Off the Chart: A Business of Medicine Podcast

Recent Episodes

1. S1 Ep173: The patient access blind spot, with Mindy Fortson of Experian Health

   Aug 3, 2026

   Mindy Fortson, Chief Operating Officer of Experian Health, discusses findings from the company's 2026 State of Patient Access Survey, revealing a significant perception gap where 46% of healthcare providers report improved patient access while only 18% of patients agree. The conversation explores key barriers to access including prior authorization complexity, insurance verification delays, and the inability to provide accurate cost estimates upfront—a finding Fortson characterizes as a public health rather than revenue problem. Fortson emphasizes the critical role of automation and AI in addressing administrative burdens in front-office operations and improving patient financial transparency.

2. S1 Ep172: A primary care physician's guide to cyclosporiasis, with Molly O'Shea, M.D.

   Jul 30, 2026

   Dr. Molly O'Shea, a pediatrician and independent practice owner in Michigan, discusses the unprecedented cyclosporiasis outbreak affecting her state and nation. The episode covers clinical presentation and differential diagnosis, testing protocols (ova and parasite vs. PCR), evidence-based treatment with trimethoprim-sulfamethoxazole, and the importance of patient communication when managing media-driven health anxiety. Dr. O'Shea also addresses the impact of federal surveillance dismantling and reduced CDC capacity on outbreak response and prevention infrastructure.

3. S1 Ep171: Another year of Medicare cuts, with Anders Gilberg of MGMA

   Jul 27, 2026

   Anders Gilberg, Senior Vice President of Government Affairs at the Medical Group Management Association (MGMA), discusses the proposed 2027 Medicare physician fee schedule, which includes another conversion factor cut of 1.68% for physicians outside alternative payment models. The episode covers budget neutrality constraints that force CMS to cut some specialties to pay others, the agency's shift away from the AMA's valuation process without new supporting data, the transition from MIPS to MVPs (value pathways), and emerging provisions like modifier 25 changes that could significantly impact certain specialties like dermatology.

4. S1 Ep170: Better care, shorter careers for women physicians, with Lisa Rotenstein, M.D., MBA, M.Sc.

   Jul 23, 2026

   Dr. Lisa Rotenstein, a primary care physician and director of the Center for Physician Experience and Practice Excellence at UCSF, discusses her landmark study on sex differences in physician attrition. The research reveals that female physicians leave clinical practice at a median age of 49 compared to 64 for male colleagues—a 15-year gap that persists across specialties and settings. Rotenstein explores root causes including pay inequities, disproportionate unpaid administrative burden, and caregiving demands, while proposing solutions such as alternative payment models, AI-assisted documentation tools, and greater physician control over workflow.

5. S1 Ep169: What most physicians get wrong about direct primary care, with Josh Umbehr, M.D.

   Jul 20, 2026

   Dr. Josh Umbehr, family physician and co-founder of Atlas MD, discusses the direct primary care (DPC) model he pioneered in Wichita, Kansas since 2010. The conversation covers the financial mechanics of DPC practices, including panel sizing, pricing strategies, and overhead reduction, with Umbehr arguing that lower-priced practices often achieve higher profitability through larger patient volumes. He addresses common physician misconceptions about DPC, the patient relationship dynamics that emerge from extended visit times, and his prediction that insurance-based primary care will largely disappear within 3-5 years as the current system becomes economically unsustainable.

6. S1 Ep168: Same procedure, 12 times the price: U.S. Women's Health Alliance sounds the alarm

   Jul 16, 2026

   Richard Payerchin from Medical Economics hosts a discussion with Dr. Jack Feltz (president of the U.S. Women's Health Alliance), Dr. Rebecca Herrero (president and CEO of Women's Health Associates of Southern Nevada), and attorney Dan Fryer (co-managing partner of Friar Levitt) about the erosion of independent medical practice in women's healthcare. The guests explain how hospital reimbursement advantages—sometimes 5-12x higher for identical procedures—are driving physicians out of private practice and reducing patient choice and affordability. They detail proposed legislation aimed at creating fairer competitive conditions, including clarifications on fair market value and narrowing reimbursement deltas between office and hospital outpatient settings, while maintaining support for physician-owned hospitals as a competitive mechanism.

7. S1 Ep167: What your practice is actually worth, with Andy Colbert of Ziegler

   Jul 13, 2026

   Andy Colbert, senior managing director at Ziegler investment bank, discusses the economics of independent medical practices and the strategic options available to physician groups. With 20 years in healthcare investment banking and experience advising on over $6 billion in transactions, Colbert explains why practices need 40-50+ providers to remain sustainably independent, how physicians often misvalue their practices, and the trade-offs between private equity partnerships, hospital alignment, and forming management services organizations (MSOs).

8. S1 Ep166: Considering concierge? Know the legal traps first, with Ericka Adler, J.D.

   Jul 9, 2026

   Erica Adler, practice group manager of healthcare for Rexel and Andras, discusses the legal considerations physicians must navigate when transitioning to concierge or hybrid concierge medical practices. The episode covers key legal pitfalls including the requirement that membership fees be tied to non-covered services, the critical importance of reviewing insurance contracts before implementing concierge models, and the necessity of clear patient agreements. Adler emphasizes that physicians often overlook contract review, Medicare coverage changes, and market research—and that proper planning with legal counsel, accountants, and marketers is essential to avoid contract violations, patient abandonment claims, and financial failure.

9. S1 Ep165: The four forces reshaping physician pay, with Tynan Kugler of PYA

   Jul 6, 2026

   Tynan Kugler, a principal in PYA's consulting practice, discusses the four major forces reshaping physician compensation: supply and demand imbalances, the shift toward employment and health system affiliation, reimbursement pressures, and the interplay between productivity-based and value-based payment models. The episode explores how medical organizations balance competitive physician pay with rising costs through compensation model redesign, care optimization, and shorter guarantee periods, while addressing why reducing physician compensation is so difficult once established.

10. S1 Ep164: Pay is up, productivity is down. Is it sustainable? With Andy Swanson of MGMA

    Jul 2, 2026

    Andy Swanson, Chief Customer Success Officer at MGMA, discusses the Medical Group Management Association's provider compensation and productivity data report, which shows physician pay rising while productivity declined for the first time in years. The conversation covers what's driving the split, the impact of the new Medicare efficiency adjustment on procedural specialties, physician burnout as a baseline condition, AI adoption challenges, and the critical metric practice leaders should track beyond work RVUs.