Off the Chart: A Business of Medicine Podcast

It's no secret that health care has a staffing problem. But are patients really resorting to artificial intelligence (AI) chatbots when they can't get in to see a physician?

Medical Economics Associate Editor Austin Littrell sat down with Rosemarie Aznavorian, D.N.P., RN, CENP, CCWP, CCRN, senior vice president of client services and chief clinical officer at MedPro Healthcare Staffing, to talk about the growing gap between patient demand and available clinical staff.

Aznavorian explains how lower nursing school enrollment, pandemic-driven retirements and rising patient acuity are stretching hospitals and outpatient settings thin. She outlines the downstream effects: longer emergency department waits, delayed surgeries, missed care and increased risk of medical errors.

And, on the emerging trend of patients turning to GenAI tools like ChatGPT Health to self-diagnose when they cannot access care, Aznavorian discusses the risks of misdiagnosis, over-the-counter self-treatment and delayed preventive care, while emphasizing the need for clinicians to approach these conversations without judgment.

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:
Retro Disco Lounge Groove by MotifLab 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 — Cold open
Why clinicians should be concerned — and not judgmental — about patients using AI tools.

0:17 — Intro and Practice Academy note

1:42 — Meet Rosemarie Aznavorian
MedPro’s staffing model and international workforce strategy.

2:42 — How staffing shortages affect patient access
Lower enrollment, retirements and rising acuity.

4:53 — Are patients turning to ChatGPT Health?
AI self-diagnosis and its risks.

6:21 — Where this is happening most
Rural areas, hospital deserts and overwhelmed emergency departments.

7:26 — Is any specialty driving patients toward AI?

8:34 — Should clinicians be worried?
Balancing awareness with non-judgmental communication.

10:21 — 5% of ChatGPT messages are health care-related
Unmet needs, curiosity or frustration?

11:45 — Risks to practices
Misdiagnosis and over-the-counter self-treatment.

12:36 — Is staffing the answer?
How acuity changes nurse needs.

13:57 — The 80/10/10 staffing model explained

16:58 — Closing thoughts

17:15 — Outro

Payment processing has become more complex for medical practices — and more vulnerable to fraud.

Medical Economics Managing Editor Todd Shryock sat down with Stephanie O’Connor, director of merchant experience at Wind River Payments, to talk about the evolving risks tied to digital payment platforms in health care

O’Connor explains how practices can unintentionally expose themselves to card testing attacks, friendly fraud and costly chargebacks when they rush to adopt trending payment tools without proper safeguards. She breaks down common red flags front office staff should recognize, why refund scams are targeting health care and how artificial intelligence (AI) is now playing a critical role in fraud detection behind the scenes.

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:
Chasing the Moonlight 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 — Cold open
Why practices shouldn’t have to compromise patient experience to prevent fraud.

0:18 — Intro and Practice Academy note

1:42 — Introducing Stephanie O’Connor
Payment modernization and revenue protection.

2:17 — Why practices need a payment strategy
Balancing cost control and fraud prevention.

3:21 — The biggest mistake practices make
Turning on new payment options without safeguards.

4:46 — Card testing attacks explained
How fraudsters use your website to validate stolen cards.

6:57 — Friendly fraud and chargebacks
When confusion turns into revenue loss.

7:55 — Who should practices call first?
Coordinating IT and payment processors.

8:18 — Patient portals and fraud risk
How AI works behind the scenes to protect transactions.

10:39 — Healthcare-specific chargebacks
Services not rendered and telemedicine disputes.

13:01 — P2 Management Minute

14:09 — Red flags for front office staff
Multiple declines, refund requests and rushed payments.

16:10 — Where fraud originates
Foreign BIN numbers and local “friendly” disputes.

17:16 — Are small practices more vulnerable?
Why size matters in fraud exposure.

18:06 — Can you protect revenue without hurting experience?
Why modern AI tools change the equation.

19:41 — Questions to ask your payment processor
What type of fraud are you actually protected against?

21:26 — Trends heading into 2026
Fraud stability, AI growth and proactive planning.

23:30 — Outro

In this episode, Keith Reynolds, managing editor of Physicians Practice, speaks with Katie Russell, J.D., partner at Brown Immigration Law in Cleveland, Ohio, about what recent shifts in immigration enforcement really mean for medical practices.

Russell explains why enforcement has moved toward employer-focused compliance audits, particularly I-9 documentation and visa adherence. She outlines what practices often misunderstand about their obligations, how to distinguish between judicial and administrative warrants and what staff should do if federal officers arrive unexpectedly.

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:
CALM CHILL RELAXED SMOOTH JAZZ (OWE YOU) by Tasty Tunes - 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 — Cold open
Healthcare is not insulated from employer compliance standards.

0:27 — Intro and Practice Academy note

1:56 — Reconnecting since October
What’s changed in immigration enforcement?

2:39 — The biggest shift in ICE enforcement
From dramatic raids to employer compliance audits.

3:33 — I-9 documentation and why it matters
Common gaps practices overlook.

6:11 — Is this really new?
Why compliance scrutiny has always been there.

9:17 — What practices misunderstand
Healthcare is subject to the same employer standards as any industry.

11:18 — Judicial vs. administrative warrants
What staff should know before granting access.

13:42 — What to do if officers show up
Verify, document and call counsel.

16:47 — P2 Management Minute

17:57 — First compliance step this quarter
Audit your I-9 process and training.

20:48 — Is this just paperwork?
The purpose behind employer verification.

22:34 — The new $100,000 H-1B visa fee explained
Who it affects and who pays.

28:31 — Employer responsibility for visa costs

30:12 — Alternatives to H-1B visas
Exploring other pathways.

32:30 — The most practical step for overwhelmed leaders
Preparation, perspective and reducing panic.

35:27 — Final thoughts
Why most compliant practices have little to worry about.

Rising patient acuity. Aging demographics. Tight margins. Artificial intelligence (AI) moving from buzzword to workflow tool.

Medical Economics sat down with Shannon Sims, M.D., Ph.D., FAMIA, chief product officer at Vizient, and Matthew Bates, M.P.H., managing director at Kaufman Hall, to talk about Vizient's 2026 State of the Industry Report and what it calls a "reset" moment for U.S. health care.

Sims and Bates explain how AI is already reducing documentation burdens through ambient listening and revenue cycle automation, why access has overtaken staffing as the defining operational challenge and how advanced practice providers (APPs) are reshaping team-based care as physician shortages persist.

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:
Cherry Blossom Memories 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 — Cold open
Can AI help return the joy to medicine — and improve the economics of practice?

0:34 — Intro and Practice Academy note

2:01 — Introducing Vizient and Kaufman Hall

2:12 — What does a “reset” in 2026 really mean?
AI moving from hype to workflow, and the growing role of advanced practice providers.

3:59 — How AI is changing day-to-day physician work
Ambient listening, documentation and automation.

4:46 — Patients are sicker — but outcomes are improving
Quality gains despite rising case mix.

7:03 — The aging population and care coordination challenges
Who becomes the “quarterback” for complex patients?

8:50 — Rising costs per employed provider
Why physicians are working harder but margins remain thin.

10:36 — APPs now make up 40% of employed providers
What effective team models look like — and where they can go wrong.

13:01 — P2 Management Minute

13:52 — Labor, drug and supply cost pressures
What smaller practices can realistically do.

15:01 — Fewer big hospital mergers, more targeted partnerships
Governance, ownership and alignment risks.

16:28 — AI beyond the hype
Revenue cycle, clinical decision support and the need for a human in the loop.

18:27 — What should small practices be watching right now?
Access, patient experience and payer mix realities.

20:15 — One practical takeaway for physicians in 2026
Embrace digital tools and fix access bottlenecks.

22:00 — Final reflection
Can AI restore professional satisfaction and extend careers?

23:00 — Outro

Medicare often pays dramatically different rates for the exact same service depending on where it’s delivered. That difference has helped fuel hospital acquisition of physician practices and reshaped the structure of U.S. health care.

Medical Economics Senior Editor Richard Payerchin sat down with Christopher Whaley, Ph.D., associate professor in the Department of Health Services, Policy and Practice at the Brown University School of Public Health, to learn more.

Whaley breaks down site-neutral payment policy, why Medicare’s 2026 rule takes what he calls a "meaningful step forward" and whether reform could help level the playing field for independent physicians.

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:
Empty Spaces 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 — Cold open
Is the genie out of the bottle for independent practice?

0:20 — Intro

1:46 — What the 2026 OPPS and ASC rule gets right
Why CMS is taking incremental but meaningful steps toward site-neutral payment.

2:03 — Why Medicare pays more for the same service in hospital settings
How site-of-care differentials incentivized consolidation.

4:46 — The inpatient-only list explained
How advances in surgical safety changed where procedures can be performed.

6:18 — Is 2026 a breakthrough year for site neutrality?
Whether CMS is signaling broader reform.

7:00 — Too little, too late for independent practice?
Can payment reform meaningfully reverse consolidation trends?

8:41 — Off-campus hospital outpatient departments
How billing classifications affect Medicare spending.

9:43 — Do hospitals deserve higher reimbursement?
Arguments for and against differential payment rates.

11:09 — P2 Management Minute

12:01 — Rural hospitals and payment fairness
Balancing access concerns with cost control.

15:12 — When “rural” isn’t rural
How geographic classifications can distort payment policy.

16:27 — If you could change one thing in U.S. healthcare
Whaley’s view on the most impactful reform lever.

17:03 — Reaction to the administration’s broader health policy agenda
Where site-neutral payment fits into the larger strategy.

18:05 — Why price transparency hasn’t worked as intended
Behavioral economics and the limits of consumer-driven reform.

19:28 — Could transparency help independent practices compete?
Where leveling the payment field intersects with pricing visibility.

20:40 — What happens next with site-neutral payment policy
Political feasibility and stakeholder resistance.

22:04 — Who stands to gain — and who loses — under site neutrality
Hospitals, physicians and Medicare beneficiaries.

23:17 — What primary care physicians should be watching now
Practical implications for referral patterns and reimbursement.

24:20 — Outro

The health care system is changing quickly, and the legal and regulatory systems that govern it are struggling to keep up.

Medical Economics Associate Editor Austin Littrell sat down with Richard Anderson, M.D., CEO of The Doctors Company and TDC Group, to talk about the organization’s annual predictions report, Healthcare on the Horizon: Predictions for U.S. Healthcare Through 2026.

Anderson explains why artificial intelligence may soon become part of the standard of care — and why clinician trust, legal precedent and liability exposure will determine how quickly that happens. He outlines the paradox physicians face when deciding whether to follow AI recommendations, the growing impact of nuclear verdicts and social inflation in malpractice litigation and the widening access gaps as rural hospitals close and reimbursement pressures mount.

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:
Cloud Garden 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 — Cold open
A system being revolutionized and torn apart at the same time.

0:20 — Intro
Austin Littrell introduces the episode and Dr. Anderson.

1:39 — The most underappreciated risk in 2026
Rapid change, consolidation and burnout.

6:04 — AI integration and clinician trust
Why liability concerns may slow adoption.

12:06 — How physicians should use AI today
Ambient listening, EHR burden and practical realities.

14:46 — The $1 trillion digital migration
Unexpected legal and clinical risks.

17:46 — P2 Management Minute

18:38 — Measuring digital progress
Why courts lag behind technological change.

20:26 — Nuclear verdicts explained
Why awards over $50 million are reshaping expectations.

25:56 — Hospital closures and access gaps
Rural care under pressure.

27:57 — Tort reform priorities
Why caps on non-economic damages matter.

31:52 — Agentic AI and responsibility
Who gets sued when machines act independently?

36:12 — Outro

Artificial intelligence (AI) is moving closer to patients, often before they ever step into the exam room. Tools like ChatGPT Health and other health-focused AI platforms are shaping how patients interpret test results, prepare questions and form expectations about care.

Medical Economics Associate Editor Austin Littrell sat down with Amber Maraccini, Ph.D., M.A., vice president and head of health care and life sciences at Medallia, to talk about what that shift means for physicians.

Maraccini explains how AI tools differ from earlier “Dr. Google” searches, why natural-language explanations can lower anxiety before a visit and where the real risks emerge when technology is poorly designed or over-trusted. She also shares practical guidance for clinicians navigating visits where patients arrive with AI-generated conclusions, including how to keep conversations productive, preserve trust and re-center care on clinical context.

Music Credits:
Steady State of Mind by Yigit Atilla - 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 — Cold open
Why the future isn’t AI versus clinicians.

0:31 — Intro
Austin Littrell introduces the episode and the Practice Academy note.

1:54 — Interview begins
Amber Maraccini introduces her role and Medallia’s focus on trust and experience.

3:12 — What’s different about ChatGPT Health
Why these tools go beyond symptom checkers.

3:28 — AI as a narrator of health data
Natural language, interpretation and emotional impact.

5:13 — Preparing patients before a visit
How AI can reduce anxiety around test results.

7:50 — Moving beyond “Dr. Google”
Shifting from worst-case scenarios to meaningful questions.

8:22 — When patients arrive with AI conclusions
How physicians can keep visits productive.

10:14 — AI mistakes and safety concerns
Why errors are inevitable — and how to address them.

10:39 — Teaching patients how to use AI
Leaning in rather than avoiding the conversation.

11:54 — Red flags for displaced relationships
When AI feels easier than talking to a doctor.

13:36 — P2 Management Minute
Keith Reynolds shares practical guidance for practices.

14:27 — Where AI fits in the patient journey
Before visits, after visits and education moments.

16:09 — What success should look like
More prepared patients, not longer visits.

17:37 — Final reflections
Using AI to support trust, presence and human connection.

18:55 — Outro
Wrap-up, subscription reminder and Practice Academy note.

Government funding deadlines, expiring coverage subsidies and temporary policy fixes are creating real-world disruptions for physician practices — often with little warning.

Keith Reynolds, managing editor of Physicians Practice, sat down with Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association (MGMA), to talk about how recent federal policy decisions are landing inside medical groups.

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:
Retro Rhythm 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 — Cold open
Why 2026 is shaping up to be another unpredictable year for health care policy.

0:22 — Intro
Austin Littrell introduces the episode, the Practice Academy note and the conversation with Anders Gilberg.

1:41 — Interview begins
Keith Reynolds welcomes Gilberg and sets the policy context.

1:44 — What breaks first during funding delays
How last-minute government decisions disrupt medical groups.

2:15 — Telehealth disruptions after shutdowns
What expired flexibilities meant for care continuity.

4:07 — Are repeated telehealth extensions real progress?
Why short-term fixes keep practices in limbo.

4:21 — A longer telehealth extension on the table
Why a 2027 extension would be a meaningful shift.

5:39 — If telehealth rules were permanent
What flexibilities matter most for patients and practices.

7:29 — The 1.0 work GPCI floor explained
Why rural physician payment protections matter.

7:46 — What happens if the floor expires
Billing chaos and reduced reimbursement in rural areas.

10:09 — PAMA lab payment cuts
What scheduled reductions would mean for in-office labs.

12:30 — The RESULTS Act
Why MGMA supports broader reform beyond delaying cuts.

12:44 — Value-based care math
Are practices backing away from Advanced APMs?

12:59 — Why incentives matter
How APM bonuses help practices transition from fee-for-service.

15:06 — P2 Management Minute
Keith Reynolds shares practical guidance for practice leaders.

15:58 — Expiring ACA subsidies
Early signs of coverage loss and financial strain.

16:20 — What practices are seeing so far
Payment plans, uncompensated care and patient access concerns.

19:13 — Direct primary care and concierge models
What policy signals may — and may not — mean.

21:27 — MGMA’s 2026 advocacy agenda
What the organization is watching closely.

21:39 — Cybersecurity and unfunded mandates
Concerns about new regulatory costs for practices.

22:55 — Final thoughts
Why policy volatility isn’t slowing down.

23:15 — Outro
Wrap-up, subscription reminder and Practice Academy note.

When patients talk about what they want from a visit with their physician, the answer is often simpler than the system makes it feel: they want to feel understood.

Melissa Lucarelli, M.D., FAAFP, a family physician, owner of Randolph Community Clinic and longtime editorial advisor for Medical Economics speaks with Ronald Epstein, M.D., FAAHPM, professor of family medicine and palliative care at the University of Rochester and author of "Attending: Medicine, Mindfulness and Humanity."

Their conversation explores how mindfulness shows up in everyday clinical practice — not as meditation or another box to check, but as attention, curiosity, presence and communication in the exam room. Epstein reflects on burnout, the limits of productivity-driven care and why small moments of awareness can improve patient relationships, teamwork and professional satisfaction.

They also discuss mindfulness beyond the individual clinician, including its role in teams, leadership and organizational culture, as well as where tools like artificial intelligence (AI) may support — but never replace — human connection in medicine.

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:
Crystal Grind by NISO - 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 — Cold open
What patients say they want most from a doctor visit.

0:23 — Intro
Austin Littrell introduces the episode and the Practice Academy note.

1:03 — Interview begins
Melissa Lucarelli introduces Ronald Epstein and frames the conversation.

1:53 — Burnout and dissatisfaction
Why physicians and patients are both struggling with the system.

2:30 — The four foundations of mindfulness
Attention, curiosity, beginner’s mind and presence.

3:45 — Relationships before prescriptions
Why feeling understood matters as much as treatment.

4:25 — Curiosity in long-term care
Staying engaged with patients over years and decades.

5:20 — Beginner’s mind and the clinical gaze
How expertise can both help and limit perception.

6:25 — Defining presence
A story from the emergency department.

7:58 — Learning from missed details
What early experiences taught Epstein about attention.

10:56 — Seeing the disease, missing the person
A lesson from inpatient rounds.

11:54 — A turning point with electronic health records
What a patient taught Epstein about listening.

13:07 — A simple practice that changed visits
Why delaying the computer improved care.

14:41 — Mindfulness and malpractice risk
Why insurers care about communication.

15:55 — “I don’t have time for mindfulness”
Small practices that take seconds, not hours.

17:54 — Finding beauty during COVID-19
Staying present in bleak moments.

19:24 — Mindfulness in teams
Shared purpose in high-risk environments.

20:14 — Applying mindfulness in daily practice
Lucarelli reflects on what’s worked for her.

21:12 — Meditation and other paths
Mindfulness beyond sitting on a cushion.

22:30 — Emotional regulation in difficult encounters
Responding instead of reacting.

23:01 — Organizational mindfulness
Why teams and culture matter.

25:10 — Artificial intelligence and presence
Where AI helps — and where it doesn’t.

29:13 — Communication training with avatars
Using technology to improve listening and clarity.

31:02 — Can mindfulness fix a broken system?
The role of leadership and organizational change.

37:35 — Productivity and value-based care
Why throughput isn’t the same as health.

39:32 — Medical education and survival skills
What training still misses.

42:27 — If Epstein were rewriting the book today
Leadership, community and collective intelligence.

46:38 — Burnout as a long-standing reality
What’s systemic and what’s intrinsic to medicine.

47:34 — Final reflections
Why mindfulness belongs in education, culture and leadership.

48:08 — Outro
Wrap-up, subscription reminder and Practice Academy note.

In 2026, physicians are facing a familiar mix of pressure — reimbursement uncertainty, rising labor and supply costs, staffing shortages and growing exposure to legal and cyber risk.

Medical Economics Managing Editor Todd Shryock caught up with Peter Reilly, North American health care practice leader at HUB International, to talk about what those risks look like in practice, and which ones physicians can no longer afford to ignore.

Reilly explains why reimbursement instability is unlikely to ease in the near term, why rural hospitals and critical access facilities remain especially vulnerable, and how burnout and disengagement continue to affect retention. He also breaks down what’s happening in the medical professional liability market, including the rise of “nuclear” and “thermonuclear” jury verdicts and what that means for rates moving into 2026.

He shares practical guidance on planning, mitigation and why proactive steps matter more than ever in an increasingly unpredictable health care environment.

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

Music Credits:
Neon Rainfall 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 — Cold open
Why health care hasn’t fully emerged from its post-COVID hangover.
0:21 — Intro
Austin Littrell introduces the episode and previews the conversation with Peter Reilly.
1:31 — Interview begins
Todd Shryock welcomes Reilly and frames the challenges facing physicians.
1:35 — Why pressures aren’t easing in 2026
Reimbursement uncertainty, labor shortages and lingering instability.
3:34 — Rural hospitals under strain
Why critical access facilities remain especially vulnerable.
5:29 — Burnout and disengagement
What practices can do now to support staff and improve retention.
7:39 — The medical professional liability market
Competition, consolidation and what it means for rates.
10:06 — Nuclear and thermonuclear verdicts
Why outsized jury awards are becoming more common — and costly.
13:06 — Cyber risk and vendor exposure
Common misconceptions about data ownership and responsibility.
16:29 — P2 Management Minute
Keith Reynolds shares practical tips for practice leaders.
17:21 — Enterprise risk management
Why even small practices need a formal risk mindset.
20:10 — Blind spots in physician practices
Risks practices don’t always see coming.
22:23 — Physical and location-based risk
Why storefront care and parking lots matter.
23:16 — Weather and disaster planning
Natural disasters as a growing operational risk.
25:33 — Closing thoughts
Why proactive planning beats constant reaction.
26:00 — Outro
Wrap-up, subscription reminder and Practice Academy note.