Speaker 1 00:00:00 So stay tuned. Lots of things still going on this year and so we expect it to be an active fall.

Speaker 2 00:00:13 Welcome to Off the Chart, A Business of Medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Littrell. I'm the assistant editor over at Medical Economics, and I'd like to thank you for joining us today. This week we're talking politics, as Keith Reynolds is the editor of Physicians Practice. Is joined by Anders Gilberg, senior vice president of government affairs at the medical Group Management Association, or MGMA. They'll be covering the impact of new health care legislation on Medicaid and Medicare payments, the policy and administrative challenges facing medical groups, key upcoming deadlines, and the latest MGMA advocacy efforts. Plus, you'll get a preview of the MGMA's annual Leaders conference September 28th through October 1st in Orlando. Medical economics and business practice will be on the ground, and we'll have plenty more on that when the conference rolls around.

Speaker 2 00:01:04 With that, a big thank you again to Anders for joining us. And let's get into the episode.

Speaker 3 00:01:25 Hey there folks. We're here today with honors. Gillberg, a senior vice president for government affairs at the medical Group Management Association. How are you doing today, honors?

Speaker 1 00:01:32 Good. Keith, how are you?

Speaker 3 00:01:34 Oh I'm fantastic. Any day I get to chat with you is always a good one. so let's. You know, I don't want to take up too much of your time, so let's dig right into it. Just give us a quick and dirty explainer on, you know what? What is the one big beautiful Bill act?

Speaker 1 00:01:47 Okay, well, that's actually the name of the bill if you are the act now. so it's not just we're using shorthand. So it's an interesting name for a bill, I think, you know, like beauty is in the eye of the beholder. There's just so much in that bill that I'll probably be just talking about the health care provisions that MGM is focused on.

Speaker 3 00:02:08 It's probably better not to get in the weeds on everything else.

Speaker 1 00:02:11 Yeah, I think so, too. so the, one big beautiful bill. The key issues for medical groups that we are monitoring closely will be it's really kind of future really at this point would be implementation of the Medicaid cuts that the Congressional Budget Office predicts that, you know, potentially around 10 billion, 10 million people will lose coverage as a result of the Medicaid cuts. And a lot of the cuts are related to kind of administrative issues within Medicaid, like work requirements and things that sound really easy. But the fact is, is that, you know, in some of the states that have, you know, tested out some of the work requirement reporting, Hoarding. It's just shown that, you know, while someone might be actually doing the work. It's really about did they report at the right frequency, and if they didn't, then they lose their coverage. That's kind of what CBO is looking at in the future. the one thing from like an executive standpoint or a physician standpoint that just to remind everybody is that the Medicaid cuts just really won't take place, or these administrative issues will not, like, be implemented into really 2027 and 2028.

Speaker 1 00:03:27 And so, for all of the consternation about the Medicaid cuts, we still might not be even implemented in the same form as the one big beautiful bill did it. And why is that? I mean, just stepping back. A lot of, Republicans who are in the majority kind of had to hold their nose on that provision with the bill because they were concerned about their constituents, and they may still revisit it. There's an election next year prior to implementation of the Medicaid cuts. And so we could see changes to what they're doing, what's scheduled to happen in 2027 before it even is implemented. So stay tuned. I will say, Keith, like, one of the things that worried me a little bit is I talked to some members and, they were talking about some of the medical groups in their community taking action and closing locations and, you know, actually making business decisions based on this. I would just say, wait. Stay tuned. see what happens. There's also a big state component to, so, you know, depends largely with Medicaid where you are practicing in your state.

Speaker 1 00:04:37 So the Medicaid issue is huge. We're monitoring it. We obviously express extreme concern over the Medicaid provisions. in the bill, it was a positive piece in the bill, that, will increase physician Reimbursement in Medicare next year. 2.5%. So that was a small success. And an otherwise huge bill, I will say, is that we expressed a great deal of dismay that Congress did not fix the 2025 problem, though. So medical groups and physicians received a 2.83% cut in 2025, and that was not addressed. So even with the 2.5% increase next year, we still aren't where we were last year. So that's a disappointment. And it really speaks to the fact that we need a permanent solution. And that's what we're continuing to work on, is like find a permanent solution to all these Medicare cuts to physicians.

Speaker 3 00:05:40 All righty. And you know, I know you guys is big, you know, big topic lately has been about administrative workload and payment reconciliation and the, like anything in this big old bill that, might actually give some relief.

Speaker 1 00:05:56 I don't know if I'd say it would give a whole lot of relief in the bill. however, I think when you do have a situation with, the potential for such a large number of beneficiaries and patients to lose their insurance, I think one of the things that GMA will be doing is to make sure that our members are very much using the best practices for, for example, eligibility, verification of insurance before the patient comes in. And, just to make sure that their revenue cycle management, processes are efficient and in good, good standing, because there could potentially be issues with the Medicaid population going forward. And then also there is an expiration of the Affordable Care Act subsidies at the end of this year, which poses a more immediate potential issue, if not renewed by Congress by the end of the year. So again, good practice management and things like eligibility verification. So you don't have patients coming in who don't know they're uninsured. But then all of a sudden they're uninsured. And then you have to make tough decisions about whether or not you see that patient, whether they have to be cash paying.

Speaker 1 00:07:14 And then a lot of that money will just go uncollected as a result.

Speaker 3 00:07:18 All right. So and you know, a lot of the the horse trading to get this bill through, it's, it seems like Congress has got a bit more of an appetite to touch these sort of third rail issues, things that were unthinkable in the past. Do you think this is going to open up any doors for, you know, administrative and administrative simplification sort of deals, you know, the the bills you guys have supported in the past, you think those might be able to get through now?

Speaker 1 00:07:44 I'm just not sure. I mean, the last Congress was the least productive Congress for potentially ever in terms of the number of bills that actually passed. And we're talking like 200. probably like 10,000 were introduced. and so what we're seeing now is, again, individual bills don't pass. They're part of like an amalgamation at the end or as part of the big beautiful bill, something called the Reconciliation Act, which used but, you know, we're still pursuing a number of legislative initiatives.

Speaker 1 00:08:18 Chief among them would be prior authorization reform and especially some of the problems we're seeing in Medicare Advantage right now. As Medicare Advantage becomes the prominent and the majority of Medicare beneficiaries receive Medicare on Medicare Advantage. you know, now all of a sudden, they're subject to prior authorization, which they were not in traditional Medicare. So we're working on a number of bills to continue the reform efforts there, which has been interesting because, you know, some of your folks might have heard about this. Voluntary was a voluntary pledge by the insurers to fix all this problem. Doing it on their own. But, you know, we've seen such massive abuses over the last couple of years. I think we still need the legislative approach. And I think one of the deep ironies that I would say in terms of that pledge is many of the things that the insurers pledge to do, they're actually required to do under law, because the prior administration implemented several regulations that required a lot of those prior authorization reforms in Medicare Advantage. So they pledge to voluntarily follow the law that they have to follow.

Speaker 1 00:09:36 Yeah. We'll see.

Speaker 3 00:09:38 Gotta gotta love that. Gotta love that. All right, so let's, pivot a little bit to the, physician fee schedule. you know, it's it's out. It's, you know, as always, there's crazy cuts in weird places, you know? What's what's the biggest adjustment that practices are going to have to make? You know, if, if the fee schedule goes into effect as it's, you know, put out now.

Speaker 1 00:10:02 Yeah, I think there are the major financial repercussions in the fee schedule result from two reforms that CMS is implementing. The first one deals with an adjustment to the work reviews to in CMS mind, account for certain efficiencies that have occurred. but. In the end, you know, it's also very critical of some of the data that came out of the American Medical Association and the specialties as part of the CPT process and the relative value Update Committee process. But I would say this about it, what they did was, is that they just instituted a 2.5% percent are approximate across the board, cut on a thousands of codes and they increased some.

Speaker 1 00:10:54 But in doing so they they created kind of just a huge swath of codes. They created a shift from. I'd say very generalizing and generalizing quite a bit, but for more specialty based codes towards more primary care based codes. So for primary care physicians, they would benefit from it. But my warning would be this CMS rationale for doing this across the board, efficiency adjustment is that they didn't have sufficient data from the AMA and these other processes, but they definitely didn't have sufficient data to just make this broad cut. And the methodology they used doesn't really make sense to me. it's based on Productivity adjustments in the Medicare Economic Index. A lot of very wonky stuff. But, you know, physicians haven't received a Medicare economic index based increase in years. So, you know, the rationale is a little shaky. And what I would say is, is the last thing we really want is the government to then making really big, arbitrary decisions on physician payment, because I don't believe that any specialty will like that in the end.

Speaker 1 00:12:13 So a lot of folks are at least pointing out some of the methodological issues that are going to create these shifts. So just to sum it up, you know, again, your listeners, and readers, if you're in a specialty that isn't primarily primary care base like offices at base, you just need to be mindful that the view shifts both on the work review and then some additional practice expense reviews that could penalize, let's say, independent practices that take care of patients in a hospital setting. It would reduce their overhead. But the fact is, is that even if you're a surgical practice, you still have to have an office to see the patients and have nurses outside of the hospital, even if you're doing your surgery in the hospital. So some of the rationale is flawed. But again certain surgical specialties and different other, you know, specialties might see cuts to their use that will surprise them and override any increase that Congress provided in the one big beautiful bill. So be mindful of that.

Speaker 4 00:13:28 Say, Keith, this is all well and good, but what if someone is looking for more clinical information?

Speaker 3 00:13:33 Oh, then they want to check out our sister site, Patient Care Online.

Speaker 3 00:13:37 Com the leading clinical resource for primary care physicians. Again that's patient care online. Com. You know, it's the 21st century. So I got to ask you a tech question. You know, any any changes to technology or EHR? that practice should be preparing for now.

Speaker 1 00:14:00 Well, I mean, again, I think it's interesting with this administration, they had it started even with the Doge, Elon Musk, cuts to the government. It's like we're going to just solve all problems with AI. And, you know, I has incredible, you know, opportunity to help solve problems. But I'm not sure based on what we're seeing yet if it's going to be the solution. I'll give you a couple examples. So, ironically, a lot of the folks that got fired out of some of the Medicare agencies we work with based on AI as part of the Doge initiative are all being rehired now, too. So, you know, I'm not sure I can say that was a big success, at least on the health care agencies we follow.

Speaker 1 00:14:48 But then also, there was a recent announcement at the white House that a number of large technology vendors and companies are going to come together and to really, like, improve the IT ecosystem related to interoperability and, patient access to their own data using, you know, apps and whatnot. But again, one of the areas that I think has been very clear in healthcare over the years is, for the most part, MGM members don't really want the government telling them what to do, telling them how to treat patients. But I think, you know, what's become clear is we do need certain standards. So all of the players use the same standard. Otherwise that creates these incredible inefficiencies in healthcare. And then everybody makes a buck off the inefficiencies. So I don't know this. There's a voluntary pledge to address some of the biggest issues in health information technology today. So we'll see if that's enough. But I still think like, you know, continued focus on some of the reforms and standardization initiatives to make sure that, you know, patients do have access to their records, but also in a way that preserves their privacy and making sure that, you know, we don't just lose a bunch of information on Medicare patients or just patients in general, out there in the ether.

Speaker 1 00:16:13 And, you know, that could be used for have really negative consequences when their privacy is violated.

Speaker 3 00:16:21 So, President Trump is taking issue with a lot of the, historically neutral data about the economy coming out of his own administration. he's making some moves on that. You know, what sort of impact could this sort of, meddling with the numbers have on, you know, future fee schedules and the like.

Speaker 1 00:16:43 Yeah, it would be indirect. And again, like, I'm not sure we have fully seen whether or not, you know, I think you're referring to some of his consternation about the jobs number recently and the firing of the head of the Bureau of Labor Statistics. and putting one of his own folks in there. but clearly, like physician payment and the Medicare economic Index and different measures of productivity and economic macroeconomic measures are inputted into the physician fee schedule and are reliant on important solid numbers coming out of the government on inflation, for example. And, you know, even though it's very indirect, but, making sure that the consumer price index and other measures of inflation are accurate is critical for then the downstream effects that we have in terms of making sure that payments to physicians keep up with inflation.

Speaker 1 00:17:45 I mean, unfortunately, they haven't anyway, and that is the real need for reform. But I mean, my hope is, is that things like government data don't become politicized to the extent that we're having to deal with that issue. I mean, the president obviously had his own concerns, but I'm not sure we have evidence yet of any kind of direct tinkering. But obviously, if there was, we would be we would have concerns about that and the impact on Medicare payments and things like that.

Speaker 5 00:18:25 Hey there folks, my name is Keith Reynolds. I'm the editor of Physicians Practice, and this is the P2 management minute when stress soars, keeps spirits high with these three morale boosters. One open huddles with gratitude. Kick off every team huddle with a 32nd win round. around staff, shout out a colleague or patient moment that made their day drop. Thank you notes on it, colored index cards and read a few aloud each morning. Instant dopamine. Stronger psychological safety. Number two flip the negativity bias.

Speaker 5 00:18:51 Complaints about no shows can hijack hallway talk. Host a whiteboard title, today's hurdle and our fix. Tackle the problems together, then wipe the hurdle away at day's end, leading the solution up as a visual win. Number three drill emotional intelligence. Micro skills. At each shift change, ask on a scale of one exhausted to five energized. Where are you? Low numbers? Cue teammates to pitch in. Grab labs return calls before frustration spills over to patience. Five minutes of daily EQ drills can lift well-being scores, bass, gratitude, reframing, and micro skills. Your trio for positivity under pressure. For more bite sized practice tips and tricks, make sure you visit Physician's practice.com. Thanks for watching and I'll see you tomorrow on the Pizza Management Minute.

Speaker 3 00:19:35 All right. So what else does magma have cooking out in Washington?

Speaker 1 00:19:40 Yeah. I'm not sure everybody knows about this, but, it's a little bit of a, you know, budgetary drama thing that we're going to hit here at the end of September.

Speaker 1 00:19:52 That also includes some real policy issues that are important to physicians and medical practices. So at the end of last year, a continuing resolution that would have funded the government for a longer period of time was, scuttled by tweets from Elon Musk and the president. So that was back in December. And as a result, the physician payment cuts were not averted in 2025. So that scuttled all our work last year. But also, included was a very small set of health care issues. it was that continuing resolution went to March. And then there was a new continuing resolution that went to the end of September. So for health care, two key issues are in there. One is the telehealth extension. So what that is, is the extension of the flexibilities that were created during Covid that allowed rural practices and urban practices to provide telehealth directly to patients, and outside of what used to be a requirement that a patient literally have to go to an originating site, a HIPAA, covered originating site, in order to get, for example, telehealth from a specialist in another community or in a city.

Speaker 1 00:21:11 So all of the conveniences over the last five or so years that people have grown accustomed to, could expire at the end of September without being renewed. So we're watching that very closely. And obviously with the Medicare population, elderly folks who need transportation. And I'm not saying it's for everything, but, you know, it's been important to provide access to specialists, as well as for chronic care management and just basic kind of primary care services with their position. So we're advocating for an extension. We're in fact advocating for a bill that would, at a minimum, extend it for two years. While there's some studies done to make sure it's implemented correctly. So that's at the end of September. That's a big decision point for Congress. But it's also tied into things like the expiration of the continuing resolution, funding the government, shutting the government down, those type of issues. So it'll be highly politicized for unrelated issues. And then also rural practices and physicians in rural areas enjoy what is known as a gypsy flaw, which is the geographic price indices for the work view in Medicare payment calculations is raised to one in those areas where it's below one.

Speaker 1 00:22:32 So all that really means is that physicians in rural areas for a number of years. That calculation has been overridden by Congress. So they are paid on par with their counterparts in urban areas. So payment parity for rural physicians, will that work? Gypsy flaw expires at the end of September as well. And so we are advocating to keep that. So rural physicians aren't disadvantaged. But there are some real key issues coming up at the end of September. And then I think just more broadly, you've got the Medicaid stuff that's couple years out, but then the expiration of the Affordable Care Act subsidies at the end of this year are really going to come into play politically. And beneficiaries who receive their insurance on the exchange will start to get these notices of their premiums. That could be up 100%, and they'll get those in October. And whether or not Congress acts to fund this extension of the Affordable Care Act subsidies to the tune of like $275 billion. That's going to be a really interesting political conundrum for a number of folks who don't love the Affordable Care Act or Obamacare, but also many of the states and those members of Congress that have expressed their dislike for the ACA are the states where the subsidies have allowed the number of beneficiaries to grow exponentially over the last several years.

Speaker 1 00:24:09 So states like Texas, states like Florida, states like Georgia, which might vote potentially more Republican. those areas are going to see some of the greatest impact if Congress lets it expire. So stay tuned. Lots of things still going on this year, and so we expect it to be an active fall.

Speaker 3 00:24:31 All right. so it sounds like the end of September is going to be pretty chaotic, especially for you, because you will definitely be at the MGM Leadership conference. Medical economics and physicians Practice will be there as well. What are you looking forward to?

Speaker 1 00:24:44 Well, I'm looking forward to seeing you, Keith.

Speaker 3 00:24:46 Oh.

Speaker 1 00:24:47 Yes. but no, it's a great conference this year. We're in Orlando, and, you know, this conference brings together, you know, both, just administrative folks, practice administrators, physicians and leadership positions, as well as executives across the country in the medical group ambulatory space. brings them together every year. We have a huge exhibit hall. We have a great location now in Orlando this year.

Speaker 1 00:25:16 And, in addition to my team providing everybody with the latest and greatest on the fee schedule, what happened at the end of September? all the Washington issues. we have a whole host of really good content to allow people to, you know, work on ways to both improve their revenue. To cut costs in their practice, to maintain a healthy workforce and make sure that, you know, physicians in an independent practice or a hospital owned practice, you know, that we can reduce burnout and just some of the ills of healthcare today. So, you know, it's really based on the concept of bringing leaders together to solve these problems and provide them an opportunity to network and really work together to both learn and to solve problems at the same time.

Speaker 3 00:26:06 All righty. You heard it here first, folks. Anders thinks that it's not humid enough in Washington. He's got to go down to Florida. That's right. All righty. I think that's all I got for you. Anything you want to add?

Speaker 1 00:26:17 That was great to see you.

Speaker 1 00:26:18 And if we don't talk before then, I'll see you in Orlando.

Speaker 3 00:26:22 Oh, yeah. We'll have a nice, frosty drink of some kind. Definitely. All righty. Thanks, Anders.

Speaker 1 00:26:27 Thank you. Keith.

Speaker 2 00:26:40 Once again, that was a conversation between Keith Reynolds, the editor of Physicians Practice, and Anders Gilberg, senior vice president of government affairs at MGMA. My name is Austin Littrell, and on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show and as you please, subscribe so you don't miss the next episode. You can find us by searching off the chart wherever you get your podcasts. Also, if you'd like the best stories that Medical Economics and physicians practice publish delivered straight to your email six days of the week, subscribe to our newsletter. So that medical economics and physicians practice off the chart. A Business of Medicine podcast is executive produced by Chris Mazzolini and Keith Reynolds and produced by Austin Littrell. Medical economics, Physicians Practice and Patient Care Online are all members of the MJH Life Sciences family.

Speaker 2 00:27:25 Thank you.