Off the Chart: A Business of Medicine Podcast

Point-of-care testing has become a core part of how many primary care practices diagnose, treat and manage patients — but deciding which tests to offer, how to implement them and whether the investment makes sense isn’t always straightforward.

Daniel Krajcik, D.O., MBA, a primary care physician with the Cleveland Clinic, joins the show to break down the real-world considerations of bringing rapid testing into the office. He talks about which low-cost tests make sense for small practices, how to evaluate your patient population, what fixed and variable costs look like, and what it actually takes to manage staffing, training and compliance.

This interview was conducted in preparation for the feature-length Medical Economics article: "Rapid Testing: Is it right for your practice?"
Read more: https://www.medicaleconomics.com/view/rapid-testing-is-it-right-for-your-practice-

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

0:00 — Cold open
Why rapid COVID and flu diagnosis can reduce hospitalization risk.

0:21 — Intro
Austin Littrell sets up the conversation on point-of-care testing in primary care.

1:23 — Where practices should start with testing
How patient population and practice location shape which tests make sense.

1:41 — Low-cost testing essentials
Why urine dip tests and glucometers offer high clinical value with minimal upfront cost.

3:05 — What a CLIA waiver is and how to get one
What practices need to know about federal requirements and eligible tests.

4:37 — Which rapid tests practices can offer
Strep, STIs, pregnancy, A1C, INR and the real cost tradeoffs.

6:27 — Who manages and runs point-of-care tests
Training staff, assigning a compliance lead and maintaining quality control.

7:36 — How rapid testing changes clinical workflow
When testing adds time—and when it actually saves visits and improves care.

8:50 — Revenue and patient satisfaction impact
How in-office testing boosts both billing opportunities and patient experience.

9:05 — Competing with urgent care centers
Why rapid testing has become part of primary care’s market positioning.

9:54 — P2 Management Minute
Keith Reynolds on real-world practice workflow, efficiency and engagement.

10:48 — Legal, documentation and ethical considerations
What physicians must disclose about test accuracy and limitations.

12:53 — Inventory, expiration dates and waste
Why test tracking matters for small practices and revenue protection.

13:56 — How molecular rapid tests expand primary care capabilities
STIs, COVID, flu and testing for vulnerable populations.

15:15 — Value-based care and reimbursement incentives
How point-of-care diagnostics support chronic disease quality metrics.

16:28 — Advice for overwhelmed small practices
Why starting with a single test often leads to sustainable growth.

17:29 — Geography, labs and rural access challenges
When in-office testing matters most based on distance to labs.

19:23 — The economics of primary care
Why prevention and early intervention are finally gaining financial recognition.

20:03 — Outro
Final thanks, credits and where to find future episodes.

American College of Physicians President Jason Goldman, M.D., MACP joins the show to talk about one of the most difficult realities in clinical practice today: medical misinformation.

Goldman discusses the ripple effects he sees in the exam room — confused patients, politicized vaccine debates and growing skepticism toward scientific evidence. He also shares his perspective on the broader challenges weighing on primary care, including stagnant reimbursement, administrative overload and the deepening physician shortage.

Music Credits:
Coffee Lo-Fi by Mit-Rich - 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 — Intro
Trust in medicine breaks down as misinformation and politicization reshape patient care.

1:12 — The current state of trust in science
Jason Goldman, M.D., MACP, describes a “polarized” environment where echo chambers replace evidence.

2:17 — A public challenge to federal vaccine advisors
Why Goldman says the Advisory Committee on Immunization Practices must return to basic evidence standards.

4:59 — The real damage of vaccine politicization
How confusion, outbreaks, and patient doubt are reshaping public health.

7:58 — Vaccine access vs. vaccine uptake
Supply barriers, pharmacy restrictions, and rising patient hesitation collide in clinical practice.

10:53 — How physicians fight misinformation in the exam room
Goldman walks through the communication strategies that work — and the ones that fail.

13:31 — When vaccine resistance harms families
Preventable disease, household transmission, and the limits of “personal choice.”

19:43 — Autism, Tylenol and recycled health rumors
Why debunked claims still gain traction — and what real science says.

23:00 — Life inside the misinformation echo chamber
Why patients rely on filtered sources instead of public data and primary evidence.

25:04 — P2 Management Minute
Keith Reynolds on real-world practice workflows, staff morale and engagement.

26:03 — The reality of private practice economics
Flat reimbursements, crushing regulation and why primary care is financially fragile.

28:53 — Prior authorization: promises vs. reality
Why physicians still aren’t seeing relief from payer restrictions.

31:19 — Fixing the physician shortage
Medical education reform, student debt, and why primary care needs structural investment.

34:01 — A message to primary care physicians
Advocacy, resilience and unity in a strained system.

35:08 — Outro
Final thoughts, credits and where to find future episodes.

Jared Rhoads, M.S., M.P.H., founder of the Center for Modern Health and senior lecturer of health policy at the Dartmouth Institute for Health Policy and Clinical Practice, joins the show to talk about private equity’s role in health care and how politics are reshaping policy.

Rhoads offers a different take on private equity, arguing that current research is too mixed and fragmented to justify sweeping conclusions or aggressive regulation. He notes that outcomes differ widely across sectors and that positive cases are likely underreported. He also outlines findings from his 2024 prediction survey on health reform, highlighting rising expectations for psychedelic-assisted therapy legalization, growth in direct-pay models, expanded direct primary care and loosened HSA limits.

Throughout, he emphasizes market incentives, empirical evidence and caution against ideology-driven policymaking.

Check out Rhoads' September 2025 article in Medical Economics, "In defense of private equity in health care, mostly."

Music Credits:
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Relaxing Lounge by Classy Call me Man - stock.adobe.com
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Editor's note: Episode timestamps and transcript produced using AI tools.

00:00 — Why it’s too early to vilify private equity
Rhoads questions strong anti–private equity narratives and discusses limitations in current evidence.

01:20 — How the literature frames costs, outcomes, and price effects
He points to the BMJ systematic review and mixed findings on quality, utilization, and pricing.

04:55 — The case against broad private equity regulation
Concerns about deal-size review thresholds, bans, and financial instruments; Rhoads favors targeted guardrails over blanket restrictions.

08:50 — When private capital may actually help
Why hospitals in financial distress or needing infrastructure upgrades might benefit from outside investment — and why positive cases rarely surface.

12:30 — Surveying policy under Make America Healthy Again
Rhoads outlines his prediction survey on 28 health policy propositions tied to the Trump administration.

14:50 — Psychedelic-assisted therapy on the rise?
Why he sees legalization in several states as increasingly likely.

16:15 — Direct pay surgery centers and direct primary care
Cultural alignment with MaHA principles driving expectations of growth.

18:10 — HSAs: modest movement, but real movement
Contribution-limit changes and why he sees further shifts ahead.

20:35 — Call for clinicians to join the next prediction survey
Rhoads encourages physicians to participate in the 2025 policy outlook assessment.

21:00 — Close
Final thoughts.

David N. Gans, MSHA, FACMPE, retired senior fellow at MGMA, joins the show to talk about the real pressures facing practices today — rising costs, flat reimbursement, staffing strain and the push for efficiency.

Gans breaks down the key metrics leaders should watch in 2026, the compliance gaps he sees most often, and how to evaluate new technologies like automation and artificial intelligence. He also shares why private-practice profits may have peaked and what that means for administrators planning ahead.

Music Credits:
SEDUCCION by Bopper Beats - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

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

00:00 — Introduction
Austin opens the episode and tees up the conversation with David Gans, retired senior fellow at MGMA.

01:15 — Setting the stage
Keith greets David and dives straight into the big-picture question: which operational and financial trends practice leaders are still underestimating.

01:38 — The real cost pressures
David breaks down rising costs, static reimbursement, wage competition, and why efficiency is now non-negotiable for practices.

03:19 — The reimbursement squeeze
How Medicare, commercial insurers, and Medicaid leave little room for negotiation—and what that means for practices of different sizes.

04:22 — Efficiency or bust
Why “doing more with less” has become the only path forward, and how automation, workflows, and scheduling changes help practices stay afloat.

05:00 — Primary care vs. surgical pressures
David explains why cognitive specialties feel revenue constraints differently than procedural ones.

06:34 — What can practices actually control?
Coding accuracy, revenue cycle discipline, and the push to optimize every minute.

06:55 — What data should leaders watch in 2026?
David lays out the essential metrics: top-line revenue, encounter mix, RVUs, staffing costs, and net income trends.

07:33 — Productivity & expense alignment
Why practices need to understand revenue drivers and compare staffing benchmarks against peers.

08:52 — Quality and safety without more admin burden
David shares a framework: right staff, right tasks, right incentives, right outcomes.

09:46 — Technology and environment matter
How COVID reshaped expectations for clinical environments and cleanliness standards.

10:40 — Accreditation realities
David describes Triple-A-HC and where practices most often fall short in compliance.

12:23 — The metrics administrators misinterpret
David explains why FTE calculations are often flawed—and how job-sharing, varied schedules, and workload mismatches distort perceptions.

14:54 — Tech adoption: what’s really new?
Keith asks about telehealth, automation, and artificial intelligence. David places today’s tech challenges in a 100-year historical context.

16:31 — Practices have always adapted
From telephones to punch-card records to EHRs, David highlights the through-line of efficiency.

18:00 — How to evaluate AI today
Use case frequency, patient impact, niche opportunities, and reimbursement potential.

19:49 — Leadership in uncertainty
David identifies the core leadership trait that matters most: cultivating a healthy work environment that boosts efficiency.

20:02 — Staff morale as a performance driver
How workplace culture alone can lift productivity by up to 20%.

20:54 — The surprising trend in private-practice profits
David breaks down his recent Data Mine column on revenue after operating expenses and why private practices may have hit “peak profits.”

22:39 — A 15-year look at the numbers
Inflation-adjusted revenue trends, productivity gains, and why the recent plateau is worrisome.

25:00 — Why profits finally dropped
Payment constraints, supply-chain fallout from COVID, and shifts in patient services.

25:40 — Closing thoughts
Keith and David wrap up and agree to revisit the data when the next column comes out.

26:16 — Outro
Austin closes the show and promotes upcoming episodes, newsletters, and subscription options.

Krista Blackwell, Ph.D., clinical assistant professor of biomedical sciences at the University of South Carolina School of Medicine, Greenville, joins the show to talk about two new reports from the U.S. Centers for Disease Control and Prevention (CDC) and the American Heart Association (AHA) examining ultraprocessed foods and their growing role in the American diet.

Blackwell explains why youth consumption stood out in the data, how convenience, family routines, school meals and food marketing influence eating patterns, and what the latest research says about cardiometabolic risks. She also discusses how primary care physicians can approach nutrition counseling more effectively using motivational interviewing and principles of culinary medicine.

AHA report:
"Ultraprocessed Foods and Their Association With Cardiometabolic Health: Evidence, Gaps, and Opportunities: A Science Advisory From the American Heart Association" https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000001365

CDC report:
"Ultra-processed Food Consumption in Youth and Adults: United States, August 2021–August 2023"
https://www.cdc.gov/nchs/products/databriefs/db536.htm

Music Credits:
Midnight Jazz by Alexey Anisimov - stock.adobe.com
Relaxing Lounge by Classy Call me Man - 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 — Intro
Overview of today’s topic: new CDC and American Heart Association reports on ultra-processed foods.

1:30 — First impressions of the new data
Dr. Blackwell explains why the findings align with lifestyle-medicine training and culinary-medicine education.

2:43 — CDC survey surprises
Why children ages 6–11 had the highest intake of ultra-processed foods.

3:56 — Pandemic effects on diet
How COVID-19 changed food preparation, access, and reliance on processed foods differently for different populations.

5:56 — Why kids consume so many ultra-processed foods
Marketing, school meals, fast-food access, and environmental factors.

6:40 — Key takeaways from the AHA scientific advisory
What the advisory says about saturated fat, sugar, sodium, additives, and unknowns about processing techniques.

8:47 — Are 70% of grocery-store products “bad”?
How to evaluate ultra-processed foods using nutrition labels and the “1:1 sodium-to-calories” rule taught in culinary medicine.

10:24 — How physicians can approach nutrition counseling
Motivational interviewing, identifying small changes, and real-world examples for primary care.

12:20 — How patients respond to motivational interviewing
Why meeting people where they are leads to better engagement.

14:09 — What culinary medicine looks like in practice
Hands-on patient cases, meal prep, and teaching medical students practical nutrition skills.

16:29 — What future research needs to explore
Additives, processing methods, and understanding their impact on cardio-metabolic disease.

17:41 — The GLP-1 conversation
How GLP-1 drugs fit into the gut-brain axis research and what they mean for individualized patient care.

19:29 — Ultra-processed foods and national policy
How MAHA and recent federal attention could accelerate progress.

21:03 — Defining “ultra-processed” foods
Why the lack of a unified definition complicates dietary guidelines.

22:23 — Where primary care physicians can learn more
Culinary-medicine certification and integrating nutrition into practice.

24:12 — What global models can teach the U.S.
Australia and EU “health scores” and how clearer labeling could help patients.

25:47 — Closing thoughts
Full-circle wrap-up and final remarks from Richard Payerchin and Dr. Blackwell.

26:12 — Outro
Show credits and where to find future episodes.

Loren Adler, fellow and associate director at the Brookings Institution's Center on Health Policy, joins the show to talk about his new Health Affairs study examining the rise of insurer-owned primary care practices.

Adler breaks down how quickly payer ownership has expanded, why certain markets are seeing far higher concentrations and what this consolidation means for costs, competition, Medicare Advantage and independent physicians. He also discusses the data sources behind the research, the role risk adjustment plays in shaping insurer incentives and the policy questions that come with these trends.

Music Credits:
Cozy Evening Time Coffee by BJBeats - stock.adobe.com
Relaxing Lounge by Classy Call me Man - 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
“There are a few markets where nearly half of the primary care market is payer-operated — and typically those are largely Optum operated.”

0:20 – Introduction
Austin Littrell introduces Off the Chart and previews the conversation between Richard Payerchin and Brookings Institution health policy expert Loren Adler.

1:35 – How the study began
Richard asks Adler what sparked the analysis behind The Changing Landscape of Primary Care, and why payer ownership needed real measurement.

1:54 – Why insurers are acquiring practices
Adler explains the motivations behind payer acquisitions and the lack of hard data before this study.

3:05 – Key findings
A breakdown of how payer-owned primary care grew from under 1% in 2016 to more than 4% by 2023 — and why 6% of clinicians now work for a payer.

4:17 – The biggest surprises
Adler discusses misconceptions about Optum’s size and the complexity of “affiliated” versus employed clinicians.

4:22 – Where consolidation is happening
Why markets with high Medicare Advantage penetration and less hospital consolidation are hotspots for insurer acquisitions.

7:10 – Why 4–6% matters
Adler explains how national averages hide dramatic geographic concentration — including counties where Optum controls nearly 40–50% of primary care.

7:35 – Antitrust implications
A look at counties with more than 10% payer ownership and the antitrust concerns that follow.

9:31 – Input from payers
What Brookings learned from stakeholder interviews — and why major insurers didn’t influence the data.

9:54 – Why Kaiser and Intermountain were excluded
Adler clarifies why hospital-integrated payers were left out of this analysis.

11:29 – How the data was built
Behind the scenes of the dataset: Medicare claims, ownership tracking, press releases, and acquisition timelines.

14:11 – P2 Management Minute
A quick workflow and operations segment with Keith Reynolds.

14:57 – Core concerns about integration
Adler outlines the biggest risks: antitrust issues, risk-coding incentives, and how payer ownership can change documentation behavior.

15:27 – Risk adjustment and coding intensity
How Medicare Advantage payment design creates incentives to document as many diagnoses as possible.

17:12 – Market foreclosure concerns
Could payer-owned practices limit access to rival insurers? Adler explains the risk — and the open questions.

18:40 – Potential benefits
Areas where payer ownership could improve care coordination, cost alignment, or reduce hospital use.

21:12 – What the study didn’t yet measure
Why patient outcomes remain an open research area — and what anecdotal reports suggest.

23:15 – Pressure on independent practices
Adler discusses aggressive contracting tactics, including first-right-of-refusal clauses.

25:19 – The reality for small practices
Why some independents join IPAs or third-party organizations for leverage and better reimbursement.

25:37 – How this fits into MAHA
Adler’s take on how consolidation trends intersect with federal policy priorities.

26:32 – Policy actions that matter most
The need for transparency, antitrust scrutiny, and major changes to Medicare Advantage risk adjustment.

29:08 – The role of AI
How large language models can help track ownership and consolidation across markets.

30:19 – What’s still unknown
Will payer ownership keep accelerating, or level off? Adler outlines the unanswered questions.

31:26 – What independent physicians should know
Why hospitals — not payers — remain the dominant consolidator of primary care, and how Medicare policy shapes that.

33:04 – Closing thoughts
Richard wraps up the conversation and thanks Adler for joining.

33:27 – Outro
Austin closes the episode with subscription reminders, publishing schedule, newsletter information, and production credits.

Mental health remains a silent crisis among physicians.

Medical Economics Senior Editor Richard Payerchin sat down with Daniel Saddawi-Konefka, M.D., MBA, and Christine Yu Moutier, M.D., to learn more about the rising rates of depression and suicidal ideation among physicians, why stigma and licensing questions still keep many from seeking help, and how to separate burnout from true mental health conditions.

They also outline practical steps that can make care safer and more accessible for clinicians at every stage of training and practice.

Saddawi-Konefka and Moutier are co-authors of a JAMA Special Communication on reducing barriers to mental health care for physicians, published earlier this year.

Learn more: https://www.medicaleconomics.com/view/barriers-remain-between-physicians-and-needed-mental-health-care

Music Credits:
Lo Fi Warm Piano by Elonix - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

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

00:00 — Opening statistic: Hidden physician mental health crisis
Depression, suicidal ideation and suicide attempts among physicians.

00:22 — Welcome + episode setup
Austin introduces the guests and framing of the discussion.

01:24 — Conversation begins
Richard welcomes Dr. Saddawi-Konefka and Dr. Moutier.

01:29 — Why the JAMA special communication was needed
How the paper came together and why the topic remains urgent.

02:28 — Personal stakes: Colleagues lost, suffering overlooked
Both guests explain how their own experiences pushed this work forward.

03:47 — The current state of physician mental health
What the latest data reveals — and why so much remains hidden.

04:49 — Silence, stigma and the treatment gap
Why physicians rarely seek help even when symptoms are severe.

05:54 — Burnout vs. diagnosable mental health conditions
A clear distinction — and why conflating the two can be dangerous.

08:48 — How burnout gets mislabeled — and why it matters
Why calling every form of distress “burnout” can delay real treatment.

09:41 — The culture of medicine: perfectionism, toughness and silence
How training and tradition fuel stigma and avoidance.

11:15 — Stigma beyond medicine: Broader cultural misunderstandings
Why mental health remains poorly recognized even at the societal level.

14:25 — The role of medical schools
Accreditation requirements, missed opportunities and needed reforms.

15:44 — What med schools still get wrong
How fear of stigma grows during training — and what could change it.

17:15 — Normalizing vulnerability through education
Why modeling “being human” matters for future physicians.

18:35 — Self-prescribing: How common it is and why it’s risky
Data on antidepressant self-prescribing and its consequences.

19:50 — Suicide data: Physicians less likely to be in treatment
How self-management and avoidance increase long-term danger.

21:45 — Fixing licensing and credentialing questions
Why outdated forms perpetuate stigma — and where reforms stand.

24:10 — Why changing the forms isn’t enough
Remaining cultural barriers even after policy fixes.

25:22 — Multi-level solutions: What leaders can actually do
Approaches from screening tools to sustained institutional strategy.

26:45 — Opt-out therapy programs
A promising model that flips the default on seeking help.

28:12 — The most vulnerable moments in training
ACGME mortality findings and early-year risk.

28:28 — Closing reflections + sign-off
Richard wraps the discussion; Austin closes the show.

After the longest federal shutdown in U.S. history, the government is finally open again — but for medical practices, the relief is short-lived. In this episode, Physicians Practice editor Keith Reynolds sits down with Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association (MGMA), to talk about what the reopening actually means for medical groups.

Gilberg breaks down the temporary deal that extends key health policies only through January 30, including Medicare telehealth flexibilities and the geographic work floor. He explains the ripple effects practices are already feeling — from underpaid Medicare claims that now need to be reprocessed to renewed uncertainty around ACA premium tax credits heading into 2026.

Read more from Physicians Practice: "Shutdown deal offers short-term relief, long-term headaches for medical practices"

Music Credits:
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Relaxing Lounge by Classy Call me Man - 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
Anders on key issues for medical practices being delayed only a few months.

0:18 – Intro
Austin introduces the show, Keith, and Anders, and sets up the shutdown, short-term deal, ACA credits, telehealth, and Medicare underpayments.

1:22 – Setting the scene
Keith welcomes Anders and notes the government reopening after a historic shutdown.

1:49 – 6:13 | What’s in the deal?
ACA premium tax credits, short-term telehealth extension, 1.0 work floor issues, Medicare underpayments, and avoided PAYGO cuts.

6:13 – 7:36 | Immediate impact on practices
Reprocessing guidance, telehealth coverage, and the 2.5% conversion factor bump for 2026.

7:36 – 9:02 | How hard did the shutdown hit?
Different effects depending on Medicare volume, telehealth use, and location.

9:02 – 13:37 | 2026 Medicare fee schedule
Conversion factor increase, work RVU “efficiency” cut, practice expense changes, and which specialties may see real hits.

13:37 – 18:11 | Shutdown politics and ‘health care extenders’
How short-term budget bills, telehealth, rural floors, and APM incentives keep getting tied together and delayed.

18:11 – 18:59 | P2 Management Minute promo
Keith invites listeners to share practice tips and workflow hacks.

18:59 – 22:59 | Looking ahead to 2026
Telehealth flexibilities, ACA tax credits in an election year, and a historically unproductive Congress.

22:59 – 26:46 | Noncompetes
FTC interest in noncompete bans, state patchwork, and MGMA’s balanced view for employed physicians vs independent groups.

26:46 – 30:41 | Policy horizon
Physician payment reform, new prior auth rules, value-based care concerns, and what MGMA will push for next.

31:22 – 31:58 | Outro
Austin closes the episode, plugs subscriptions, and gives production credits.

Denied claims are cutting deeper into practice revenue — and the numbers are getting worse.

In this episode, Medical Economics Managing Editor Todd Shryock talks with Clarissa Riggins, chief product officer at Experian Health, about the company’s 2025 State of Claims Report.

Riggins explains why claim denials are rising, how inaccurate patient data and staffing shortages are fueling the problem, and where artificial intelligence (AI) can make a measurable difference. She also discusses how practices can use automation and predictive analytics to prevent denials before they happen, and why getting ahead of payer complexity is now essential to financial survival.

Music Credits:
Ambient Jazz by AurbanniAudio - stock.adobe.com
Relaxing Lounge by Classy Call me Man - 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
“If you can address the issues from the outset of the revenue cycle, it makes everything so much easier — and helps prevent denials before they happen.”

0:20 – Introduction
Austin Littrell introduces Off the Chart and previews the conversation between Todd Shryock and Clarissa Riggins, Chief Product Officer at Experian Health.

1:22 – Setting the stage
Todd introduces the 2025 State of Claims Report and asks what’s driving the sharp rise in claim denials.

1:59 – The top cause: bad data
Riggins explains how missing or inaccurate patient data has become the leading driver of denials — and why AI could help fix it.

2:32 – Why clean claims are harder to submit
Riggins discusses new regulatory pressures, workflow friction, and the challenges of preparing for complex documentation requirements.

4:01 – Staffing shortages and technology gaps
How workforce turnover and fragmented tech stacks compound denial problems and strain practice operations.

5:34 – The biggest problem areas
Why fixing inaccurate data and registration errors at intake remains the most urgent step for revenue recovery.

6:32 – The AI awareness gap
Although 62% of providers say they understand AI, only 14% use it. Riggins explains the hesitation — and how to start small.

7:59 – Lessons from early adopters
Practices seeing ROI from AI share common traits: they start small, track measurable outcomes, and scale success.

9:01 – Building trust in AI
Riggins discusses HIPAA, payer rules, and why transparency is key to physician confidence in AI-driven claims tools.

12:01 – Falling confidence in tech
Todd asks why fewer providers feel their claims systems are effective — and what’s behind the frustration.

12:56 – Fixing payer–provider collaboration
Why better technology and open communication are both needed to reduce denials for good.

13:59 – Where providers should start with AI
Practical first steps for adopting automation — from identifying pain points to choosing the right technology partners.

16:36 – Training and workflow integration
How to implement new AI tools with minimal disruption and staff retraining.

18:28 – What surprised Experian most
Riggins shares the biggest takeaways from the State of Claims data — and why adoption still lags optimism.

19:30 – Final takeaways
Why AI works best when it starts small, delivers measurable ROI, and helps staff focus on higher-value work.

22:12 – Closing
Todd thanks Clarissa for joining, followed by Austin’s closing credits and subscription reminder.

In the 100th episode of Off the Chart: A Business of Medicine Podcast, host Austin Littrell is joined by Todd Shryock, Richard Payerchin, and Keith Reynolds — the editors from Medical Economics and Physicians Practice who helped build Off the Chart into what it is today. Together, they look back on favorite conversations, memorable guests and defining trends from the show’s first 100 episodes.

From the rise of artificial intelligence and new liability concerns to the return of independent practice, rising costs and shifting patient trust, the team discusses how medicine’s business landscape continues to evolve — and what stories they plan to chase next.

Music Credits:
Cup of Coffee by Ionics - stock.adobe.com
Relaxing Lounge by Classy Call me Man - 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 – Opening thanks
Richard opens with gratitude to guests and listeners who helped shape 100 episodes of Off the Chart.

0:20 – Introduction
Austin welcomes listeners to the 100th episode and introduces Todd Shryock, Richard Payerchin and Keith Reynolds.

1:17 – Looking back on the journey
Austin recalls joining the show at episode 48 and asks what the 100-episode milestone means to the team.

1:42 – Milestone reflections
Austin shares appreciation for the show’s growth and its role as a forum for fresh ideas in medicine.

2:17 – Podcast evolution
Todd Shryock on how Off the Chart grew from a side project into a polished, professional production.

3:01 – Early days and transition
Keith Reynolds describes taking over around episode 35 and credits Austin for elevating production and consistency.

4:15 – Memorable episodes
Austin asks which episodes have stuck with the editors over the years.

4:24 – Running for office
Richard Payerchin highlights Episode 43: The Physician’s Guide to Running for Office and lessons from doctors-turned-policymakers.

5:06 – What’s broken in healthcare
Todd Shryock revisits his interview with Michigan Medicine’s Marschall Runge, M.D., Ph.D., and how academic leaders see systemic challenges.

6:18 – Behind the mic
Keith recalls producing the “Running for Office” episode, his conversations with MGMA’s Anders Gilberg, and his latest chat with attorney Katie Russell, J.D.

8:03 – AI and malpractice
Austin reflects on Episode 97: AI, malpractice and the future of physician liability, and the October cover story on artificial-intelligence liability in medicine.

8:28 – Team reflections
Keith shares why editor roundtables and behind-the-scenes episodes remain his favorite part of the job.

9:04 – How medicine has changed
Austin asks how the health care landscape has shifted since the podcast began.

9:30 – AI everywhere
Todd explains how artificial intelligence went from novelty to necessity — and raises the looming question: who pays for it?

12:05 – The changing public mood
Keith discusses how public perception of physicians has evolved since the pandemic and why trust feels more fragile today.

13:41 – Independence and private practice
Richard points to episodes 70 and 95 on physician autonomy and the growing nuance around private-equity partnerships.

15:25 – Lightning round: trends for 2026
Austin asks each editor for one trend to watch in the year ahead.

15:35 – Price transparency
Richard predicts renewed momentum for transparency policy under the current administration.

15:53 – Trust in AI
Todd warns that adoption will hinge on physicians’ confidence in AI accuracy.

16:29 – Return to independence
Keith expects a migration back to physician-owned practices as consolidation stalls.

17:14 – P2 Management Minute
Keith delivers a quick interlude of practice-management advice and listener call-to-action.

18:04 – Looking ahead: the next 100
Austin asks what stories or themes should shape Off the Chart going forward.

18:16 – Keith: More creative episodes
Keith lobbies (again) for holiday specials and continued AI coverage.

19:06 – Richard: Rural healthcare and affordability
 Richard calls for deeper dives into rural access, insurance costs and medical debt.

20:08 – Todd: Front-line voices
Todd wants more firsthand perspectives from practicing physicians on fixing medicine.

20:47 – Austin: Financial literacy
Austin advocates expanding coverage of physician wealth-building, taxes, and loan repayment.

21:08 – Lightning round: advice for 2026
One-sentence takeaways from each editor for practice leaders.

21:08 – Richard's advice
“Tune in twice a week to Off the Chart.”

21:15 – Todd’s advice
“You can’t save the world — start with the patient in front of you.”

21:25 – Keith’s advice
“Take care of your coders; they make everything work.”

21:33 – Closing and gratitude
Austin thanks the editorial team and listeners for helping reach the 100-episode milestone.

21:57 – Outro
Final wrap-up, subscription reminder and acknowledgments to the Medical Economics and Physicians Practice teams.