Anders Gilberg of MGMA on expectations for the second Trump administration

Physicians Practice

This interview is happening on Thursday, January 23. This is the week of the inauguration. The newly minted second Trump administration is barreling in like a lion, we’ll say—just so everybody knows where we’re at right now. So, Anders, let’s start it out real vague: what’s the state of play right now? What are you guys seeing on the ground?

Anders Gilberg
A lot of what we’re looking at are things that were left unfinished for physician medical practices at the end of last year, and also the fact that the key agencies we work with—typically HHS as well as CMS—have no political leadership yet. We haven’t gone through those confirmation hearings. So we have RFK, we have Dr. Oz—a new set of leaders set to most likely be confirmed in those positions.

As with any administration, we spend a lot of time early on establishing relationships and making sure our priorities are at least put forth. We represent physician medical practices and especially their business interests. I wouldn’t say it’s the calm before the storm, but it’s a little bit of a calm right now because the administration has put a moratorium on new regulations for the time being. Until the machine starts to get revved up, Congress will be our focus before we get more on the regulatory side from the administration.

Physicians Practice
Okay. You mentioned some of the personalities being bandied about for various roles in HHS—how do you guys see the prospect of HHS Director Bobby Kennedy Jr.?

Anders Gilberg
I mean, it’s quite an interesting coalition of leaders that President Trump has put together. I only know RFK from other health care issues, not necessarily the issues we focus on. Specifically, Dr. Oz—I know a little about his positions politically when he ran for the U.S. Senate in Pennsylvania. But in many ways, they’re unknown quantities as it relates to the non-FDA issues that we focus on more readily, like reimbursement and deregulation—which, I think, fits nicely within the purview of this administration—and ways to get the red tape out of delivering health care in this country.

We also want to make sure that medical groups still have the ability to operate independently if they wish to. Some of those issues are not as well known, but we’ll spend the next few months working to establish these relationships. I feel like we’ll have a sympathetic ear, especially on the deregulation side.

Physicians Practice
All right. So, it’s a very exciting time, and everybody’s looking forward to what’s coming next—but let’s take a few steps back. The last Congress sort of left physicians in the lurch. Talk to me a bit about that.

Anders Gilberg
We thought we had a reasonably good bill toward the end of the year that dealt with a couple of our key priorities. We’re still dealing with the aftermath of changes made in 2020 to evaluation and management codes—office visit codes. Increasing those caused a budget neutrality adjustment that reduced all the other Medicare payments by reducing what’s called the conversion factor. Congress delayed that for several years, but now we’re dealing with the aftermath, and the cut ultimately went into effect.

At the end of last year, there was a bill—about 1,000 pages—that would fund the government. It had a lot of health care “extenders.” Among the key ones we were looking for were provisions to wipe out the 2.83% cut in Medicare’s conversion factor, extend some of the flexibilities for telehealth that expired at the end of 2024, and extend the three-and-a-half percent bonus for practices in Advanced Alternative Payment Models.

Then Elon Musk started tweeting about it, which caused an uproar, and within a couple of days, 900 pages of that 1,000-page bill were scrubbed. We had a bare-bones continuing resolution with a few health care items passed, which will get us to mid-March in terms of government funding. The physician payment fix did not survive, so physicians are now facing a 2.83% Medicare cut.

We’re regrouping as a physician lobby to ensure these issues are addressed in the next month. Ideally, we’d like to see Congress prorate the payment retroactively into the next bill rather than apply it fully retroactively, which can be administratively burdensome.

Congress is now fully Republican. Some of our champions have retired, including physicians in Congress. It’s a new game, and there are a lot of issues on the table for this March budget bill—that’s what we’re focused on.

Physicians Practice
This is a bit of an inside baseball question, but how do you, as an organization, deal with that? You mentioned you had a bill you felt confident about, then Musk tweets and things get scuttled. You didn’t use to have billionaires in California scuttling 1,000-page bills. How do you guys approach it now?

Anders Gilberg
We just have to regroup and re-educate. It’s a new Congress, with new members and some retirements, so we’re regrouping. I expect legislation to be reintroduced that we worked on last year with the AMA and many specialties, addressing both short-term and long-term reforms.

Really, we need long-term reform of the physician payment system. Everyone agrees we need more stability in physician payment. It’s probably not productive to dwell on why that bill fell apart—it’s just the new reality of government.

This presidency is unique—having a president with a gap between terms is unusual in my experience. Trump starts this final term with the impetus to get things done now. His power will never be greater than it is now. A year from now, he’ll be closer to being a lame duck. He certainly has the bully pulpit and a mandate.

We’re regrouping to make sure MGMA’s priorities are included in early legislative vehicles. There’s discussion of one, two, maybe even three “beautiful” bills—Trump’s phrase. My advice: get in the first one. The second and third will be harder to pass.

One big disappointment last year was the prior authorization reform bill—it had bipartisan support and a zero CBO score but didn’t make it. That’s something we’re urgently working to include early this year.

There’s a strong deregulatory agenda with this administration. I worked on “Patients Over Paperwork” during the first Trump administration, and we were modestly successful in reducing regulatory red tape. I think we’ll see another push like that after the early big-ticket items like tax reform and immigration.

Physicians Practice
It’s interesting you mention the time element of all this. This is the first non-consecutive presidency since Grover Cleveland, if I’m remembering correctly. Never mind—I was going to crack a joke about Grover Cleveland.

Anders Gilberg
I appreciate your historical knowledge.

Physicians Practice
I paid some attention in school—not too much—but certainly to people who share a name with the city I grew up in. But we’re in unprecedented territory here. Where’s MGMA’s head at? What are you looking to accomplish?

Anders Gilberg
Each year, we put out an advocacy agenda—maybe you can link to it—but I’ll go through a few highlights. MGMA focuses on the business of medical practice. We want practices to run efficiently and profitably, reducing regulatory burden so physicians can focus on patients and improve access.

We have 15,000 medical groups in our membership, so protecting their financial viability is always a top priority.

One big issue is reforming prior authorization. Our surveys consistently rank it as the top administrative burden. We’re pushing for more transparency—so physicians know upfront what’s subject to prior authorization—and fewer overall requirements. Ultimately, we want decision-making to remain between clinicians and patients, not for-profit insurers.

Another issue is the Medicare quality reporting program, MIPS. It’s largely seen as an onerous government exercise. We may need to scrap it and rethink how to measure quality without excessive administrative burden.

We’re also focused on cybersecurity and health IT, especially after last year’s Change Healthcare cyberattack, which shut down claims processing nationwide. Even practices not directly contracted with Change were affected because their clearinghouses used Change on the backend. We need to reexamine how much consolidated power exists in the system and strengthen cybersecurity.

We’re also maintaining access to telehealth and addressing workforce issues. Those are key items on our advocacy agenda this year.

Physicians Practice
It certainly seems like you have a partner in wanting to do things differently—putting it lightly. The new administration clearly wants to do things differently.

All right, Anders, I think that’s all the questions I’ve got for you. Anything I’m overlooking? Anything you want to add?

Anders Gilberg
No, it’s great to see you again. Maybe we’ll touch base throughout the year and see how things progress. If nothing else, this administration is going to be a little less predictable than the last one—that could be a good thing. Once we get the players in place, I think things will start to fall together. I’m happy to come back and chat anytime.

Physicians Practice
Oh, absolutely, Anders. It’s easy to forecast doom and gloom, but you never know—the sun might shine. Let’s hope.

Anders Gilberg
Yeah, absolutely.

Physicians Practice
All right. Thank you so much.

Anders Gilberg
Thanks.