Off the Chart: A Business of Medicine Podcast

Recent Episodes

1. S1 Ep186: When physicians know the right care and can't give it, with Rebecca Schoon of Pacific University

   Sep 17, 2026

   Dr. Rebecca Schoon, associate professor of public health at Pacific University and board member of Healthcare for All Oregon, discusses moral injury among physicians in a profit-driven healthcare system. The episode examines Oregon's response to corporate consolidation of medical practices, including the 2025 law restricting corporate control of medical entities, and explores the state's push toward universal healthcare through its Universal Health Plan Governance Board.

2. S1 Ep185: Who gets paid when the AI does the work? with Caroline Pearson of the Peterson Health Technology Institute

   Sep 14, 2026

   Caroline Pearson, executive director of the Peterson Health Technology Institute, discusses how payment models—not technology itself—will determine whether clinical AI reduces or inflates healthcare costs. The conversation explores the risks of fee-for-service reimbursement for AI tools, the distinction between assistive and autonomous AI, liability questions when AI makes medical errors, and emerging direct-pay models that could bypass physicians entirely.

3. S1 Ep184: Why banning corporate medicine won't save independent practice, with Wayne Winegarden, Ph.D., of the Pacific Research Institute

   Sep 10, 2026

   Health care economist Wayne Winegarden, Ph.D., senior fellow in business and economics at the Pacific Research Institute, argues that Medicare payment erosion—not corporate ownership—is the primary driver of independent practice consolidation. He discusses how physician payments have risen only 12% since 2000 while practice operating costs climbed 48%, the difference between MSO partnerships and acquisitions, and why state-level corporate practice restrictions should focus on physician decision-making control rather than ownership structures.

4. S1 Ep183: The first thing to do after a medical error, with Anthony Orsini, D.O.

   Sep 7, 2026

   Dr. Anthony Orsini, a practicing neonatologist and founder of the Orsini Way, discusses medical error disclosure and the critical steps physicians must take after an error occurs. He highlights that fewer than half of physicians know the exact protocol for disclosing errors and emphasizes that how errors are communicated often determines whether cases result in lawsuits or rebuilding trust. The conversation covers common mistakes in disclosure including remaining silent, speculating about causes, using medical jargon, and mismatched body language, while presenting data showing transparency programs reduce malpractice claims by up to 36%.

5. S1 Ep182: The interchangeable physician, with Lawrence Casalino, M.D.

   Sep 3, 2026

   Dr. Lawrence Casalino, Professor of Population Health Sciences at Weill Cornell Medicine, discusses the decline of independent physician practice and the consolidation of medicine into large corporate entities. He examines five structural forces driving this trend—including payment leverage, administrative burden, EHR challenges, policy uncertainty, and work-life balance—and argues that as physicians are treated as interchangeable widgets within large organizations, unmeasured dimensions of quality care suffer, particularly in timely and accurate diagnosis.

6. S1 Ep181: Why physicians are getting sued less and paying more, with The Doctors Company President Robert White

   Aug 31, 2026

   Robert White, president of The Doctors Company and TDC Group, discusses two contrasting trends in medical malpractice: claims frequency at historic lows (one physician in 21 sued nationally in 2025, down from one in five in 1999) while claim severity reaches all-time highs, with average physician payments of $514,000 per closed report in 2025. White explains how nuclear and thermonuclear verdicts—including a record $963 million verdict in Utah—drive settlement costs upward despite low litigation frequency, and identifies artificial intelligence as an emerging liability risk requiring careful monitoring.

7. S1 Ep180: Why private equity can own a hospital and a physician can't, with Gary Price, M.D., of The Physicians Foundation

   Aug 27, 2026

   Dr. Gary Price, president of the Physicians Foundation and a retired surgeon, discusses federal restrictions on physician ownership of hospitals stemming from the Affordable Care Act of 2010. He argues that the prohibition was based on a misinterpretation of Dartmouth Atlas data from 2000 that incorrectly attributed healthcare cost variations to physician ordering patterns rather than patient socioeconomic factors. Dr. Price presents research showing physician-owned hospitals deliver care at 7–15% lower cost with equal or better quality, charge uninsured patients 47% less than non-physician-owned hospitals, and operate in markets with less consolidation. He connects the restriction to physician burnout, as doctors lose control over clinical decisions while remaining responsible for outcomes, and discusses a recent CMS request for information about allowing existing physician-owned hospitals into Medicare's new team payment model.

8. S1 Ep179: Vaccine schedules, stocking costs and the back-to-school visit, with AAFP President Sarah Nosal, M.D.

   Aug 24, 2026

   Dr. Sarah Nosal, President of the American Academy of Family Physicians and a family physician practicing in the South Bronx for nearly two decades, discusses vaccine schedules, back-to-school immunization visits, and the economics of vaccine stocking for independent practices. The conversation covers which vaccine recommendations family physicians should follow, the rising complexity of vaccine counseling without separate reimbursement, approaches to vaccine hesitancy, and the trade-offs practices face when outsourcing vaccines to pharmacies.

9. S1 Ep178: A year after the prior authorization pledge, what changed? with Colin Banas, M.D., of DrFirst

   Aug 20, 2026

   Dr. Colin Banas, Chief Medical Officer of DrFirst, evaluates the progress made on prior authorization reform one year after major insurers pledged to improve the process. He analyzes each of six commitments made in the 2025 pledge, finding minimal measurable improvement and widespread skepticism from frontline physicians. The episode examines the upcoming January 2027 federal interoperability mandate requiring FHIR-based APIs and identifies practical steps practices can take to prepare.

10. S1 Ep177: What's really keeping practices independent, with Aaron Ledbetter of Veradigm

    Aug 17, 2026

    Aaron Ledbetter, Solutions and Growth Strategist at Veradigm, discusses findings from Veradigm's 2026 State of Independent Practice report based on surveys of 360 healthcare leaders from independent ambulatory practices. The conversation explores why 79% of practices view technology as essential to independence yet only 64% are confident in current tools, the administrative and financial pressures driving 26% of practices to acquisition negotiations, and why denied claims take 1-2 weeks to surface. Ledbetter advocates for EHRs to evolve from systems of record to systems of work, with AI and automation addressing fragmented revenue cycle workflows and administrative burden.