Ep. 72: Medicare reform with Susan Dentzer of America's Physician Groups

Susan Dentzer, president and CEO of America's Physician Groups, joins the show to talk Medicare reform and the specific proposals included in America's Physician Group's latest report, "Medicare Done Right."

Download the full report.

Don't miss our previous episodes on agentic AI, the state of private practice, the physician shortage and the risks of prescribing GLP-1 drugs.

Music Credits:
PARIS DINNER by Bopper Beats - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
COCKTAIL by Mythical Audio - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

Introduction and Episode Overview (00:00:00)
Austin introduces the episode, guest Susan Dentzer, and the focus on Medicare reform and accountability.

Biggest Issue with Medicare and Key Fix (00:01:18)
Susan discusses the main problem with Medicare and the report’s top recommendation: increasing accountability in both Medicare arms.

Accountable Relationships in Practice (00:02:25)
Explains what it means for every beneficiary to have an accountable relationship with a healthcare professional, especially for small practices.

Importance of Care Coordination and Outcomes (00:03:47)
Highlights the value of primary care teams, care coordination, and minimizing unnecessary hospital use for better outcomes.

Problems with MIPS and MACRA (00:04:16)
Critique of the current MIPS/MACRA system, why it hasn’t worked, and the need for system-level reforms.

Restoring and Expanding Incentives (00:06:24)
Calls for restoring and expanding advanced alternative payment model bonuses to better reward clinicians in accountable models.

Challenges for Small and Independent Practices (00:07:28)
Addresses the risks and complexities of two-sided ACOs for small practices and suggests partnership solutions.

How At-Risk MA Arrangements Save Money (00:10:04)
Explains how Medicare Advantage at-risk models achieve better outcomes and could save $22 billion if replicated in traditional Medicare.

Improving Medicare Advantage: Prior Authorization and Star Ratings (00:14:00)
Discusses the popularity of MA, issues with prior authorization and star ratings, and visions for improvement.

Dental, Vision, and Hearing Coverage in Accountable Models (00:17:10)
Proposal to offer extra benefits to traditional Medicare patients who join accountable care models and how it could work.

Top Medicare Policy Change for 2025 (00:20:51)
Susan’s pick for the most impactful policy change: updating the Medicare physician fee schedule to reflect practice cost inflation.

Clarifying Medicare Advantage Misconceptions (00:23:31)
Emphasizes the diversity within MA, the benefits of delegated risk models, and the importance of understanding risk adjustment.

Conclusion and Report Access (00:26:37)
Wrap-up, thanks to Susan, and information on where to find the full report and subscribe to the podcast.