement recovered more than $6 billion last year. Shannon Sumner, CPA, CHC, expects this year to be even larger.

In this episode, Sumner, managing principal of PYA's Nashville office and the firm's chief compliance officer, explains how enforcement has shifted from targeting large health systems to going after individual physicians and practice leaders. She walks through the highest-risk areas regulators are focused on in 2026, including billing and coding integrity, value-based care arrangements, telehealth documentation and artificial intelligence (AI)-assisted tools, and what practices of every size can do right now to get ahead of it.

Sumner also breaks down what a realistic compliance program looks like for a smaller practice — separating the true must-haves from the nice-to-haves — and explains exactly what to do if an internal audit turns up a potential problem, including when self-disclosure is necessary and when a corrective action plan is enough.

Music Credits:
Soft Morning by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

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

0:00 – 0:22 | Cold open Sumner previews the episode's central warning: health care fraud recoveries hit a record last year, and 2026 is on track to surpass it.

0:22 – 1:11 | Introduction Austin Littrell introduces the episode and previews the conversation with Sumner.

1:11 – 2:38 | Meet Shannon Sumner and PYA Sumner introduces herself and PYA, a top-100 national health care consulting and accounting firm, and describes her background spanning traditional accounting, internal auditing and regulatory compliance.

2:38 – 5:43 | How the enforcement environment is changing in 2026 Sumner explains that enforcement is now analytics-driven — practices get flagged because their data doesn't look like their peers. She walks through the top risk areas: billing and coding integrity, quality reporting and value-based payment errors, Medicare Advantage and risk adjustment, and data privacy and cybersecurity.

5:43 – 7:40 | Where value-based care arrangements create fraud and abuse risk Sumner identifies the biggest compliance risks in VBC deals — risk adjustment, quality reporting, patient attribution and incentive payments — and urges practices to demand clear contractual definitions, independent access to performance data and thorough legal vetting before signing or renewing any arrangement.

7:40 – 9:42 | Red flags in VBC negotiations — and fixes that don't blow up the deal Sumner says most deals don't need to be scrapped, just properly vetted. Key fixes include clarifying definitions, adding payment guardrails, requiring data transparency and building in ongoing monitoring. She flags False Claims Act exposure for knowingly inaccurate data submissions and warns that Stark law remains strict liability.

9:42 – 12:36 | Telehealth fraud patterns drawing regulatory attention Sumner outlines the concerning patterns the OIG is flagging: brief or scripted encounters, improbable utilization, incorrect place-of-service coding and remote prescribing violations. She also stresses HIPAA risks including platforms without business associate agreements and recording sessions without patient authorization.

12:36 – 14:22 | How analytics have changed compliance and what practices should do Sumner explains that regulators now analyze the full population of claims, not just samples — and practices should be doing the same internally. She recommends building dashboards to track outlier metrics, conducting targeted audits and focusing on the 20% of activity generating 80% of risk.

14:22 – 15:14 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

15:14 – 20:44 | Must-haves vs. nice-to-haves for a compliance program in 2026 Drawing on the OIG's updated General Compliance Program Guidance, Sumner outlines the must-haves for small practices: a designated compliance lead who isn't involved in coding and billing, written policies that match actual workflows, role-specific training, a mechanism to report concerns without retaliation, basic auditing and monitoring, and a corrective action roadmap. Nice-to-haves include third-party compliance assessments every three to five years and advanced analytic tools — though she says the latter is quickly becoming a must-have.

20:44 – 22:29 | What to do when an internal audit finds a problem Sumner's plan of action: contain the issue immediately, pause billing, locate documentation and seek counsel versed in fraud, waste and abuse before doing anything else. She walks through how to determine whether self-disclosure or an internal corrective action plan is the appropriate response.

22:29 – 24:16 | Where the next wave of enforcement is heading Sumner points to AI-enabled documentation and coding tools as the next major enforcement frontier and recommends practices form an AI governance committee — even a small one — to inventory tools and assess risk. Third-party vendor risk is another growing area, with business associate agreements and security assessments taking on new importance.

24:16 – 26:38 | The CRUSH initiative and what it means for individual physicians Sumner explains that enforcement has shifted from large health systems to individual providers, notes that CMS held a "chili cook-off" contest to solicit better fraud-detection analytics, and warns that the government has now put practices on notice: the absence of an effective compliance program is an aggravating factor in enforcement actions.

26:38 – 27:22 | Closing thoughts Sumner's bottom line: the best compliance programs are operational partners, not paper programs. Practices need to move from reactive to proactive compliance — because prevention is the best medicine.

27:22 – 28:15 | Outro Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.

Nearly half of all physicians are now employed by or affiliated with a hospital system, and the forces behind that consolidation aren't slowing down.

John Pack, vice president of health care finance at Mitsubishi HC Capital America, explains to Physicians Practice Managing Editor Keith A. Reynolds what's driving independent practices toward consolidation, and why mid-size practices in particular get stuck in a lending no man's land.

He walks through what lenders are actually looking at when they evaluate a practice, including EBITDA — that's earnings before interest, taxes, depreciation and amortization — margins, accounts receivable aging and payer mix, and what the cleanest path to funding growth looks like without surrendering equity or clinical control.

Music Credits:
Cozy Evening Coffee Time by BJBeats - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

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

0:00 – 0:22 | Cold open Pack previews the episode's bottom line: small operational fixes often have a bigger financial impact than simply adding new patient volume.

0:22 – 1:17 | Introduction Austin Littrell introduces the episode and previews the conversation with Pack.

1:17 – 4:09 | What's driving practice consolidation Pack outlines the four main forces squeezing independent practices: rising operating costs, stagnant or declining reimbursements, aggressive acquisition by hospitals and private equity, and the lingering financial aftershocks of COVID-19. He notes that nearly 50% of physicians are now employed by or affiliated with hospital systems, up from under 30% a decade ago.

4:09 – 5:53 | Why mid-size practices hit a ceiling with traditional bank financing Pack defines mid-size practices as those between $10–15 million and $120 million in revenue and explains why they fall into a lending no man's land — too large for local banks, too small for large ones — and why health care's cash flow profile makes traditional bank underwriting a poor fit.

5:53 – 8:03 | What lenders are actually looking at Pack walks through the key metrics lenders use to size up a practice: EBITDA margins (typically 10–20% for outpatient specialties), accounts receivable aging (under 45 days is strong, 90-plus days is a red flag), and payer mix across Medicare, Medicaid, commercial insurance and self-pay.

8:03 – 9:01 | Funding growth without giving up control Pack identifies cash flow-based debt — traditional or private credit — as the cleanest path to growth, with no equity issued, no board seats surrendered and no covenants tied to clinical decision-making. Asset-backed credit lines are a secondary option.

9:01 – 10:02 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

10:02 – 11:37 | What makes an acquisition deal financeable — and what raises red flags Pack says verifiable EBITDA is the first thing credit analysts look for, followed by a diversified provider base with no key-person dependency, consistent revenue growth, strong payer mix and clean accounts receivable under 45 days.

11:37 – 13:07 | Cash flow fixes that unlock better financing terms Pack's top two levers: normalizing physician compensation so retained earnings stay in the practice, and tightening accounts receivable management — which he calls the fastest and most common cash flow win lenders cite.

13:07 – 14:22 | How to stress-test your debt Pack advises practice owners to model downside scenarios — not just base cases — asking whether the practice can still service its debt if reimbursements drop, labor costs rise or a key provider leaves.

14:22 – 16:08 | Three steps before expanding your practice Pack's pre-expansion checklist: get a clear picture of your true cash flow stripped of one-time expenses, assess operational readiness and leadership depth, and engage financial partners early — a step he says probably belongs at the top of the list.

16:08 – 17:16 | One tip to improve practice finances today Pack's closing advice: start managing the practice like a business, not just a clinic. Review cash flow regularly, understand where money is leaking and recognize that small operational fixes often outperform chasing new volume.

17:16 – 18:00 | Outro Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.

Virtual care has reshaped medicine since COVID-19, but the shift to the screen comes with real trade-offs.
 
In this episode, Sarah Matt, M.D., MBA — practicing physician, health technology strategist, author of "The Borderless Healthcare Revolution" and a recent addition to the Medical Economics editorial advisory board — joins Managing Editor Todd Shryock to explore what's actually at stake when care moves online. She explains what gets lost in a virtual encounter, why certain patient populations actually do better with telehealth than in person, and why reliable internet access has become a social determinant of health.

Matt also pushes back on the idea that individual physicians are responsible for bridging the digital divide, arguing that health systems need to own that problem, and that technology vendors need to start designing with patients at the table rather than on their behalf.

Her closing advice for any practice navigating the virtual care landscape: be flexible, because one size fits nobody.

Music Credits:
Sleepy Sunday by Buurd - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

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

0:00 – 0:22 | Cold open Matt opens with a provocation: reliable internet access has become a social determinant of health and should be treated as a utility.

0:22 – 1:17 | Introduction Austin Littrell introduces the episode and previews the conversation with Matt.

1:17 – 2:24 | How virtual care has changed clinical practice Matt describes the spectrum of virtual care since COVID-19 — from fully remote telehealth-only practices in primary care and women's health to hybrid models that blend in-person and virtual visits.

2:24 – 3:22 | What's at risk in a remote encounter Matt explains what physicians lose when care moves to a screen — the contextual cues of a full in-person visit — and notes that patients lose the ability to read their provider too.

3:22 – 4:12 | Building trust and rapport virtually Matt argues that digital empathy and in-person empathy require the same skills: small talk, active listening and genuine relationship-building matter whether you're in a clinic or on a video call.

4:12 – 5:21 | The role of preparation in virtual visits Matt is candid about the reality most physicians face: limited prep time, limited environmental control and a chart review that often happens seconds before the visit. She says preparation is a shared responsibility between provider and patient.

5:21 – 6:47 | When virtual care actually works better Matt points to older adults using iPads for virtual discharge as one example where virtual care improved communication — noting features like volume control, lip reading and transcription. She also highlights reduced commute stress and the ability to reference notes as patient-side advantages.

6:47 – 9:06 | Virtual care, equity and the infrastructure gap Matt is hopeful that virtual care can raise the floor for access but flags a hard reality: for patients without reliable internet — whether urban poor or deeply rural — the infrastructure gap is its own barrier. She uses a snowstorm analogy to make the point that technology can't fix an unplowed road.

9:06 – 9:57 | What individual physicians can do Matt says systemic problems require systemic solutions, but urges physicians to stay open across all communication channels — while also protecting their own well-being, because a burned-out physician helps no one.

9:57 – 10:47 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

10:47 – 12:32 | Digital literacy on both sides of the screen Matt describes a generational knowledge gap affecting both patients and providers, and calls for communities and health care organizations to draw on expertise from all levels — from medical students to senior clinicians — rather than deferring only to leadership.

12:32 – 13:32 | Physician responsibility vs. system responsibility Matt pushes back on placing the burden of technology adaptation solely on individual physicians, arguing that health systems need to own the responsibility of enabling providers with tools that don't get in the way of care.

13:32 – 14:51 | Designing virtual care for the people who actually use it Matt's core design principle: stop assuming you know what patients need and start including them in the process. Whether the population is rural farmers, non-English speakers or urban transit riders, solutions built without them will miss the mark.

14:51 – 15:25 | One guiding principle for virtual care Matt's closing advice: be flexible. Virtual care is not one-size-fits-all for patients or for physicians, and recognizing where it works — and where it doesn't — is the starting point.

15:25 – 15:57 | Book plug and closing remarks Matt points listeners to her national bestseller "The Borderless Healthcare Revolution" as a roadmap for improving health care access, and encourages everyone to identify one thing they can do to improve access today.

15:57 – 17:05 | Outro Shryock closes the interview. Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.

The Merit-based Incentive Payment System (MIPS) has been around since 2017, but that doesn't mean the program has gotten easier to navigate.

Holly Black, project manager for regulatory affairs and compliance at Sightview Software — and often referred to as a "MIPS Geek Guru" — walks through the most consequential changes for 2026, including the removal of the three-point scoring floor for large practices and new documentation requirements for security risk assessments.

She explains why MIPS performance is never really one person's job, what practices should be doing quarterly to avoid a scramble at year-end, and how electronic health record (EHR) documentation habits show up directly in performance scores. Black also covers the shift toward MIPS value pathways (MVPs), what the transition means for specialists and sub-specialists, and how time-strapped practices can focus their limited hours on the changes that will have the biggest impact on their score.

Music Credits:
Swinging Lounge Bar by NC MUSIC - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

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

0:00 – 0:18 | Cold open Black previews the episode's central theme: MIPS is a team sport, not a one-person job.

0:18 – 0:59 | Introduction Austin Littrell introduces the episode and previews the conversation with Black.

0:59 – 3:40 | What's changed in MIPS for 2026 Black breaks down the biggest updates by category: the removal of the three-point scoring floor for large practices, new documentation requirements for security risk assessments under the promoting interoperability category, and the updated 2025 SAFER guide that practices need to be using.

3:40 – 5:58 | What practices can still do right now Black's top recommendations for mid-year course correction: build a MIPS team, run reports at least quarterly, and know your key deadlines — including the September 30 registry mapping deadline and the March 31 MIPS attestation window for 2025.

5:58 – 8:36 | MIPS value pathways: what they mean for specialists Black explains how MVPs work in 2026, why practices can opt in now and let CMS take the higher of the two scores, and what the shift to four quality measures instead of six means for specialty practices. She flags where sub-specialties may run into trouble finding applicable measures.

8:36 – 10:14 | Lessons from ophthalmology Drawing on Sightview's eye care client base, Black reports that practices opting into MVPs are scoring roughly the same as traditional MIPS — and says the takeaway for all specialties is to start looking at MVPs now and focus on measures specific to your patient demographics.

10:14 – 11:02 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

11:02 – 14:08 | Compliance mistakes that are still costing practices Black walks through the most common and avoidable errors: missed registry mapping deadlines, EHR switching mid-year without updating the registry, failing to validate data throughout the year, and leaving all MIPS responsibility on the practice administrator.

14:08 – 15:44 | How EHR documentation affects your MIPS score Since CMS eliminated manual data submissions last year, EHR use is now essential for meaningful MIPS reporting. Black explains why structured fields, automated workflows and patient portal engagement all feed directly into performance scores.

15:44 – 17:07 | Protecting Medicare revenue without adding administrative burden Black's practical advice for small and mid-size practices: use the EHR to its full capability, understand your category weights, and double-check registry data rather than assuming it's pulling correctly. Quality and cost categories each carry 30% of the total score.

17:07 – 19:00 | MIPS priorities for time-strapped practices For practices with only a few hours a month to dedicate to MIPS, Black says focus on tracking the right measures and reviewing workflows with the team — drawing on her own experience spending five hours a month as a MIPS coordinator at a medical practice.

19:00 – 20:38 | Final advice and outro Black closes with a reminder to check qpp.cms.gov regularly and never assume last year's approach still applies — especially for improvement activities, where documentation requirements can shift quietly from year to year. Littrell thanks listeners and wraps the episode.

Texas has long carried the highest uninsured rate in the country — but research by Texas 2036 found the reasons why are more complicated than most people assume. In this episode, Charles Miller, J.D., director of health and economic mobility policy for Texas 2036, unpacks what the organization learned when it went directly to uninsured Texans to ask why they hadn't enrolled in coverage many of them could get for free.

He also explains how a bipartisan Texas law called premium alignment has quietly made ACA bronze and gold plans more affordable, what physicians need to understand about how plan metal levels actually affect patient cost-sharing, and why market consolidation — driven by both large hospital systems and insurers — is the central threat to independent practice.

Miller closes with a direct message to independent physicians: if you want that model to survive, you need to make your voice heard on market reform, because the current rules of the game are working against you.

Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EDT: https://registration.physicianspractice.com

Music Credits:
Ocean Calm by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

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

0:00 – 0:31 | Cold open Miller warns that without serious market reform, independent physicians are going to be squeezed out — and says the current rules of the game are what's driving that outcome.

0:31 – 1:59 | Introduction Austin Littrell introduces the episode, plugs the Practice Academy Practice Management track on March 19, and previews the conversation with Miller.

1:59 – 3:24 | Meet Charles Miller and Texas 2036 Payerchin introduces Miller, who explains the organization's two-track focus: expanding health insurance coverage and making the underlying prices of health care more affordable ahead of Texas's 2036 bicentennial.

3:24 – 4:24 | Why Texas made health care a priority Texas has long held the highest uninsured rate in the country — and Miller explains how that designation pushed the organization to look beyond coverage alone and into the broader affordability of the system.

4:24 – 9:01 | Who are the uninsured in Texas? Miller walks through a Texas 2036 research project that went directly to uninsured Texans to ask why they hadn't enrolled. The findings: many didn't know options existed outside employer coverage, and most wildly overestimated what plans would cost — with some eligible for free plans assuming they'd pay $300–$500 a month.

9:01 – 10:00 | Bringing it back to physicians Payerchin pivots to the physician audience, asking whether doctors were involved in shaping the policies that followed — and what the response has been from Texas's medical community.

10:00 – 12:52 | ACA metal levels and what they mean for your practice Miller explains how bronze, silver and gold plan tiers work in practice, why silver plans carry cost-sharing reductions for lower-income patients, and why there's no single filter physicians can use to predict patient cost share based on plan type alone.

12:52 – 14:28 | Premium alignment: the policy making plans more affordable Miller describes the Texas premium alignment policy — a bipartisan 2021 law that enforces the ACA's single risk pool requirement more stringently, effectively drawing in more federal subsidies for bronze and gold plans. Illinois and New Mexico are among the states watching closely.

14:28 – 15:59 | Health care access for undocumented residents Miller separates the question of health care access from government-subsidized coverage, noting that while there is no legal barrier to anyone seeking care, Texas does not extend Medicaid or ACA subsidies to those without legal status.

15:59 – 21:42 | Price transparency: what Texas has done and what's still missing Miller traces Texas's price transparency efforts from 2021 through the most recent legislative session, covering machine-readable files for hospitals and insurers, consumer self-service tools, itemized billing requirements and a new enforceable cost estimate provision for patients shopping for procedures.

21:42 – 22:37 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

22:37 – 29:12 | Market consolidation and the squeeze on independent practice Miller addresses hospital market concentration, vertical integration and the anti-competitive contracting practices — including anti-steering clauses, most-favored-nation clauses and gag clauses — that are limiting physician independence and patient choice. He outlines Texas House Bill 711 and ongoing efforts to preserve competitive markets.

29:12 – 31:01 | What this means for independent physicians Miller and Payerchin discuss the convergence of forces — large health systems and large insurers both exerting pressure — that is making independent practice increasingly difficult to sustain, and why the physician-patient relationship is at the center of the fight.

31:01 – 32:18 | A message to primary care physicians Miller closes with a direct call to action: if independent practice matters to you, get active, make your voice heard, and make sure the groups claiming to represent you actually are.

32:18 – 33:15 | Outro Littrell thanks listeners, plugs the March 19 Practice Academy event, and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.

A new Wolters Kluwer survey of physician assistants found that 96% feel confident walking into patient interactions on day one, but 87% say they still need more training on artificial intelligence (AI).

Kelly Villella, segment leader and director of product management at Wolters Kluwer Health, unpacks what those numbers mean for the practice managers responsible for hiring and onboarding PAs.

She explains why documentation keeps emerging as a friction point, what practices should be doing right now to get ahead of shadow AI risks and why a clear written policy on acceptable AI use isn't optional anymore.

Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EDT: https://registration.physicianspractice.com

Music Credits:
Coffee Shop Sketches by Buurd - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

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

0:00 – 0:35 | Cold open Villella previews the episode's central tension: physician assistants are one of the fastest-growing health care professions, and AI is transforming both at the same time.

0:35 – 1:54 | Introduction Austin Littrell introduces the episode, plugs the Practice Academy Practice Management track on March 19, and previews the conversation with Villella.

1:54 – 2:46 | Meet Kelly Villella Reynolds introduces Villella, who shares her background: nearly 27 years in higher education technology, overseeing digital products and textbooks for students training to become PAs, physicians, pharmacists and other clinicians at Wolters Kluwer Health.

2:46 – 4:17 | What the survey found Villella walks through the top-line results: 96% of PAs feel confident in patient interaction, but 87% say they need more AI training — and 20% feel underprepared on documentation.

4:17 – 5:43 | What's changed most for PAs The two biggest day-to-day changes PAs cited: dealing with insurance companies and navigating the rise of AI tools, particularly around documentation.

5:43 – 7:40 | Where new PAs feel strong — and where they need support PAs walk in confident on patient care but often struggle with documentation and unfamiliar systems. Villella says practice managers need clear onboarding policies and pre-approved tools ready from day one.

7:40 – 9:01 | Building the ideal onboarding plan Villella outlines her onboarding must-haves, including written policies on acceptable AI use and a frank conversation about shadow AI — the unapproved tools clinicians may already be using in their personal lives.

9:01 – 10:28 | The root cause of workflow friction Villella describes the core tension: PAs enter the field to focus on patients, but documentation pulls them away from that mission. She frames AI-assisted documentation as the most promising area to reduce that friction.

10:28 – 12:53 | Balancing productivity, quality and AI in onboarding Practice leaders need to identify trusted AI-integrated tools already in their workflow, train staff to use them — and be explicit that AI is an aid, not a replacement. Checks and balances matter.

12:53 – 14:21 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

14:21 – 16:06 | AI as a feature, not a solution Villella makes the case that AI shouldn't be thought of as a standalone tool but as a feature built into the trusted, evidence-based solutions practices are already using — pointing to radiology's second-read model as an example.

16:06 – 17:21 | One thing practice managers can do next week Villella's concrete takeaway: sit down as a team, document your current AI policy and communicate it clearly. Don't assume every incoming clinician has the same understanding of what's acceptable.

17:21 – 18:30 | A message for PA educators Villella closes with a note for PA programs: the mindset around AI use needs to start in the classroom, so that by the time new clinicians arrive at a practice, the groundwork is already laid.

18:30 – 19:45 | Outro Littrell thanks listeners, plugs the March 19 Practice Academy event, and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.

Osteopathic medicine has grown from a single school in the 1890s to 73 campuses across 36 states, now accounting for nearly 30% of all U.S. medical students.

In this episode, Robert Cain, D.O., FACOI, FAODME, president and CEO of the American Association of Colleges of Osteopathic Medicine (AACOM), walks through the association's inaugural workforce and economic impact report, which found that roughly half of D.O. graduates go into primary care — more than twice the rate of their M.D. counterparts.

He also discusses how placing a college of osteopathic medicine in an underserved community can transform its local economy, why the profession's prevention-focused philosophy aligns naturally with the national conversation around healthy living, and how D.O. colleges are approaching artificial intelligence (AI) integration in ways designed to keep the patient at the center of care.

Finally, Cain makes the case for why primary care physicians deserve better pay, better working conditions and stronger policy support.

Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EDT: https://registration.physicianspractice.com

Music Credits:
Saved by You by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

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

0:00 – 0:30 | Cold open Robert Cain, D.O. previews the episode's central argument: that osteopathic medicine is at a tipping point in its contribution to the U.S. health care system.

0:30 – 1:47 | Introduction Austin Littrell introduces the episode, plugs the Practice Academy Practice Management track on March 19, and previews the conversation with Cain.

1:47 – 3:27 | Growth by the numbers Payerchin and Cain open with the facts: from a single school in the 1890s to 73 campuses across 36 states, with nearly 30% of all U.S. medical students now earning the D.O. degree.

3:27 – 4:25 | The state of osteopathic medicine today Cain describes the profession as being at a genuine tipping point — with visibility, applications and influence all on the rise.

4:25 – 6:35 | What drew Robert Cain to osteopathic medicine — and what's drawing students today Cain traces his path from working as an EMT in western Pennsylvania to choosing osteopathic medicine for its philosophy and manual medicine approach. He describes today's students as drawn to its health-first, patient-centered identity.

6:35 – 7:53 | A self-propagating profession Discussion of how geographic expansion and growing visibility are creating a cycle: more schools attract more students, which leads to more physicians and even more visibility.

7:53 – 9:47 | The origins of the workforce and economic impact report Cain explains the thought experiment that sparked the report: if osteopathic medicine disappeared overnight, what would be missing — and who would care?

9:47 – 12:46 | Key findings: primary care, high-need specialties and rural placement Roughly 50% of D.O. graduates enter primary care — more than twice the rate of M.D. graduates. About 25% go into high-need specialties. More than half of colleges are in medically underserved areas, and rural placement numbers are strong.

12:46 – 15:03 | Why D.O.s go into primary care — and whether that will continue Cain traces the primary care pipeline to the profession's foundational principles, its community-based training model and its deliberate selection of students with a generalist mindset.

15:03 – 17:40 | Specialty care vs. the big picture Cain reflects on his own career as a pulmonologist — and how an osteopathic education shaped his ability to treat the whole patient, not just the lungs.

17:40 – 18:34 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

18:34 – 22:16 | Economic impact: jobs, communities and the Pikeville story Cain describes how opening a college of osteopathic medicine in a community generates jobs and economic activity — using Pikeville, Ky., as a vivid example of a rural coal town transformed.

22:16 – 25:22 | Policy priorities: the Community Teams Act and primary care reimbursement Cain calls for more funding for community-based teaching sites through the Community Teams Act, and advocates for leveling the compensation playing field for primary care physicians.

25:22 – 27:13 | Osteopathic medicine and the healthy living movement Cain explains why conversations around nutrition, sleep and exercise align naturally with osteopathic principles — and what the profession wants from those policy discussions.

27:13 – 29:43 | AI in osteopathic medical education Cain discusses how D.O. colleges are approaching AI integration — with a focus on using tools like ambient scribing to restore face-to-face patient interaction, not replace it.

29:43 – 30:33 | A message to primary care physicians Cain closes with a direct message to primary care physicians: osteopathic medicine sees them as partners and shares their commitment to improving the health care system.

30:33 – 31:40 | Outro Littrell thanks listeners, plugs the March 19 Practice Academy event, and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.

Workplace violence in health care settings isn't just a safety issue — it's a financial and operational one.

In this episode, Andrea Greco, SVP of healthcare safety at CENTEGIX, breaks down key findings from the company's 2026 Healthcare Trends Report, including why duress alerts now spike nearly 300% during morning hours, why hallways and exam rooms remain the most dangerous spaces in a practice, and what a realistic ROI looks like when evaluating safety technology. She also addresses staff resistance to real-time location tracking, how to build an effective internal response protocol, and the federal and state legislation that could soon raise the accountability stakes for practice leaders.

Register now for Physicians Practice's Practice Academy event: Practice Management Track, on March 19, 2026, from 1:00 PM-5:00 PM EDT: https://registration.physicianspractice.com

Music Credits:
Her Name by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

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

0:00 – 0:37 | Cold open Andrea Greco previews the episode's core argument: that the cost of inaction on workplace violence is starting to outweigh the cost of hoping things improve.

0:37 – 1:58 | Introduction Austin Littrell introduces the episode, plugs the Practice Academy Practice Management track on March 19, and previews the conversation with Greco.

1:58 – 2:37 | Setting the stage Littrell introduces Greco.

2:37 – 3:45 | Violence as a business risk Greco explains why practice leaders need to see workplace violence as a financial and operational issue — not just a security one — and why a comprehensive, executable safety strategy beats siloed solutions.

3:45 – 4:33 | Shifting alert patterns across the week Greco reacts to a key finding: duress alerts, which previously spiked on certain days, have leveled out across all seven days — reinforcing that risk is present every day.

4:33 – 5:35 | The morning spike Discussion of the nearly 300% surge in duress alerts between 8:30 a.m. and 12:15 p.m., and the clinical workflows — morning rounds, discharge planning, shift changes — that drive it.

5:35 – 7:27 | Structuring an internal response Greco outlines what effective response looks like: immediate, discrete notification delivered to the right responders, customized to each organization's available resources.

7:27 – 8:34 | Where and how incidents escalate Greco describes where altercations most commonly occur — hallways and away from patient rooms — and notes a rise in staff-on-staff tensions since COVID-19.

8:34 – 9:25 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

9:25 – 10:25 | Protecting high-risk areas Greco addresses whether practices can redesign vulnerable spaces, arguing that precise location data during an alert is often more practical than physical redesign.

10:25 – 12:00 | Privacy concerns and wearable adoption Greco discusses staff resistance to real-time location tracking, and how CENTEGIX's approach — only activating location when an alert is triggered — addresses those concerns and improves adoption.

12:00 – 14:43 | Building the ROI case Greco walks through CENTEGIX's new ROI calculator, covering incident costs, backup staffing, workers' compensation, nurse replacement costs (over $60,000 per nurse), and potential insurance savings.

14:43 – 17:22 | Three themes for 2026 Greco closes with three priorities for safety planning: a workforce-centric approach, a demand for measurable ROI, and greater accountability — including the federal SAVE Act and Illinois SB 1435.

17:22 – 17:41 | Closing remarks Littrell thanks Greco and wraps the interview.

17:41 – 19:00 | Outro Littrell thanks listeners, plugs the March 19 Practice Academy event, and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.