Office Rx

Based on this article:

by Karen Blanchette

As medical practice managers, you navigate complex ethical, legal, and operational challenges daily. One topic gaining attention is Medically Assisted Suicide, or Medical Aid in Dying (MAID), which is legal in a growing number of U.S. states and select countries worldwide. Understanding its legal status, implications for practice management, and global benchmarks can help you prepare your team for patient inquiries and ensure compliance with evolving regulations.

In the U.S., MAID—where a physician provides a terminally ill patient with a prescription for self-administered lethal medication—is legal in 11 jurisdictions: Washington, D.C., and the states of California, Colorado, Hawaii, Maine, Montana, New Jersey, New Mexico, Oregon, Vermont, and Washington. Oregon led the way in 1994 with its Death with Dignity Act, followed by Washington in 2008 and others more recently, with New Mexico legalizing MAID in 2021. These laws typically require patients to be 18 or older, residents of the state, and diagnosed with a terminal illness with six months or less to live. Euthanasia, where a physician directly administers lethal drugs, remains illegal nationwide.

Data from Oregon, a pioneer in MAID, shows steady but limited use: in 2022, 278 patients used lethal prescriptions, representing 0.6% of total deaths. Across all U.S. jurisdictions allowing MAID, approximately 8,700 deaths have occurred since 1997, averaging about 300 annually. Cancer patients account for roughly 66% of MAID cases, followed by those with amyotrophic lateral sclerosis (ALS) at 8%. Practice managers in these states must ensure staff are trained on legal requirements, including patient eligibility, documentation, and reporting to state health authorities. For example, Oregon mandates detailed reporting to its Health Authority, a process that requires meticulous record-keeping to avoid penalties.

For practices in states where MAID is illegal (39 states as of 2025), managers should be prepared for patient inquiries, especially as 17 states, including New York and Florida, are considering MAID legislation. Staff training on compassionate communication is critical to address these sensitive discussions while adhering to state laws. Visit the PAHCOM Education Calendar and CEUs On-Demand for free training on patient communication and compliance, which can help your team navigate these conversations effectively.

Globally, MAID and euthanasia are legal in countries like Canada, Belgium, the Netherlands, and Switzerland, offering useful comparisons. In 2021, Canada reported 10,064 MAID deaths, accounting for 3.3% of all deaths, a sharp rise since legalization in 2016. The Netherlands, where both MAID and euthanasia are legal, saw 5.1% of deaths attributed to these practices in 2022. Belgium follows closely, with 2.6% of deaths in 2022 involving MAID or euthanasia. Switzerland, which permits only self-administered MAID, reported 1,196 assisted deaths in 2019, primarily among cancer patients.

These countries highlight stricter oversight and broader eligibility criteria than the U.S. For instance, Canada allows MAID for non-terminal but “grievous and irremediable” conditions, sparking debate among disability advocates. In contrast, U.S. laws are narrower, focusing on terminal illnesses. Globally, cancer remains the leading condition for MAID, accounting for up to 80% of cases, similar to U.S. trends. These benchmarks underscore the importance of clear policies and staff training, as patient demand may grow if U.S. laws expand.

For practices in MAID-legal states, compliance is paramount. Ensure your electronic health record (EHR) systems are configured to track MAID-related documentation securely. Train staff on state-specific protocols, such as obtaining two physician confirmations of eligibility. In states where MAID is illegal, focus on patient education and referral pathways to palliative care.

Cybersecurity is also critical, as sensitive MAID-related patient data requires robust protection. An HITCM-PP certification will prove a valuable asset when navigating privacy regulations, including HIPAA compliance, and can guide your team in safeguarding patient information. As public debate grows—49% of Americans support MAID legalization per Pew Research—practice managers must stay informed. Use The PAHCOM Forum to communicate directly with fellow members from within or outside of your state. Whether through PAHCOM or your specialty forums, networking within the professional community will help you stay ahead of regulatory changes.

Medically Assisted Suicide is a complex issue with evolving legal and ethical dimensions. By understanding U.S. laws and global trends, practice managers can prepare their teams to handle patient inquiries with compassion and compliance. Leverage professional association and specialty resources to strengthen your practice’s operational and ethical framework, ensuring you’re ready for this sensitive topic.

Sources: Statista, CDC, JAMA Internal Medicine, World Population Review

Karen Blanchette, MBA

Karen Blanchette is the Executive Director of PAHCOM. The PAHCOM collaborative network enables solo providers and small group physician practices to access focused information vital to managing their healthcare businesses effectively. Contact Karen at https://my.pahcom.com/contact-karen

Trained and professionally certified managers make a difference. Learn more about the CMM and HITCM-PP at https://my.pahcom.com/certifications. 

In the evolving healthcare landscape, the Big Beautiful Bill, signed into law in July 2025, introduces significant reforms to Medicaid aimed at reducing federal spending and tightening eligibility. While the administration touts it as a measure to eliminate waste and focus on American citizens, critics warn of substantial coverage losses. For managers of privately owned smaller practices and rural clinics, these changes demand immediate attention, as they could severely impact revenue and operations, potentially leading to permanent closures.

Key modifications, many delayed until after the 2026 midterms, include stricter eligibility verifications, frequent redeterminations, and work requirements for able-bodied adults. These modifications are projected to disenroll millions, with experts estimating drops in Medicaid enrollment by 8-10 million by 2034, disproportionately affecting underserved areas where Medicaid often comprises 20% or more of revenue.

This isn't a minor adjustment—it's a seismic shift. Many experts, including analysts from the Congressional Budget Office and healthcare think tanks, assert that without proactive measures, numerous small practices and rural hospitals will face insurmountable financial hits, resulting in widespread closures. Rural providers, already grappling with thin margins (over 40% reported negative in recent years), risk losing patients en masse, exacerbating access issues for chronic care, mental health, and preventive services. States may cut optional benefits or reimbursements, further straining local systems.

Amid these challenges, practices can proactively support patients in navigating the new landscape. Educating Medicaid enrollees on maintaining benefits—such as documenting work hours, updating contact information for redeterminations, or appealing denials—can help retain coverage and sustain patient relationships. Clinics might offer workshops, partner with community organizations for job training referrals, or integrate eligibility assistance into routine visits. Such initiatives not only mitigate volume drops but also position practices as trusted community anchors.

Moreover, the bill isn't without silver linings. It allocates $10 billion annually from 2026 to 2030 for the Rural Health Transformation Program, funding workforce recruitment, technology upgrades, cybersecurity, and innovative care models like telehealth or chronic disease programs. This could provide targeted relief for rural clinics, enabling expansions in opioid treatment, mental health services, or efficiency improvements. The emphasis on state flexibility allows practices to collaborate on demonstration projects that prioritize local needs, potentially opening doors to new revenue streams.

Proactivity is essential: Sit up and take notice now. Engage with local and national professional communities to share strategies and advocate for relief. Organizations like the Professional Association of Health Care Office Management (PAHCOM) provide invaluable resources, including discussion forums for peer insights. Their Education Calendar offers webinars and training opportunities on navigating policy changes, compliance, and operational adaptations. Basic membership is free, making it accessible for all.

Recent shifts at the Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), and Department of Education (which influences health education programs) highlight the interconnected nature of these reforms. By combining efforts and leveraging networks, practices can identify and take advantage of opportunities, such as potential funding for rural health innovations like telehealth or workforce development.

In these turbulent times, staying connected isn't optional—it's survival. Embrace the changes as a catalyst for resilience, ensuring your practice not only endures but thrives in delivering quality care to your community.

Sources:

1. https://www.crowell.com/en/insights/client-alerts/president-trumps-one-big-beautiful-bill-makes-changes-to-medicaid
2. https://www.whitehouse.gov/articles/2025/06/myth-vs-fact-the-one-big-beautiful-bill/
3. https://www.americanprogress.org/article/the-truth-about-the-one-big-beautiful-bill-acts-cuts-to-medicaid-and-medicare/
4. https://www.congress.gov/bill/119th-congress/house-bill/1
5. https://www.kff.org/tracking-the-medicaid-provisions-in-the-2025-budget-bill/
6. https://www.hklaw.com/en/insights/publications/2025/07/considering-the-one-big-beautiful-bill-acts-impact-on-skilled-nursing
7. https://www.crfb.org/blogs/breaking-down-one-big-beautiful-bill
8. https://bipartisanpolicy.org/blog/rural-hospitals-rural-health-transformation-program-what-comes-next/
9. https://www.spencerfane.com/insight/the-one-big-beautiful-bill-currently-appropriates-50-billion-for-rural-health-care/
10. https://my.pahcom.com/events
11. https://my.pahcom.com/forum

Based on the article titled:

by Karen Blanchette

Vaccinations remain a vital tool for preventing infectious diseases safeguarding patients and communities. For small physician practices across all medical specialties in the United States—especially General Practice, our largest audience segment, alongside Pediatrics, Obstetrics and Gynecology (Ob/Gyn), Allergy/Immunology, and others—adapting to recent federal policy changes is critical to delivering high-quality care. As medical office managers, practice administrators, and physicians, you face the challenge of balancing evolving guidelines, patient trust, and operational demands. This article provides practical strategies to support your patient communities, addressing the latest HHS developments while prioritizing evidence-based care.

Since Robert F. Kennedy Jr. became HHS Secretary in February 2025, significant policy shifts have impacted practices across specialties. These changes, aimed at enhancing transparency and public trust, require careful navigation to ensure compliance and patient safety.

In May 2025, Secretary Kennedy announced that COVID-19 vaccines are no longer routinely recommended for healthy children aged 6 months to 17 years or healthy pregnant women. The CDC now uses a “shared clinical decision-making” model, allowing providers and patients to assess individual risks and benefits. This shift, bypassing the Advisory Committee on Immunization Practices (ACIP), may affect insurance coverage, as private insurers and Medicaid often align with CDC recommendations. The Vaccines for Children (VFC) program’s inclusion of COVID-19 vaccines is also uncertain, potentially increasing patient costs.

General Practice and Pediatric offices, which handle childhood vaccinations, should carefully record all vaccine discussions, especially when parents choose not to vaccinate, to maintain clear records and support ongoing patient care. Ob/Gyn practices must address maternal vaccination questions, as the American College of Obstetricians and Gynecologists (ACOG) supports COVID-19 vaccines for high-risk pregnancies, citing a 61% reduction in infant hospitalizations from maternal vaccination. Allergy/Immunology specialists, often serving immunocompromised patients, may see increased demand for tailored vaccine guidance under this model.

On June 9, 2025, Secretary Kennedy dismissed all 17 ACIP members, citing conflicts of interest, and is replacing them for the committee’s June 25–27, 2025, meeting, which will address vaccines for COVID-19, RSV, influenza, HPV, and meningococcal disease. This move, reported by ABC News and The New York Times, has raised concerns about the expertise of new appointees, with critics like Senator Susan Collins noting limited vetting time.

In April 2025, HHS underwent a major restructuring, with 10,000 staff cuts across CDC, FDA, and NIH, potentially impacting vaccine outreach efforts. Unconfirmed reports on X suggested the dissolution of a team focused on undervaccinated communities, underscoring the need for practices to stay informed through CDC and professional networks like PAHCOM. For example, CDC grant cuts led to the cancellation of 50 vaccine clinics in Texas, affecting access in underserved areas.

These developments signal potential shifts in vaccine recommendations, particularly for specialties like General Practice and Family Medicine, which serve diverse populations.

The CDC’s core recommendations for childhood and maternal vaccines, including the measles, mumps, and rubella (MMR) vaccine, remain unchanged. Pediatric Vaccines: Essential for General Practice and Pediatrics, the schedule includes two MMR doses to protect against measles, a highly contagious disease with 1,168 U.S. cases reported in 2025, 96% among unvaccinated individuals.[](https://www.yalemedicine.org/news/should-you-get-a-measles-vaccine-booster)

• Maternal Vaccines: Ob/Gyn practices should offer Tdap (27–36 weeks gestation), the maternal RSV vaccine (32–36 weeks), and the influenza vaccine (before flu season) to protect mothers and newborns.
• Specialty-Specific Vaccines: Allergy/Immunology and Internal Medicine may prioritize influenza or pneumococcal vaccines for high-risk adults, per CDC guidelines.

A new HHS requirement for placebo-controlled trials for all new vaccines, announced in April 2025, may delay approvals, impacting specialties reliant on emerging vaccines.

Small practices face challenges like limited resources, vaccine hesitancy, and policy uncertainties. Below are strategies to strengthen your vaccination efforts:

Vaccine hesitancy, fueled by misinformation and policy changes, is a widespread issue. A 2023 AAP survey found 54.3% of pediatricians faced misinformation weekly, a trend likely intensified by COVID-19 vaccine shifts.

• Initiate Early Discussions: General Practice and Pediatric providers should discuss vaccines at well-child visits, Ob/Gyn providers during prenatal care, and Allergy/Immunology specialists for immunocompromised patients. Use AAP or ACOG patient guides for clarity.
• Address Concerns Empathetically: Acknowledge fears about COVID-19 vaccines, then share evidence, like Nirsevimab’s 90% RSV protection or Tdap’s prevention of 5–15 annual infant pertussis deaths.
• Leverage Trust: Personalized recommendations, across all specialties, boost vaccine uptake.

Efficient workflows are essential:

• Secure Supplies: Prebook influenza vaccines and Nirsevimab, especially for General Practice and Pediatric offices. AAP inventory guides can help.
• Integrate Vaccinations: Administer vaccines during routine visits, such as Tdap in Ob/Gyn checkups or pneumococcal vaccines in Internal Medicine for older adults.
• Monitor Coverage: Verify insurance policies for COVID-19 vaccines under shared decision-making, documenting medical necessity for appeals, particularly for Allergy/Immunology patients.

Community ties are a strength:

• Host Clinics: Organize flu or RSV vaccine events, especially in areas impacted by reduced outreach. General Practice and Family Medicine can lead, while Ob/Gyn can target pregnant patients, as Dr. Naima Joseph did with RSV clinics.
• Partner Locally: Collaborate with schools or health departments to promote routine vaccines.
• Share Outcomes: Highlight successes, like reduced RSV hospitalizations from Nirsevimab, to build confidence.

Navigating changes requires diligence:

• Track CDC Updates: The CDC offers training on vaccine storage and communication, with continuing education credits.
• Rely on Professional Guidance: AAP, ACOG, and the American Academy of Allergy, Asthma & Immunology provide evidence-based resources, especially for COVID-19 vaccines.
• Document Discussions: Record vaccine conversations, particularly declinations, to ensure compliance.

Managing vaccination programs in a dynamic environment demands clinical and administrative expertise. Professional networks like the Professional Association of Health Care Office Management (PAHCOM) offer resources for small practices across specialties, including tools to streamline vaccine documentation and forums to share strategies for addressing hesitancy or policy shifts. Connecting with the PAHCOM community or exploring its Certified Medical Manager (CMM) credential can enhance your practice’s resilience. Visit my.pahcom.com to learn more.

The vaccination landscape is evolving, with a phase 2 study for a 31-valent pneumococcal conjugate vaccine planned for early 2026 and potential ACIP changes ahead. Your leadership ensures patients receive evidence-based care. By prioritizing education, efficient workflows, and community trust, and leveraging professional resources, your practice—whether General Practice, Pediatrics, Ob/Gyn, or another specialty—can navigate federal shifts while safeguarding public health.

Sources:

• CDC Immunization Schedules, May 2025
• AAP, ACOG, and AAAAI statements, 2025
• HHS announcements, April–June 2025
• X posts on HHS restructuring, April 2025
• ABC News, CNN, and The New York Times, June 2025
• Yale Medicine, June 2025

Karen Blanchette is the Executive Director of PAHCOM. The PAHCOM collaborative network enables solo providers and small group physician practices to access focused information vital to managing their healthcare businesses effectively. Contact Karen at https://my.pahcom.com/contact-karen

Trained and professionally certified managers make a difference. Learn more about the CMM and HITCM-PP at https://my.pahcom.com/certifications

https://my.pahcom.com/certifications

https://my.pahcom.com/forum

https://my.pahcom.com/journal-online/250319

Office Rx 250424 | Changes at HHS | Show Notes

https://www.hhs.gov/

https://www.hhs.gov/press-room/hhs-restructuring-doge.html

https://www.hhs.gov/press-room/ny-post-kennedy-op-ed-slashing-unhealthy-fat-hhs.html

https://aspr.hhs.gov/

https://www.cms.gov/

https://www.fda.gov/

Free Training Resources:

https://my.pahcom.com/405d-noexcuses

Discussion Board:

https://my.pahcom.com/forum

Join the discussion at the Forum - https://my.pahcom.com/forum

Florida Today article about this event

• https://www.msn.com/en-us/health/other/space-health-symposium-at-kennedy-space-center-to-host-tech-and-health-speakers/ar-AA1CqYN1?ocid=BingNewsVerp

CommHIT event registration page

• https://commhit.org/spacehealthnexus/

PAHCOM event listings

• https://my.pahcom.com/events/250422-commhit
• https://my.pahcom.com/events/250423-commhit

Kennedy Space Center

• https://www.kennedyspacecenter.com

https://my.pahcom.com/forum

https://my.pahcom.com/cmm

https://my.pahcom.com/hit

https://my.pahcom.com/mentor

https://my.pahcom.com/mentee

https://my.pahcom.com/405d-noexcuses

Pablo Reyna is an industry professional in technology, marketing, and sales consultation. He is currently the Channel Program & Partner Manager at Texas Systems Group, an organization that works with companies in improving and reducing the cost of managing their Corporate Information Technology. Before joining TXSG, Pablo was the Business & Healthcare I.T. Solutions Consultant for CompuCom and the Business I.T. Consultant for 3S Services.

Pablo joins me today to discuss what medical practices can do to prepare for their IT audit. He discusses the three key areas healthcare providers need to assess the most when it comes to IT compliance and reveals the biggest IT security issues medical practices face. He also highlights the benefits of hiring an IT service provider and illustrates how the Texas Security Group can help protect medical practices’ IT security and compliance.

“One of the biggest issues medical practices face is IT security and awareness training. How do you keep track of that? What available training is out there?” - Pablo Reyna

This week on PAHCOM:

● What an IT audit is, what they assess, and the ramifications of failing an audit

● Improving physical security through access control and enhancing a medical practice’s technical security

● The potential problems medical practices face when doctors use free email services like Gmail or Hotmail

● Encrypted emails as part of security and why medical practices should provide separate Wi-Fi access for employees and patients

● What a medical practice manager should be aware of when it comes to personnel IT security

● How often policies need to be revamped or rewritten and why IT security needs to be assessed quarterly

● Areas in IT security compliance where medical offices experience issues the most

● Why phishing is the number one security issue with healthcare providers and the importance of providing training for IT security

● How the Texas Systems Group monitors a practice and ensures their continuing readiness for audits

● The types of tools TXSG uses to train staff with security and awareness

Connect with Pablo Reyna:

● Texas Systems Group Website

● Texas Systems Group on YouTube

● Texas Systems Group on Twitter

● Texas Systems Group on LinkedIn

● Pablo Reyna on LinkedIn

● Email: [email protected]

Subscribe, Rate & Share

Thanks for tuning into this week’s episode of the PAHCOM Podcast, the medical management radio show for the solo provider and small group physician practice. If you enjoyed this episode, please head over to Apple Podcasts to subscribe and leave us a rating and review.

Don’t forget to visit our website, like us on Facebook, and follow us on Twitter, Instagram, and LinkedIn. And be sure to share your favorite episodes with your friends and colleagues on social media.

DISCLAIMER: The PAHCOM Podcast is NOT intended to be professional or legal advice. It is a forum for sharing knowledge among healthcare peers and for entertainment purposes only.

Colin Carr is the CEO and Founder of CARR Healthcare Realty, a company founded on protecting healthcare providers in commercial real estate transactions. Colin, a commercial real estate expert, has completed over a thousand commercial real estate transactions and has helped his clients in the healthcare industry save millions of dollars and maximize their profitability. Today, CARR and its team of Healthcare Real Estate Advisors are the leading providers of commercial real estate services for healthcare professionals across the country.

Colin joins me today to discuss how healthcare providers can get the most out of real estate transactions. He highlights the importance of hiring real estate agents to represent medical practices in buying or leasing property. He reveals the top mistakes healthcare practices make when looking for real estate and shares his advice on renegotiating leases. He also discusses how the pandemic will affect the commercial real estate market and explains why landlords would be willing to work with healthcare providers, especially in the time of COVID-19.

“A mistake in a commercial real estate transaction can be worth hundreds of thousands of dollars.” - Colin Carr

This week on PAHCOM:

● Why every healthcare provider should hire real estate agents when looking for properties

● How healthcare providers can increase their net worth through commercial real estate

● Evaluating whether a medical practice should purchase or lease office space

● The importance of negotiating on multiple commercial real estate properties

● Common mistakes medical practice owners make when negotiating a lease

● The difference between residential and commercial real estate

● Renegotiating a lease in the time of COVID-19

● How COVID-19 is going to impact the commercial real estate market for healthcare providers

● How to choose the best real estate agents for healthcare providers and medical practices

● The average cost of real estate transactions for healthcare providers

Related Content:

● CARR on PAHCOM

Connect with Colin Carr:

● CARR Healthcare Realty Website

● CARR Healthcare Realty on Facebook

● CARR Healthcare Realty on Twitter

● CARR Healthcare Realty on YouTube

● CARR Healthcare Realty on Instagram

● CARR Healthcare Realty on LinkedIn

Subscribe, Rate & Share

Thanks for tuning into this week’s episode of the PAHCOM Podcast, the medical management radio show for the solo provider and small group physician practice. If you enjoyed this episode, please head over to Apple Podcasts to subscribe and leave us a rating and review.

Don’t forget to visit our website, like us on Facebook, and follow us on Twitter, Instagram, and LinkedIn. And be sure to share your favorite episodes with your friends and colleagues on social media.

DISCLAIMER: The PAHCOM Podcast is NOT intended to be professional or legal advice. It is a forum for sharing knowledge among healthcare peers and for entertainment purposes only.

Jeremy Gilman is the Co-Founder and Chief Marketing Officer of RxVantage, an organization dedicated to improving the efficiency of how healthcare providers connect with life science representatives. Jeremy and his team at RxVantage are focused on growing the network of medical practices on their platform and increasing engagement.

Jeremy joins me today to discuss how health care providers and life science representatives connect. He shares how healthcare technology is rapidly advancing and how life science representatives have specialized. He discusses the different specialists that healthcare providers can connect with and how these specialists function in their areas. He also shares best practices in managing the scheduling process efficiently and how automating a healthcare office’s rep management saves time.

“Physicians want to meet with people who have news about products that matter. We want to make sure they’re meeting with the right person with the right products.” - Jeremy Gilman

This week on PAHCOM:

● What led to the creation of RxVantage

● The shift towards the specialization of life science representatives

● The importance of managing time in the healthcare industry

● The unique perspectives that medical liaisons could provide

● How nurse educators help in training and administrating drugs

● The growing trends in medical billing and the need for reimbursement specialists and clinical trial coordinators

● How RxVantage helps healthcare offices locate and manage the life science representatives and specialists they need

● Facilitating best practices in a medical practice’s scheduling process using RxVantage

● How COVID-19 accelerated the pace of change and adoption of new technologies in healthcare and life sciences

● Creating informed conversations between physicians, their staff, and life science representatives

● RxVantage as a messaging solution for medical offices and companies

Connect with Jeremy Gilman:

● RxVantage Website

● Jeremy Gilman on LinkedIn

● Email: [email protected]

● RxVantage on Facebook

● RxVantage on LinkedIn

Subscribe, Rate & Share

Thanks for tuning into this week’s episode of the PAHCOM Podcast, the medical management radio show for the solo provider and small group physician practice. If you enjoyed this episode, please head over to Apple Podcasts to subscribe and leave us a rating and review.

Don’t forget to visit our website, like us on Facebook, and follow us on Twitter, Instagram, and LinkedIn. And be sure to share your favorite episodes with your friends and colleagues on social media.

DISCLAIMER: The PAHCOM Podcast is NOT intended to be professional or legal advice. It is a forum for sharing knowledge among healthcare peers and for entertainment purposes only.