Off the Chart

Sage Growth Partners CEO Dan D'Orazio explains what capitation and value-based contracts demand of an organization and why physician-led groups are where he sees the most promise.

Buzz Health President Joseph Kleiman explains why price checks still fall to staff after the visit and what it would take to put drug pricing inside the EHR.

Anders Gilberg of MGMA walks practice leaders through the same-day payment proposal, the practice expense overhaul and the mandatory specialty model that starts Jan. 1 with no participant list.

Rebecca Schoon, Ph.D., who helped lead the Oregon arm of a national moral injury report, explains how visit quotas, noncompete clauses and prior authorization feed the distress costing practices their physicians.

A tool that costs little to run can be billed many times over, and Caroline Pearson of the Peterson Health Technology Institute says that math is what makes clinical AI lucrative now and precarious under the next payment model.

Health care economist Wayne Winegarden, Ph.D., says state bans on corporate ownership won't keep a practice independent, and that control over decision-making is what separates an MSO partnership from an acquisition.

Most practices have no protocol for the hour after a medical error, and Anthony Orsini, D.O., says that gap is what turns a minor mistake into a lost patient and sometimes a claim.

A former MedPAC commissioner argues that whether clinicians feel like professionals or like interchangeable parts decides the quality of everything a measurement program cannot see.

Flat malpractice premiums are masking a severity trend running well ahead of inflation, and the cushion holding rates down is running out.

Vaccine inventory is getting more expensive, the counseling time around it is not reimbursed, and the practices that stop stocking lose more than the margin.

The insurer pledge on prior authorization carried no enforcement. The federal rule arriving Jan. 1, 2027 does, and it lands on payers, on EHR vendors and, through a new attestation measure, on practices themselves.

Denials that surface a week late, a hybrid revenue cycle split across internal staff and outside vendors, and payer contracts multiplying faster than anyone can track them. Veradigm's Aaron Ledbetter breaks down which of those an administrator can fix with better tooling and which still need payer reform.

Jay Bregman of Andel explains how employers are carving high-cost drugs out of the pharmacy benefit, and what happens to a patient's price when the contribution stops.

Shawntea Gordon of Atlas & Perpetua Healthcare Consulting says a cost cut made without benchmarking data is a guess, and the wrong guess costs more than it saves.

Joanne Frederick of Government Market Strategies argues the fix for runaway health care costs turned out worse than the problem it solved.

Staffing shortages, training gaps and insurance verification delays are the front-end problems dragging on patient access, and nearly all of them land on the administrator's desk. Experian Health's chief operating officer breaks down which ones automation can absorb now and which ones still need payer or policy reform.

An outbreak in the news brings a surge of calls before it brings a surge of cases. A Michigan pediatrician on the triage rule, the lab conversation and the reassurance approach that keep a practice from being overwhelmed.

The proposed 2027 Medicare fee schedule shifts payment between specialties and changes same-day billing as MIPS winds down, and MGMA's Anders Gilberg explains what practice leaders should watch before comments close Sept. 14.

Women physicians leave clinical practice 15 years earlier than men, and for practice leaders the retention levers are schedule control, documentation burden and how care time gets paid.

Most physicians know the direct primary care pitch; whether the economics hold up once you're in it is the harder question.

The same low-risk procedure can pay five to 12 times more in a hospital outpatient department than in a physician's office. Three U.S. Women's Health Alliance advocates break down what that gap does to recruiting, referrals and patient choice, and the federal bill aimed at closing it.

As consolidation reshapes the market, health care investment banker Andy Colbert breaks down what an independent practice is really worth and how to weigh private equity, a hospital deal or a management services organization.

As more physicians weigh a move to concierge or hybrid practices, health care attorney Ericka Adler, J.D., breaks down the contract and Medicare traps that can turn a panel-shrinking strategy into a legal problem.

PYA's Tynan Kugler breaks down the four forces pulling physician pay in competing directions, and why getting the underlying compensation model wrong can be expensive and legally complicated to undo.

For the first time in years, physician pay and productivity have split, and a new Medicare efficiency adjustment is about to make 2026 a hard year to benchmark, schedule and recruit.

Two new federal programs are opening Medicare and Medicaid coverage for GLP-1 obesity drugs, and Tracy Zvenyach, Ph.D., M.S., RN, of the Obesity Action Coalition explains what it means for primary care physicians and their patients.

Clinical applications are climbing while hires lag behind, and Trent Cotton of ICIMS says the practices that win top talent are the ones that make hiring fast, personal and transparent.

A new federal rule makes it far cheaper for practices to challenge denied and reduced payments, but Anders Gilberg of MGMA says the harder problem is getting insurers to pay up after physicians win.