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Feb. 23, 2026- New York State Council for Community Behavioral Healthcare Executive Director Lauri Cole talks about prompt payments for her members, curtailing the role of insurance companies, and cutting red tape.
Today, we're tuning in behind the scenes of a new series The Colorado Sun is reporting on the state's struggling child care system. The series, funded by a grant from Gary Community Ventures, will explore why child care has become too expensive for many families, the reasons why many child care providers are scraping by and what solutions might make child care more accessible. Read more: https://coloradosun.com/2026/02/15/colorado-child-care-unaffordable-out-of-reach-school-families/ & https://coloradosun.com/2026/02/17/new-mexico-is-making-child-care-free-for-all-working-parents-why-isnt-colorado/ Photo by Jeremy Sparig, Special to The Colorado Sun https://cossa.co/conference https://coloradosun.com/outsiderSee omnystudio.com/listener for privacy information.
In this episode of The Dish on Health IT, host Tony Schueth is joined by co-host Alix Goss and special guest Amy Gleason, Strategic Advisor to Centers for Medicare & Medicaid Services (CMS) and Administrator of the U.S. Department of Government Efficiency (DOGE) Service, for a wide-ranging discussion on how health IT modernization is evolving under a pledge-driven, incentive-backed federal strategy.The conversation begins not with policy, but with lived experience.From Emergency Room to Interoperability AdvocateAmy shares how her early career as an emergency room nurse exposed the dangers of fragmented information. Providers were expected to make critical decisions without access to complete patient histories, while patients, often in pain or distress, were unrealistically asked to recall complex medical details.That professional frustration became deeply personal when her daughter went more than a year without diagnosis for a rare autoimmune disease, juvenile dermatomyositis (JDM). Multiple specialists saw pieces of the puzzle, but no one could see the full picture across charts and settings. Amy reflects that if today's AI tools had been applied to her daughter's complete longitudinal record, the condition may have surfaced sooner.That experience shaped her philosophy. Technology must converge with policy and trust in ways that tangibly improve care.Why Pledges Instead of Rules?Tony presses on a central theme. Amy has argued that we cannot regulate our way to success. Why pursue voluntary pledges instead of federal rulemaking?Amy explains her frustration returning to government in 2025 to find interoperability policies she helped draft in 2020 still not fully effective until 2027. Seven years is an eternity in technology. Meanwhile, the industry had technically complied with numerous mandates including Meaningful Use, Cures Act APIs and CMS interoperability rules, yet many workflows still felt broken.In her view, regulation created a floor but not always real transformation.The CMS Health Tech Ecosystem Pledge was launched as a different model. The federal government used its convening power to articulate a clear vision and challenge industry to deliver minimum viable products within six to twelve months rather than years.Initially announced with roughly 60 companies, the pledge initiative has grown to more than 600 participants collaborating in working groups. The three initial patient-focused use cases include:Improving data interoperability“Killing the clipboard” through digital identity and QR-based sharingLeveraging conversational AI and personalized recommendations for chronic conditions such as diabetes and obesityAmy describes live demonstrations at a Connectathon showing OAuth-enabled data retrieval, QR ingestion into EHR workflows and AI-powered recommendations built on patient data. The goal is not perfection by the first milestone, but real-world minimum viable functionality that can iteratively improve.Alix notes that from the standards community perspective, this approach feels aligned with long-standing calls for industry-driven collaboration, though it remains early to measure widespread impact.Carrots, Sticks and Rural HealthThe discussion turns to incentives.Amy outlines the administration's carrots and sticks strategy:Stick: Enforcement of information blocking, with penalties up to $2 million per occurrenceCarrots: Financial incentives such as the $50 billion Rural Health Transformation Program and the CMS ACCESS Model, which pays for technology-enabled outcomesThe Rural Health Transformation Program directs money to states with expectations that ecosystem-aligned interoperability and app participation be incorporated into funding proposals. CMS retains oversight and clawback authority to ensure funds support rural providers.The ACCESS Model represents a significant shift. Technology-enabled care platforms can register as Medicare Part B providers and be paid for measurable outcomes in tracks such as cardiometabolic disease, musculoskeletal conditions and behavioral health. Providers remain in the loop and receive compensation for referral and care plan oversight.Alix underscores that rural providers face steep financial and workforce constraints. Standards participation, implementation and technology upgrades require resources that are often scarce. The success of these incentives will depend on whether they reduce burden rather than add to it.AI: Evolution, Risk and RealityAI becomes a central thread of the episode.Amy compares AI adoption to autonomous vehicle models. Some scenarios allow tightly controlled automation, such as medication refills, while others require a human in the loop for higher-risk decisions. She points to a Utah prescription refill pilot as an example of bounded automation, where malpractice coverage and clearly defined use cases mitigate risk.When Tony asks who owns risk in this evolving landscape, Amy emphasizes the need for light but clear regulatory pathways rather than fragmented state-by-state oversight.Patients, she notes, are already there. Millions are asking health-related questions weekly through AI tools. The more pressing issue is ensuring those tools are grounded in structured medical data rather than incomplete memory or unverified inputs.She shares a striking story. Her daughter was excluded from a clinical trial due to a misclassification of ulcerative colitis. By uploading her records into an AI model, they identified a more precise diagnosis, microscopic lymphocytic colitis, which did not disqualify her from the trial. For Amy, this demonstrates both the power and inevitability of AI use.Alix adds caution. AI is only as strong as the data beneath it. Dirty, inconsistent and poorly structured data limits performance. Standards and terminologies remain essential to fuel high-fidelity models and safeguard trust.FHIR, Deregulation and the Data FoundationThe conversation addresses an emerging tension. If regulatory burdens are being reduced, does that signal less need for structured standards like FHIR?Amy candidly admits she initially wondered whether AI might reduce the need for FHIR altogether. After discussions with labs and technologists, she concluded the opposite. Standardized data dramatically improves AI performance and reduces error.Deregulation is about removing unnecessary burden, not abandoning foundational data structures.Alix reinforces that FHIR enables discrete, normalized data capture that supports both legacy transactions and AI evolution. While future innovations may emerge, today FHIR remains the backbone for scalable interoperability.Prior Authorization and HIPAA ModernizationThe episode dives into prior authorization modernization across medical and pharmacy domains.Amy notes growing interest among pledge participants to expand into pharmacy prior authorization testing, diagnostic imaging, real-time benefit checks and bulk FHIR performance testing.Alix provides insight into ongoing work within the Designated Standards Maintenance Organizations to incorporate FHIR-based approaches into HIPAA-named standards, particularly for prior authorization. She highlights testing beyond Connectathons, including implementer communities and real-world pilot efforts.Both stress the importance of public comment periods and industry engagement, describing participation as a civic responsibility for health IT professionals.Trust as the Core EnablerThe final segment centers on trust.Amy explains that the ecosystem initiative aims to reinforce trust through:Stronger digital identity verification such as Clear, ID.me and Login.govCertification frameworks such as CARIN and DIME for patient-facing appsA new national provider directory to replace fragmented provider data sourcesTransparency dashboards showing data requests, volumes and purposeRather than replacing frameworks like TEFCA, she describes the pledge model as an accelerator layered above the regulatory floor.Transparency acts as sunlight, enabling visibility into who is accessing data and for what purpose.Final TakeawaysIn closing, Amy urges providers not to sit on the sidelines. Too often, she says, providers feel change is imposed on them. The pledge environment is designed as an open forum where they can directly shape what works or does not work in real workflows.Alix echoes the call. Standards require participation. Organizations must allocate budget and staff to engage, comment and collaborate. It truly takes a village.Tony concludes by framing the episode's core message. Regulation establishes baseline expectations, but voluntary movements can demonstrate what is possible before mandates reach the Federal Register.Across pledges, payment reform, AI evolution and trust frameworks, the episode underscores a consistent theme. Modernization in health IT depends not only on policy direction, but on shared accountability and active participation from every stakeholder in the ecosystem.Listeners are reminded that POCP is available to support organizations in understanding the implications of federal initiatives, enforcement priorities and their strategic implications. Reach out to us to set up an initial consultation. The episode closes, as always, with the reminder that Health IT is a dish best served hot.Prefer video? Catch episodes on the POCP YouTube channel
In December, the Department of Health and Human Services proposed a new rule that would ban hospitals from receiving any Medicare and Medicaid funding if they offer gender-affirming care for minors. Today, Kimberly checks in with Marketplace's Samantha Fields to hear about her reporting on how this is affecting health care providers across the country. Plus, we'll get into how the proposed rule fits into a larger wave of restrictions on transgender health care, years in the making.
In December, the Department of Health and Human Services proposed a new rule that would ban hospitals from receiving any Medicare and Medicaid funding if they offer gender-affirming care for minors. Today, Kimberly checks in with Marketplace's Samantha Fields to hear about her reporting on how this is affecting health care providers across the country. Plus, we'll get into how the proposed rule fits into a larger wave of restrictions on transgender health care, years in the making.
Many EMRs now embed ICD‑10 and CPT codes directly into the medical record. But is that advisable? The safest approach is still to let the documentation stand on its own. The content of the record should support the coding choices, and coders and auditors should base their work on the medical facts as documented. Codes can—and should—be applied only after the documentation is complete. On today’s CodeCast episode, Terry explains that when providers insert billing codes into the note, the intention may be good, but the risk of contradictions or inaccuracies can outweigh any perceived benefit. Should medical record documentation stand alone, without templated teaching language that was never meant to be included? Should codes appear in the record simply to give the impression of accuracy, rather than allowing the documentation to speak for itself? Subscribe and Listen Find all of Terry’s official links in one place: https://www.terryfletcher.net/links The post Who's Doing the Coding — Providers or Coders? appeared first on Terry Fletcher Consulting, Inc..
Health Affairs' Rob Lott interviews Jane Zhu of Oregon Health & Science University about her recent paper exploring how many physicians enrolled in Medicaid see few or no Medicaid beneficiaries as patients, highlighting a greater need for targeted policies to boost participation and improve access.Order the February 2026 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast
In this episode, host Don Adeesha joins Laura Crowley, CEO of Laura Janet & Co, to tackle the "retail gap" in aesthetic practices. Laura explains why the best clinical providers often struggle with retail sales, feeling that it compromises their clinical integrity. She shares how to psychologically rewire a team to reframe product recommendations from a commercial upsell to a necessary part of patient advocacy and optimal medical results. Laura breaks down the operational failures that cause half of your patients to leave empty-handed, advocating for retail integration that starts with pre-appointment paperwork. She details how to fix the consultation and checkout process by presenting a comprehensive written treatment plan and then simply "stopping talking" to avoid over-explaining the price. Beyond tactics, she warns against just throwing commission at low sales, instead emphasizing financial transparency, regular one-on-ones, and targeted product education to foster an ownership culture among staff. Finally, Laura encourages owners to embrace employee personal branding as a powerful marketing tool rather than fearing patient theft. For owners trapped in the treatment room, she shares her blueprint for stepping back: delegating low-hanging tasks to an assistant, building Standard Operating Procedures (SOPs), and dedicating non-negotiable "CEO hours" to strategically work on the business instead of in it.
In this episode, I had a pre-conversation with Rishin Shah about the relationships between patients and providers' medical treatments. We also discussed the importance of billers having conversations with medical billers to ensure claims are billed and coded correctly. Millions of providers don't have conversations with their medical billers, coders, or AR specialists. We also discuss the importance of you taking care of your overall health and wellness internally and externally. The importance of understanding how the mind, body, and spirit work together when it comes to your health and wellness. The importance of taking care of your heart. #healing #recoveryjourney #healthylifestyle #WellnessJourneyBecome a supporter of this podcast: https://www.spreaker.com/podcast/a-happier-you-leads-to-a-healthier-you--5161886/support.This episode includes AI-generated content.
Global technology spending is projected to reach $5.6 trillion by 2026, with nearly two-thirds of this investment directed toward software and computer equipment, particularly servers, according to Forrester. Generative AI is cited as a primary driver of this increase, shifting the balance of power toward cloud providers such as AWS and Azure. This escalation has implications for operational margins and the position of IT service providers, as businesses increasingly migrate complex workloads to cloud infrastructure ecosystems.Supporting data shows a disconnect between tech employment trends and hiring activity. In January 2026, technology companies cut approximately 20,155 jobs, mainly in telecommunications, while job postings for tech positions rose by 13% compared to the prior month, based on CompTIA analysis. Dave Sobel interprets this as a shift away from permanent IT headcount to project-based, AI-focused engagements. This development places pressure on service providers, who must adapt to buyers reallocating spend from traditional staffing models to short-term, outcome-oriented contracts.Adjacent discussion covered two press releases: VirtuaCare launched a support offering for Windows-based MSPs needing Apple expertise, delivering an externally verifiable, Apple-certified service. In contrast, Miso announced a roadmap for an autonomous AI L1 technician but did not substantiate claims with deliverables or customer data. Dave Sobel emphasized the need for MSPs to demand piloting, outcome metrics, and auditable product maturity, warning against reliance on unproven AI solutions and highlighting the risk of outsourcing as only a temporary solution.The core implication for MSPs and IT providers is a need for tactical negotiation and operational risk management. Dave Sobel recommends using AI first to reduce internal labor costs before introducing it as a client offering, prioritizing outcome-based pricing and adjusting contracts to retain value from efficiency gains. Providers should avoid becoming displaced labor, rigorously test new technologies before adoption, and remain vigilant regarding vendor claims. The emphasis remains on capturing and defending margins through accountable operations and contract governance rather than chasing speculative innovation.Three things to know today00:00 Tech Spending Hits $5.6T but MSPs Face Margin Squeeze Without AI Pricing Reset05:31 VirtuaCare Ships Apple Support; Mizo Announces Roadmap—One's Testable Today08:17 MSPs Must Capture AI Efficiency Value or Face Margin CompressionThis is the Business of Tech. Supported by: Small Biz Thought CommunityCheck out Killing IT
Mid-market organizations are transitioning from pilot projects to operationalizing generative AI and agentic workflows, according to a TechEYE article and Tech Isle survey cited by Dave Sobel. This shift centers on outcome-driven automation but exposes providers to new liability concerns, mainly due to fragmented, unreliable data and shadow AI usage—employees employing unauthorized tools outside official controls. The primary risk is that MSPs may be blamed for incidents where contract boundaries and technical controls do not cover browser-based generative AI use, making forensic evidence and documented enforcement essential for defending accountability. Supporting data from Tech Isle found that over 5,000 companies are pursuing structured approaches to AI-enabled growth, but face persistent issues in data trust, governance, and user fatigue. Additionally, European investment in sovereign cloud infrastructure is projected to triple between 2025 and 2027, driven by regulatory demands and concerns about U.S. data sovereignty. MSPs managing split architectures—sovereign providers for regulated data and hyperscalers for everything else—encounter API mismatches, operational complexity, and margin pressure. The recommendation is to standardize policy enforcement, identity management, and residency mapping while prioritizing audit-ready reporting and exception handling. AI-driven cyberattacks have increased, with reports from Level Blue and Check Point Research highlighting a surge in both attack volume and sophistication. Only 53% of CISOs feel prepared for AI threats, despite 45% expecting to be impacted within a year. Browser-based generative AI use introduces visibility gaps, raising the risk of negligence claims when service providers cannot demonstrate governance or forensic readiness. Reauthorization of the Cybersecurity Information Sharing Act (CISA) underscores that voluntary data sharing is inadequate, with CIRCA now requiring mandatory 72-hour incident reporting for critical infrastructure. The key takeaways for MSPs and IT leaders are to proactively define AI coverage and governance in contracts, enforce acceptable use policies, and instrument monitoring to close visibility gaps. Providers who can deliver forensic-grade telemetry, managed compliance programs, and operational readiness for incident reporting will be better positioned to defend against penalties, retain higher-value accounts, and offer meaningful differentiation. These structural challenges—fragmented control planes, increased compliance costs, and permanent risk friction—necessitate a strategic shift toward governance-led service models.Three things to know today00:00 Midmarket Shifts to Agentic AI as Europe Triples Sovereign Cloud Spending by 202706:08 Most Security Chiefs Say They're Not Ready for AI-Powered Cyberattacks Coming This Year09:46 CISA 2015 Reauthorized Through 2026; CIRCIA Mandates Expose Voluntary Sharing Failure This is the Business of Tech. Supported by: TimeZest IT Service Provider University
Robin Heffernan, PhD, started Empassion during the COVID-19 pandemic to help support people with hospice and palliative care in their last year of life. During this time, she had a personal brush with the benefit as her dad needed it. The company's new hospice certification, launched earlier this month, aims to separate the high-quality hospices from the rest. The certification has generated a lot of interest, from providers and regulators, she said. With the certification, the company is not creating new metrics, but rather paring the metrics down to five to seven that really matter. With the mainstream press talking about hospice fraud, the certification is a way to take advantage of the attention and help people understand that there are great hospices available to provide care. The Value-Based Insurance Design (VBID) model, the hospice component of which ended in 2024, was also an impetus for the certification. Because a second demonstration likely is inevitable given the prevalence of MA, it's important that MA plans be able to work with good hospices. She is optimistic that, given the healthcare savings that hospice allows, MA plans would pay hospice agencies fairly. While home health agencies had a difficult experience with MA plans, at least initially, the difference is MA plans truly see the ROI of hospice; not all grasp the value of home health, she said.Follow us on social media:X: @McKHomeCareFacebook: McKnight's Home CareLinkedIn: McKnight's Home CareInstagram: mcknights_homecareFollow Empassion on social media:LinkedIn: Empassion HealthShow contributors:McKnight's Home Care Editor Liza Berger; Robin Heffernan, PhD, co-founder and CEO, Empassion Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
“Women should feel excited about giving birth and every woman should feel confident in giving birth.”Brianna's first birth didn't feel this way. She transferred to the hospital from a birth center at 42 weeks for a Foley induction. And before labor even started, she was already mentally preparing for a c-section. Pitocin was started without her consent. After about 14 hours, an epidural, AROM, and being stuck at 4 cm, she ultimately had a cesarean at 6 cm after 30 hours of labor due to heart decels.“It breaks you down mentally and physically.”When she became pregnant with her second, Bri thought she'd have another c-section, until her provider told her about VBAC. Then she decided she was all in.Bri found The VBAC Link podcast and listened to three episodes a day on the treadmill. After hearing Lily's 66-hour labor story, she thought, “If she could do it, I can do it.” She transferred providers and vigorously prepped physically and mentally.When the time came, she was excited to be in labor!She experienced moments that felt similar, but weren't. She pushed for just 20 minutes, and her midwife later said it was the funniest birth she'd ever attended.Now, as a junior high health teacher, Bri is normalizing birth (and VBAC!) for 11-year-olds. We know you will love her just as much as we do. She is as hilarious as she is inspiring, and her stories are a joy!The Ultimate VBAC Prep Course for ParentsOnline VBAC Doula TrainingSupport this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands
A bill that would allow healthcare providers the right to deny care based on conscience failed in the South Dakota legislature on Tuesday.
"If you ask the surgeon how much time they have to spend thinking about the business side of their practice, it's too high... Let's let doctors be doctors." - Ryan WellsMy guest this week is Ryan Wells, Founder and CEO of Health Here. Ryan joins me to explain why the key to fixing the broken doctor-patient relationship is getting providers out of the debt collection business.We explore how Episodic Care (bundled payments) can finally align the financial incentives of self-funded employers and high-value specialists. Ryan breaks down how his platform automates payments, getting surgeons paid in under 15 days while eliminating patient liability entirely.We dive deep into Ryan's background in the OR, the lessons learned from the "Metal on Metal" hip recall, and why we need to move from "open enrollment confusion" to real-time, event-driven patient navigation.If you are tired of administrative waste and want to see a model where doctors focus on care instead of claims, this episode is for you.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Let Doctors Be Doctors(00:03:04) Ryan's Journey: From Anthropology to the OR (00:07:00) Lessons from Medicare's Acute Care Episode Demo (00:10:46) Defining the "Bundle" vs. Fee-for-Service (00:13:00) Value-Based Care = Outcome / Cost (00:16:14) Why Orthopedics is the Perfect Starting Point (00:18:32) Moving from "Elective" to "Discretionary" Care (00:21:38) The Navigation Problem: Open Enrollment Fails (00:31:48) Owning the Payment Rails: 15-Day Payments (00:37:38) Automating the "Outlier Workflow" (00:41:35) The "Metal on Metal" Hip Recall & Registries (00:48:30) Expanding to Cardiology and Bariatrics (00:53:03) The Moonshot: Removing the Business Burden from MDsKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/
In this powerful episode, Dr. Robyn McKay goes deeper into the conversations patients need to be having with their intuitive clinicians and healthcare providers. She explores why intuitive medicine is shaping the future of healthcare, why intuition matters for every leader, and how it's redefining healing and caregiving.This episode explores:Why being an intuitive should be honoredHow Western healing is converging with intuitionWhy intuition is going to be the major leadership abilityWhy intuition is a respected and valued assetWhat patients actually want from practitionersHow tools are dependent on our nervous systemHow to use intuition for deeper discernmentThe need for an entirely holistic way of healingWhy we should start feeling safe in our own skinIf you're an intuitively intelligent physician or clinician, this is your moment to honor your gifts and consciously integrate intuition into the way you practice and lead.Love what you're hearing?Leave a review on Apple Podcasts and send a screenshot to Robyn. Each month, one listener will receive a Scroll of Recognition—a custom energetic blessing, activation, or intuitive message written just for you.Robyn McKay, PhD, is an award-winning therapist and psychospiritual advisor who teaches and leads at the intersection of psychology × spirituality × energetics. With deep roots in clinical psychology and a lifetime of living at the crossroads of intuition and credentials, she is a rare bridge between science and soul, credentials and codes, strategy and spirit.Early in her career, Robyn served as a university psychologist before stepping into her broader calling as a guide for high performers, creatives, and seekers. She addresses a wide spectrum of human experience — healing trauma, anxiety, depression, mood disorders, and ADHD in women; accessing spiritual gifts; and navigating existential crossroads.Having sold $2.5M+ in retreats and private intensives, Robyn is now architecting an entirely new category of retreats: expert-led, trauma-informed, miracle-level. She helps credentialed, neurodivergent, and spiritually awake women leaders design transformational retreats that carry depth, meaning, and lasting impact.Connect with Dr. Robyn McKay:LinkedIn: Robyn McKay, PhDFacebook: Dr. Robyn McKayInstagram: @robynmckayphd Book a call with Dr. Robyn! https://drrobynmckay.com/call Join the $100K Retreat Leaders Secrets: https://www.facebook.com/groups/100kretreatsecrects
"If you ask the surgeon how much time they have to spend thinking about the business side of their practice, it's too high... Let's let doctors be doctors." - Ryan WellsMy guest this week is Ryan Wells, Founder and CEO of Health Here. Ryan joins me to explain why the key to fixing the broken doctor-patient relationship is getting providers out of the debt collection business.We explore how Episodic Care (bundled payments) can finally align the financial incentives of self-funded employers and high-value specialists. Ryan breaks down how his platform automates payments, getting surgeons paid in under 15 days while eliminating patient liability entirely.We dive deep into Ryan's background in the OR, the lessons learned from the "Metal on Metal" hip recall, and why we need to move from "open enrollment confusion" to real-time, event-driven patient navigation.If you are tired of administrative waste and want to see a model where doctors focus on care instead of claims, this episode is for you.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Let Doctors Be Doctors(00:03:04) Ryan's Journey: From Anthropology to the OR (00:07:00) Lessons from Medicare's Acute Care Episode Demo (00:10:46) Defining the "Bundle" vs. Fee-for-Service (00:13:00) Value-Based Care = Outcome / Cost (00:16:14) Why Orthopedics is the Perfect Starting Point (00:18:32) Moving from "Elective" to "Discretionary" Care (00:21:38) The Navigation Problem: Open Enrollment Fails (00:31:48) Owning the Payment Rails: 15-Day Payments (00:37:38) Automating the "Outlier Workflow" (00:41:35) The "Metal on Metal" Hip Recall & Registries (00:48:30) Expanding to Cardiology and Bariatrics (00:53:03) The Moonshot: Removing the Business Burden from MDsKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/
The ANC Youth League in Gauteng will today lodge a formal complaint with the South African Human Rights Commission against the Gauteng Department of Education over its alleged failure to pay scholar‑transport service providers. A strike that has left thousands of pupils without transport for a second week. For more on the League's complaint, Elvis Presslin spoke to ANCYL Gauteng Provincial Chairman, Ntsako Kevin Mogobe
There's been a recent flare-up in the pelvic rehab world around cash-based versus insurance-based care. And while emotions are running high, we wanted to pause the noise and add something that feels increasingly rare: context.In this episode, we start with what we all agree on:Every pelvic PT and OT is doing their best for their patientsWe all want clinicians to be paid fairly and sustainablyMore practice models = more options for both clinicians and patientsPatients benefit from having real choicesWe should be referring to one another, not competing against the field itselfThe current medical system requires both insurance and cash-based care — in every country we've seenFrom there, we address the two biggest areas of disagreement head-on.First, the claim that cash-based practices reduce access to care. We walk through the data around deductibles, waitlists, and real-world barriers to care — and why more options actually increase access, not reduce it.Second, the idea that one model inherently produces better care. We're very clear here: you can get excellent or poor care in any setting. But when you take the same caliber clinician, the environment matters — and we explain why time, autonomy, documentation burden, and feedback loops change outcomes.This episode isn't about picking sides. It's about understanding incentives. And it's about recognizing that the growth of pelvic rehab depends on all of us moving forward together.About UsNicole and Jesse Cozean founded Pelvic PT Rising to provide clinical and business resources to physical therapists to change the way we treat pelvic health. PelvicSanity Physical Therapy (www.pelvicsanity.com) together in 2016. It grew quickly into one of the largest cash-based physical therapy practices in the country.Through Pelvic PT Rising, Nicole has created clinical courses (www.pelvicptrising.com/clinical) to help pelvic health providers gain confidence in their skills and provide frameworks to get better patient outcomes. Together, Jesse and Nicole have helped 800+ pelvic practices start and grow through the Pelvic PT Rising Business Programs (www.pelvicptrising.com/business) to build a practice that works for them! Get in Touch!Learn more at www.pelvicptrising.com, follow Nicole @nicolecozeandpt (www.instagram.com/nicolecozeandpt) or reach out via email (nicole@pelvicsanity.com).Check out our Clinical Courses, Business Resources and learn more about us at Pelvic PT Rising...Let's Continue to Rise!
Ary Rosenbaum talks about the new catch up rules and why plan providers will be blamed when things go sideways.
Here is the latest episode of The Compliance Guy! SummaryIn this episode of The Compliance Guy, Sean M Weiss and Terry Fletcher discuss various topics related to compliance, telehealth, and revenue cycle management. They emphasize the importance of accurate documentation in medical records, the impact of government shutdowns on telehealth services, and the responsibilities of EMR companies in ensuring accurate data entry. The conversation highlights the consequences of inaccurate documentation and the need for providers to maintain compliance in their practices.TakeawaysThe government shutdown impacts telehealth services.Compliance applies to various aspects of business and healthcare.Inaccurate documentation can lead to serious consequences.Every medical encounter must support the billed service level.EMR systems can default to incorrect coding, causing issues.Providers must ensure their documentation is accurate and up-to-date.The responsibility for medical record accuracy lies with the provider.EMR companies may have liability for errors in their systems.Documentation should stand on its own without unnecessary coding.Providers need to advocate for better EMR functionality.
The latest episode of the athenahealth podcast looks at the vital work being done in rural communities, where healthcare providers must overcome unique geographic, economic, and infrastructure challenges to deliver comprehensive care – with the help of athenaOne solutions. Get tips for engaging patients with limited internet connectivity, using incentive programs and athenaOne tools to drive clinical efficiency, and preparing reluctant clinicians for AI adoption while maintaining the personal touch that's essential to building trust in tight-knit communities.
Pediatric hospitals are one of the most important segments in the industry to watch right now. Although children's hospitals make up only 5% of total hospital market share, more than 40% of U.S. children rely on Medicaid, leaving pediatric organizations disproportionately exposed as the Medicaid-related provisions of the One Big Beautiful Bill Act take effect. The pressures inside pediatric care were mounting even before this moment. After years of outperforming adult hospitals, children's hospitals have seen margins fall from double digits to just 1% last year. Rising bad debt, higher supply and labor costs, a rapid shift toward lower margin outpatient care, and emerging challenges like declining birth rates and vaccine policy upheaval have created a perfect financial storm. While some of these dynamics are unique to pediatrics, the sector also offers an early warning signal for the rest of healthcare — and an opportunity to translate lessons across both worlds. In this episode, host Abby Burns and Advisory Board expert Vidal Seegobin break down why pediatric leaders must simultaneously manage immediate-term margin pressure, prepare for a more ambulatory-dominant model, and futureproof their organizations amid shifting demographics. Vidal also shares actionable steps leaders can take now, along with the critical lessons pediatric hospitals offer the wider healthcare ecosystem. We're here to help: 5 insights on the state of pediatric hospitals today 12 things CEOs need to know in 2026 The State of the Healthcare Industry in 2026 Read Advisory Board's 2026 research agenda 3 trends shaping healthcare in 2026 (and how to respond) 278: Dr. Emily Oster on fighting misinformation and rebuilding trust in healthcare 277: Patient distrust is costing you. Here's how to rebuild it. Learn how outpatient shifts can impact your organization by using Advisory Board's Market Scenario Planner tool. Sign up today for this Optum Health Webinar: Scaling your EHR: How Optum Health built an enterprise platform to redefine care delivery. A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.
What can we be doing to reduce LDL-C to decrease the risk for cardiovascular disease, particularly in our patients with diabetes? Learn from Margo B. Minissian, PhD, RN, ACNP-BC, NEA-BC, FAAN about the role of high blood sugar in cardiovascular disease, effective strategies for lowering LDL-C, and the importance of early treatment.Related Resources:PCNA Lipid Resources for Providers and PatientsPCNA Diabetes Resources for Providers and Patients2018 AHA/ACC Guideline on the Management of Blood Cholesterol2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular DiseaseIVUS Regression Trials: REVERSAL (2004), ASTEROID (2006); SATURN (2011); GLAGOV (2016); PRECISE-IVUS(2015); JAPAN-ACS (2009)COURAGE trialVESALIUS-CV trialPleiotropic effects of statinsSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
People often use free email providers only to lose everything when a problem occurs. So what should you look for in a paid email provider?
This episode comes straight from my own lived experience of spiraling before doctor's appointments and feeling dismissed when it comes to hormones. I dig into why so many hormone providers get it wrong and what's actually happening behind those rushed, frustrating conversations. Why does advocating for ourselves feel so hard? I walk you through what most doctors are (and aren't) trained to do when it comes to perimenopause and menopause. How much of this is about lack of education versus lack of time? And how do you stop blaming yourself when you're told your labs are "normal," but you feel terrible? We also talk about what good hormone care should actually look like, no matter where you get it. What questions should you be asking? What red flags should make you pause—or run? And how can you walk into your next appointment calm, confident, and clear instead of anxious and second-guessing everything? In this episode, we uncover: Why so many women feel dismissed or gaslit during hormone-related doctor visits. How to approach hormone conversations without feeling awkward, emotional, or intimidated. What good hormone care actually includes beyond "your labs look normal." How to spot red flags and green flags in hormone providers and clinics. Why understanding hormones changes your confidence and long-term health outcomes. Tune in and let's change the way you show up for your body! Sponsors Get 20% off your Cozy Earth Bed Sheets and entire store with coupon code HORMONES Coupon KM20 to get 20% off your order of Vitali Skin Care! Get 15% off our Velvet V Vaginal Moisturizer with coupon code "Vagina" at checkout. Are you in perimenopause or postmenopause and struggling with symptoms—but not getting the support you deserve? At Midlife Solutions, we specialize in hormone optimization for women in midlife. Our all-female clinical team offers telehealth care across all 50 U.S. states, with the ability to prescribe bioidentical estrogen, progesterone, testosterone, and thyroid medication. Book your FREE Hormone Discovery Call Find out what's really driving your symptoms and what your next best steps are. Visit the website: https://karenmartel.com Shop the Midlife Solutions Store Over-the-counter bioidentical hormone creams and oils — no prescription needed. Including: • Progesterone • Estrogen Face Cream • Vaginal Moisturizer and more! Take the Hormone Quiz Discover hidden hormone imbalances that could be driving your symptoms. Get personalized results (and yes, they may surprise you). Women's Peptide Weight Loss Program Clinically guided, hormone-aware weight loss for midlife women. Midlife RESET HRT Program A complete, supportive approach to hormone replacement therapy in midlife. Your host: Karen Martel Certified Hormone Specialist, Transformational Nutrition Coach, & Weight Loss Expert Karen's Facebook Karen's Instagram
Behavior-based interventions (sometimes under the auspices of lifestyle medicine) can be evidence-based, health-supporting, and weight-neutral. Unfortunately, when it comes to recommending behavior-based interventions to higher-weight people, there are common mistakes that providers make. We'll talk about the mistakes and then what patients and providers can do to avoid and/or navigate them. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
The emergence of Moltbot, an open source AI agent designed to operate across various messaging platforms and automate tasks through local device execution, is creating new risk vectors for MSPs and IT providers. Functioning with admin-level access and connecting to services like OpenAI and Google, Moltbot's deployment has raised direct concerns around authority delegation without sufficient governance. Security researchers identified hundreds of exposed Moltbot instances, often due to misconfiguration, increasing the possibility of breaches and unauthorized data access. The episode underscores that these agents, treated as productivity tools, actually represent operational infrastructure capable of independent action, with potential impacts on client trust and regulatory liability.Expert sources cited in the discussion, including Cisco and Hudson Rock, have labeled Moltbot a security risk due to its storage of sensitive information in plain text and broad access permissions. The narrative warns that vendors and providers may underestimate the risks by normalizing deployment before establishing proper controls. Once these agents are embedded into workflows, reversing their use becomes difficult due to client reliance on perceived efficiency. The lack of mature governance frameworks, as shown by studies from Drexel University, means that many organizations lack even basic oversight of these autonomous agents.Adjacent industry developments highlight additional layers of operational complexity. Apple posted a 16% revenue increase, led by iPhone demand, and acquired Q AI to deepen its ambient automation capabilities, while shifting defaults that providers cannot easily influence or control. Simultaneously, the Linux community's succession planning and Microsoft's ongoing struggles with Windows 11 reliability further demonstrate systemic issues around authority, trust, and transparency in technology ecosystems.The episode's analysis signals clear expectations for MSPs and technology leaders: explicit approval protocols for AI agents are necessary, akin to traditional admin controls. Providers must proactively define governance boundaries, anticipate non-billable labor resulting from automation failures, and assess vendor behavior in terms of roadmap rigidity and escalation pathways. Teaching clients about authority in automated environments, not just managing installations, will reduce exposure and clarify accountability as agentic technologies become standard.Three things to know today00:00 Moltbot's Rise Highlights How AI Agents Are Becoming High-Risk Operators Without Governance03:49 Record iPhone Sales and a $2 Billion AI Acquisition Signal Apple's Long-Term Control Strategy06:04 Leadership Succession, Software Trust, and AI Agents Reveal a Shared Governance ProblemThis is the Business of Tech. Supported by: ScalePad
France's decision to discontinue American collaboration platforms such as Zoom and Microsoft Teams for government use—replacing them with the domestically developed Vizio platform—signals a shift toward digital sovereignty and data control within regulated jurisdictions. This move, formalized as part of France's Suite Numerique and to be implemented by 2027, highlights the increasing fragmentation of technology policy where national governments assert authority over platform selection and sensitive data handling. The development underscores operational risk for MSPs and IT service providers as assumptions of technology homogeneity across regions become unreliable.Supporting these shifts, South Korea enacted the world's first comprehensive AI legislation, requiring mandatory labeling of AI-generated content and risk assessments for high-impact systems, such as those in hiring and healthcare. According to the transcript, 98% of AI startups in South Korea report they are not prepared for compliance. Both developments reveal a pattern: early regulatory efforts tend to produce vague requirements, unclear enforcement, and real operational complexity. Providers operating in multiple jurisdictions must now anticipate compliance fragmentation and increased overhead as regulatory regimes diverge.Additional analysis focused on the continued evolution of the managed services stack, particularly through the lens of AI and workflow automation. Companies like Thrive are investing in enterprise platforms that embed AI-driven reasoning within workflow tools, shifting coordination away from traditional PSA ticketing systems. Meanwhile, integrations such as Quark Cyber with ScalePad's Lifecycle Manager X, and new partnerships between ServiceNow, TeamViewer, Anthropic, and OpenAI, illustrate a market splitting between providers focused on standardization and those managing more complex, enterprise-like environments. Microsoft's financial results further highlighted this trend, with record capital expenditure on AI infrastructure and increased reliance on proprietary chips to reduce dependency on external vendors like Nvidia and OpenAI.For MSPs, these developments raise practical governance and accountability questions. Shifts in regulatory authority and technology platforms create increased risk exposure for providers that do not proactively manage cross-jurisdictional compliance and secure defaults. Vendors are tightening control over platforms as AI becomes central to product architecture, often prioritizing internal risk management over shared upside with partners. Providers that fail to enforce robust data governance, understand cost drift, or plan for architectural lock-in are positioned less as strategic advisors and more as absorbers of client and vendor risk.Four things to know today00:00 France's Platform Ban and South Korea's AI Law Show Regulation Catching Up to Technology04:23 AI Is Reshaping the MSP Tool Stack as Thrive, ServiceNow, and ScalePad Take Different Paths07:37 Microsoft's SMTP AUTH Delay and CISA's AI Slip Show the Risk of Optional Security ControlsAND10:26 Earnings Show Microsoft Turning AI From Feature to Infrastructure as Partner Risk GrowsSponsored by: TimeZest
When the FDA removed GLP-1s from the shortage list, many were unsure whether compounded versions could still be prescribed. In this episode, hosts Brad and Michael share the story of a medical weight loss clinic and the fallout after these drugs were removed from the shortage list. Tune in to learn how regulatory shifts, misinformation, and risk management collide in modern medicine. Find out how practices can navigate evolving regulations and avoid pitfalls when prescribing compounded weight loss drugs.Chapters00:00 Intro 00:50 Banter 04:34 Story 17:18 Access+ 17:48 Legal Takeaways 30:07 OutroWatch full episodes of our podcast on our YouTube channel: https://www.youtube.com/@byrdadatto Stay connected for the latest business and health care legal updates:WebsiteFacebookInstagramLinkedIn
Mental health providers aim to reach more men If you are a millennial, you likely remember dial-up internet, flip phones and being told that education was the key to stability. But for many born between 1981 and 1996, adulthood arrived with the Great Recession, student loan debt and a job market filled with uncertainty. Those factors may help explain why this generation reports higher levels of anxiety, depression and burnout than previous generations. Not everyone who experiences mental health challenges is willing to seek help, especially men. Some mental health professionals hope to reach reluctant men, particularly millennial men, where they are. Wednesday on the “Sound of Ideas,” local experts will explore the mental health challenges facing this group and what meaningful change could look like. Guests: - Jake Ross, Licensed Independent Social Worker & Owner, The Ross Wellness Group - Walter Patton, Executive Director, Ghetto Therapy - Neel Parekh, M.D., Clinical Assistant Professor, Urology, Cleveland Clinic - Jessica Vazquez, Prevention & Wellness Manager, School Health Program, MetroHealth "Missing Sam" by Thrity Umrigar Later in the hour, we're joined by Northeast Ohioan and best-selling author Thrity Umrigar. Her latest novel centers on a woman named Sam from Cleveland Heights who goes missing during an early morning run. Her wife, Ali, is shaken by the disappearance and suspected by some in the community. Ideastream Public Media's Carrie Wise spoke with Umrigar about “Missing Sam,” which explores how prejudice can spread in the wake of a tragedy. Guests: - Thrity Umrigar, Author, "Missing Sam" - Carrie Wise, Deputy Editor of Arts & Culture, Ideastream Public Media
In this episode of The Dish on Health IT, host Tony Schueth, CEO of Point-of-Care Partners (POCP), is joined by colleagues Mary Griskewicz, Regulatory Resource Center Lead, and Janice Reese, Senior Consultant and Program Manager of FHIR at Scale Taskforce (FAST), for a wide-ranging discussion on two major proposed rules released in mid-December 2025: the HTI-5 proposed rule from the Assistant Secretary for Technology Policy (ASTP) and CMS's latest proposal on healthcare price transparency.Rather than treating these rules as abstract policy exercises, the conversation focuses on what the government is trying to accomplish, how these proposals may reshape the interoperability and data access landscape, and why stakeholder participation during the comment period is not optional if the industry wants workable outcomes.Setting the Stage: How Proposed Rules Become RealityThe episode opens with a level set for listeners who do not spend their days in the Federal Register. Mary walks through how proposed rules originate, typically from legislation or executive policy, and how they move from proposal to public comment to either a final rule, an interim final rule, or, in some cases, a complete pause or reset.She emphasizes a point that often gets overlooked: every public comment is read and reviewed. The agencies group and analyze the comments section by section and respond to themes and concerns in the final rule text. Janice builds on this by explaining that the comment period is where high-level policy intent meets operational reality. The most effective comments are not lengthy manifestos, but specific, experience-based feedback that highlights feasibility issues, sequencing challenges, and unintended consequences.HTI-5: From Experimentation to ExecutionThe discussion then turns to HTI-5, with Mary outlining the core problem the rule is trying to address. Prior certification requirements placed a significant burden on vendors, often locking innovation into long development cycles while the market waited for updates. HTI-5 seeks to modernize this approach by reducing prescriptive certification requirements and relying more on modern, open architecture, particularly FHIR-based APIs, to enable faster, more scalable data exchange.Janice frames HTI-5 as a clear signal that the industry is moving out of the experimentation phase and into execution. By reinforcing a “FHIR-first” direction while pulling back on some certification detail, the rule implicitly raises expectations for real-world performance. As FHIR becomes the default, security, identity, consent, and trust cannot be treated as optional or inconsistently implemented components.From a FAST perspective, this shift is critical. HTI-5 creates the regulatory space, but the infrastructure and implementation guidance needed to make trusted interoperability work at scale must come from industry-led collaboration. Janice explains that FAST's work on security, identity, consent, and national directory services is about operationalizing trust so organizations are not reinventing these foundations on their own.Information Blocking, Automation, and Trust at ScaleA pivotal moment in the conversation centers on HTI-5's clarification that information blocking explicitly includes automated and AI-driven access. Mary underscores that automation is now central to how data moves across the healthcare ecosystem. When access decisions are embedded in APIs, workflows, and algorithms, trust becomes the defining requirement.Janice expands on this by noting that the issue is not just whether data can be accessed, but whether access is appropriate, provable, and governed. As automation increases, expectations shift toward accountability, auditability, and consistent enforcement of identity and consent. FHIR APIs, once viewed as certification checkboxes, are becoming the primary channel for data exchange across networks, including consumer-facing applications.Stakeholder Impacts: Vendors, Providers, and PayersThe episode then walks through how HTI-5 affects different stakeholder groups. For health IT vendors and digital health companies, Janice describes a trade-off: fewer certification guardrails provide flexibility but also remove a layer of protection. Vendors will be judged less on formal compliance artifacts and more on how their systems perform across networks at scale, including security, identity management, and reliability.Mary cautions that vendors should not interpret HTI-5 as traditional deregulation. With HTI-6 already on the horizon, organizations that underinvest now risk facing more stringent outcome-based expectations later. Tony reinforces this point, arguing that the real risk is collective. A single high-profile failure due to weak security or identity practices could undermine trust across the ecosystem and invite a regulatory response that affects everyone.For providers and health systems, the shift means becoming more informed consumers of technology. Certification alone will no longer guarantee interoperability or trustworthiness. Providers will increasingly need to ask vendors how solutions perform in environments beyond a single one and how identity, consent, and security are handled across organizational boundaries.From a payer perspective, Mary explains that while HTI-5 does not directly change prior authorization requirements, it fundamentally reshapes the data access environment. As FHIR APIs become the default, plans will be expected to exchange data more dynamically and through automated workflows. This raises expectations around timeliness, quality, and trust, and accelerates a shift from managing transactions to managing trust at scale.Price Transparency: Compliance Without ClarityThe conversation then transitions to CMS's proposed price transparency rule, with Tony noting the absence of POCP's usual price transparency expert and setting expectations for a higher-level discussion. Mary explains that this tri-agency proposal builds on earlier rules by clarifying standards, easing some reporting burdens, and refining requirements around machine-readable files, metadata, and reporting timelines.While these changes offer some relief to plans, Janice highlights a deeper challenge. Making pricing data available does not make it meaningful. Without consistent ways to connect clinical concepts to billing codes and pricing structures, patients and employers are left with technically accurate but practically unusable information. True transparency will require better integration of pricing data into real-time workflows, supported by APIs, governance, and trust frameworks.Mary also reminds listeners that employers are a critical stakeholder often overlooked in these discussions. As purchasers of coverage, they rely on usable pricing data to understand utilization and manage costs, making their perspective essential during the comment period.The Closing Message: Comment, Participate, Get InvolvedThe episode closes with a strong call to action. Mary urges listeners to “get off the bench” and engage, regardless of which rule is at issue. Comment periods directly affect compliance programs, product roadmaps, and competitive positioning. Janice reinforces that policy alone cannot solve interoperability challenges. Progress depends on shared implementation guidance, testing, governance, and sustained participation in standards organizations and multi-stakeholder initiatives, including FAST.The final takeaway is clear: HTI-5 and the price transparency proposal are not just regulatory events. They are inflection points. Organizations that participate now can help shape outcomes that are achievable, scalable, and trusted. Those that sit out will be left reacting to decisions made without their operational realities at the table.Listeners are reminded that both proposed rules have comment deadlines in late February, and that POCP is available to support organizations in understanding the implications and crafting effective comments. The episode closes, as always, with the reminder that Health IT is a dish best served hot.
Most practice owners assume culture problems show up loud — missed numbers, complaints, chaos. But what if the real danger shows up when everything looks successful?In this PPOClub Workshop interview, Adam Robin sits down with April Atchison, CCC-SLP, to unpack a real-life leadership story that every growing practice owner needs to hear. April shares how her multi-location practice appeared stable and thriving — strong revenue, expanding staff, leadership in place, and real work-life balance — right up until subtle cultural cracks began to surface.What followed was one of the most difficult seasons of her career: recognizing leadership misalignment, addressing cultural drift head-on, and ultimately losing four long-term providers — including a clinical director. Instead of avoiding the storm, April chose decisive leadership, values-based clarity, and fast action to protect the future of her organization.This conversation goes far beyond theory. It's a behind-the-scenes look at what actually happens when an owner chooses culture over comfort — and how doing so can unlock stronger teams, higher ownership, and renewed momentum.In this episode, you'll learn:The quiet warning signs of culture breakdown most owners overlookWhy high productivity can hide serious leadership misalignmentHow to run clarity and alignment conversations without fearWhen acting fast protects your best team members — not just the businessWhy losing people can sometimes strengthen culture and performanceHow proactive recruiting creates leverage before you need itWhat decisive leadership looks like when the stakes are highHow rebuilding after disruption leads to stronger ownership and accountabilityIf you've ever felt uneasy despite “good numbers,” delayed a hard conversation because things looked fine, or wondered whether holding the line on values is worth the risk — this episode will give you clarity, confidence, and a leadership framework you can apply immediately.
John Schoen, Senior Clinical Manager of Evidence-Based Medicine and Drug Information in Vizient's Center for Pharmacy Practice Excellence and Vizient's vaccine subject matter expert, joins host Stacy Lauderdale to discuss key updates to the CDC's childhood Immunization schedule and what they mean for practice. Guest speaker: John Schoen, PharmD, BCPS Senior Clinical Manager of Evidence-Based Medicine and Drug Information Vizient Center for Pharmacy Practice Excellence Host: Stacy Lauderdale, PharmD, BCPS Associate Vice President Vizient Center for Pharmacy Practice Excellence Verified Rx Host 00:00 — Introduction Announcer welcomes listeners to Verified Rx, produced by the Vizient Center for Pharmacy Practice Excellence. 00:14 — Episode Overview Host Stacy Lauderdale introduces the topic: updates to the CDC's U.S. Childhood Immunization Schedule, revised January 20, 2026. Goal of the episode: explain what changed, what didn't, and what it means in practice for providers, pharmacists, and families. Guest: John Schoen, Senior Clinical Manager of Evidence-Based Medicine and Drug Information at Vizient and vaccine subject matter expert. 01:16 — What Changed in the CDC Immunization Schedule CDC reorganized the schedule into three recommendation categories. Vaccines were reclassified, not removed. Number of diseases covered under “routine” recommendations decreased from 17 to 11 due to recategorization. 01:50 — Stated Rationale Behind the Changes Rationale provided in executive summary of scientific assessment. The supporting scientific assessment is available online and referenced for transparency (link in resources below). 03:19 — Were Any Vaccines Removed? No vaccines were removed from the CDC schedule. Some vaccines were shifted into different recommendation categories. 03:40 — Category 1: Routine Childhood Vaccinations Vaccines still routinely recommended for all children include: MMR (measles, mumps, rubella) Polio Tdap / DTaP Hib (Haemophilus influenzae type B) Pneumococcal HPV Varicella (chickenpox) 04:27 — Category 2: Vaccines for High-Risk Populations Vaccines recommended for children who meet specific high-risk criteria: RSV monoclonal antibodies (mAb) Hepatitis A Hepatitis B Quadrivalent meningococcal Meningococcal group B Dengue 05:19 — What Changed vs. Stayed the Same Hepatitis A, Hepatitis B, and quadrivalent meningococcal moved from routine to high-risk RSV mAb recommendations are effectively unchanged, as high-risk infants are defined as those born to mothers who did not receive the maternal RSV vaccine. Dengue remains risk-based. Meningococcal group B remains a mix of risk-based and shared clinical decision-making. 06:31 — Category 3: Shared Clinical Decision Making (SCDM) Defined by ACIP as an individualized decision made jointly by provider and parent/guardian. Allows vaccination when risk-based criteria are not met but benefit is still considered. 06:52 — Vaccines Under SCDM Vaccines now include: Influenza COVID-19 Rotavirus Hepatitis A Hepatitis B Quadrivalent meningococcal Meningococcal group B 08:05 — What's New in SCDM Influenza and rotavirus moved from routine to SCDM. Hepatitis A, hepatitis B, and quadrivalent meningococcal also shifted. COVID-19 moved to SCDM in September 2025 for individuals ≥6 months. 08:28 — Insurance Coverage Implications No expected changes in coverage. Vaccines recommended by CDC as of December 31, 2025 remain: Covered without cost-sharing under Affordable Care Act (ACA) plans. Covered by Medicaid, Children's Health Insurance Program (CHIP), and Vaccines for Children (VFC) program. 09:14 — Impact on Pharmacy Vaccine Access Pharmacists are considered healthcare providers under CDC SCDM definitions. Authority to administer vaccines primarily determined by state laws. Standing orders, protocols, and collaborative practice agreements may need to be updated, as applicable, to address language related to ‘routine' immunizations for children. 10:27 — Recommendations for Providers & Organizations For providers: Become familiar with schedule changes. Be prepared for patient and parent education. Recognize differences between CDC and other professional guidelines. For organizations: Review EHR documentation and order sets. Consult local state regulations to ensure compliance with vaccine administration practices. Review standing orders/protocols and collaborative practice agreements to determine if revisions are needed. Monitor vaccine utilization and adjust inventory accordingly. 11:24 — Resources & Closing Additional CDC and Vizient resources will be linked in the show notes. Announcer closes with subscription and feedback reminder. Links | Resources: Additional resources HHS press release on changes to childhood immunizations schedule Assessment of US childhood and adolescent immunization schedule HHS fact sheet: CDC childhood immunization schedule Revised CDC child and adolescent immunization schedule ACIP shared clinical decision-making recommendations Vizient resource Minute Market Insight VerifiedRx Listener Feedback Survey: We would love to hear from you - Please click here Subscribe Today! Apple Podcasts Spotify YouTube RSS Feed
The supply chain of contingent labor requires that staffing providers have the financial ability to meet the needs of their clients and organizations. Like any business, recruitment and staffing companies must meet their operational requirements even before the revenue starts rolling in. Providers need a financing partner that can stand by them through the ups and downs of the labor market.Raul Esqueda, President of 1st Commercial Credit, stops by the HRO Today Educational Podcast Series to discuss receivable financing in the provider space. Together with host Elliot Clark, CEO of HRO Today, they discuss the nuances and challenges of financial backing for B2B clients and share how financing companies, such as 1st Commercial Credit, support providers looking to grow their businesses.Listen in as Raul and Elliot explore the financial pressures that staffing providers face and define what a good financial partner looks like.For more podcasts and award-winning HR reporting, visit hrotoday.com
New abortion restrictions target in-state and out-of-state providers and add reporting requirements for doctors. Indiana students join national walkouts to protest the Trump Administration's first full year in power. Lawmakers once again take up efforts to dissolve or combine some smaller township governments. Host Jill Sheridan is joined by Republican Mike O'Brien, Democrat Robin Winston, Niki Kelly of the Indiana Capital Chronicle, and Jon Schwantes of Indiana Lawmakers to debate and discuss some of this week's top stories.
Every time I go on the interwebs, there seems to be an ongoing battle between manual therapy providers as to what is the best and most effective treatment method to apply to a chronic injury, with the hopes of getting long-lasting pain relief, with each provider believing their treatment to be superior and that any other provider is absolute garbage.In this episode, I dive into the concept that a chronic injury needs a team effort, but making sure that the first provider does quality soft tissue-based treatment is the key to achieving long-lasting pain relief.I hope you gain some new ideas and perspectives from the show.--------We just launched our new, free soft tissue injury evaluation and treatment training, The Peak Injury Treatment Method.It is the first step in learning how to cut your treatment times in half and easily double your income so you can avoid burnout and help more people get out of pain!If you want to download the training for free, with no strings attached, just click the link below ⬇️Click Here To Download Free TrainingPlease consider joining our 'Soft Tissue Treatment Revolution' community on Facebook, where it's much easier to engage as a group. It's an awesome group on Facebook, covering topics in Injury Evaluation, Treatment, Client Communication, Practice Marketing, Increasing Sales, Scaling Business, and a few other topics of interest in the Soft Tissue Injury Space.As always if you want to be part of the soft tissue revolution here's what you need to do:1. Visit our Facebook Group Page by clicking here
The 80/20 Principle of Running a Cash-Based PT Clinic In this episode of the PT Entrepreneur Podcast, Dr. Danny Matta breaks down the 80/20 principle for cash-based clinic owners and simplifies what you should track if you want to grow past yourself. Instead of obsessing over dozens of metrics, Danny argues there are three "dollar productive" KPIs that drive almost all clinic growth. He also explains why provider schedules either snowball fast or stall for a year and how to shorten that ramp from 12+ months to around six months with the right focus. In This Episode, You'll Learn: How Claire can save staff clinicians hours each week and translate that time into meaningful revenue What the 80/20 principle means inside a cash-based clinic The concept of "dollar productive activities" and why it matters The three KPIs Danny thinks drive the majority of clinic growth Why the owner should usually handle discovery calls during growth phases Benchmarks for conversion rates at different stages of scale Why recurring services are the "sneaky" variable that stabilizes schedules How to get a new provider productive faster so clinic growth compounds Claire: Turn Saved Time Into Revenue Without Burning Out Your Team Danny opens with a simple math breakdown clinic owners can understand quickly. Time is valuable, for you and for your staff clinicians. PT Biz has found that Claire, their AI scribe, saves staff clinicians about six hours per week on average. Even if you only reclaim half of that time and convert it into patient care, that is roughly three additional one-hour visits per week per clinician. Example Danny gives: 3 extra visits per week $200 average visit rate $600 more per week per clinician Roughly $30,000 per year in additional revenue per clinician The point is not to overload your team. The point is to use technology to remove the documentation burden so you can increase capacity without increasing burnout. Try Claire free for 7 days: https://meetclaire.ai The 80/20 Principle in a Cash Practice The 80/20 principle is the idea that 20% of your actions lead to 80% of your results. Danny applies this directly to clinic growth. When your clinic is small, it is easy to get busy doing "everything" and tracking a long list of numbers. The problem is most of those activities do not move the business. Instead, Danny recommends narrowing your focus to the most "dollar productive" activities. In other words, the actions and metrics that actually drive revenue and schedule utilization. The Goal: Get a Provider Productive Fast Danny frames the big objective clearly. You want to get your own schedule full enough to hire someone. Then you want any provider you hire to get productive as fast as possible. In PT Biz's world, once a provider reaches roughly 80 to 90 visits per month, it tends to snowball into 100+ pretty quickly. But getting to that point can take some clinics over a year. If you can shorten that ramp to six months, your growth compounds. In a year, you might be able to hire two people instead of one, because each provider becomes profitable faster. The Three Dollar-Productive KPIs Danny says there are three key metrics that drive the majority of growth in a cash-based clinic. Each one represents a drop-off point that can either accelerate growth or quietly crush it. 1) New Patient Volume and Discovery Call Conversion Many owners only track "how many evals we have." Danny says you need to go one step back and track conversion from lead to evaluation. There is often a major drop-off between someone becoming a lead and actually booking an evaluation. This is usually happening on discovery calls. Benchmarks Danny shares: During growth, aim for 8 to 10 new patients per provider per month Once stable, new patient volume can drop closer to 5 per month Discovery call to eval conversion should be 70%+ He also makes a strong recommendation: during growth phases, the owner should handle discovery calls. Why? In many clinics, admins convert around 45% to 50%. Owners often convert 80% to 90% because they carry authority and can handle objections better. Danny gives an example: 20 discovery calls at 50% conversion = 10 evals 20 discovery calls at 80% conversion = 16 evals That gap can be the difference between a provider staying empty and a provider getting busy quickly. He also points out that owners sometimes resist this because it feels like a step backward, but the time requirement is smaller than most people assume. If you have 20 calls at 20 minutes each, that is under 10 hours per month and it can dramatically impact growth. 2) Evaluation to Plan of Care Conversion The second KPI is how many evaluations convert into a plan of care. When people do not commit to a plan of care, Danny says many still come back a few times, often around three visits, until symptoms improve and then they disappear. That creates unpredictable revenue and inconsistent schedules. Plan-of-care conversion makes volume and revenue more predictable. Benchmarks Danny shares: Owner: 70% conversion from eval to plan of care Staff providers: 60% conversion is a strong benchmark at scale He emphasizes that this requires quality control and training. Staff clinicians need to be comfortable with diagnosis, prognosis, and presenting a clear plan. Otherwise close rates drift and schedules stall. 3) Recurring Services After Plan of Care Danny calls this the sneaky variable that people forget, but it can make the biggest difference in schedule stability. Hiring a clinician is usually a net negative for the business at first. You are paying salary, taxes, and benefits while they are still ramping up. What stabilizes and compounds a provider schedule is recurring volume. The goal is that roughly 40% of plan-of-care patients transition into some type of recurring service after discharge. Why this matters: Recurring visits fill a predictable chunk of the schedule New patient volume no longer has to carry the whole load Providers get to work with people they enjoy long term It is mentally easier than constant evaluations Danny also explains why this is often hard for staff clinicians. They may feel uncomfortable "selling" ongoing support because they never did it in insurance clinics They may not know what to do clinically once a plan of care ends So this requires two things: education on the clinical delivery of recurring services and training on how to present it confidently. Put It Together: How to Grow Faster Without Tracking Everything Danny's bigger point is that clinic owners often get lost in too many tasks and too many numbers. If you simplify down to these three KPIs and train your team around them, your odds of building provider schedules faster go up dramatically: Discovery call conversion (lead to eval) Eval to plan-of-care conversion Plan-of-care to recurring conversion When those are strong, growth compounds. You hire faster, providers get productive faster, and you get to choose what you want the clinic to become instead of being stuck trying to "just get busy." Resources Mentioned Try Claire free for 7 days: https://meetclaire.ai Talk with a PT Biz advisor: https://vip.physicaltherapybiz.com/discovery-call Join the free Part Time to Full Time 5-Day Challenge: https://physicaltherapybiz.com/challenge
Sarah Halko, Head of Regulatory and Industry Relations at TNS, joined Doug Green, Publisher of Technology Reseller News, for a Cloud Communications Alliance (CCA) podcast focused on the FCC's Do Not Originate (DNO) mandate and its role in combating robocalls and caller ID spoofing. Halko explained that DNO (Do Not Originate) identifies phone numbers that should never be used for outbound calling—such as invalid, unallocated, or inbound-only numbers like government agencies. Blocking calls that spoof these numbers allows service providers to stop obvious fraud earlier in the call path, before it reaches consumers. While DNO began as an optional tool in 2017, regulatory expectations have steadily increased. As of December 15, 2025, every service provider in the call flow must maintain a “reasonable DNO list,” making accurate, up-to-date data essential for compliance. “Without reliable, authoritative numbering data, service providers can't confidently determine which calls should be blocked,” Halko said. “DNO compliance ultimately depends on knowing how numbers are assigned, used, and routed in real time.” TNS supports providers by delivering trusted, continuously updated numbering and routing intelligence across the U.S., Canada, and the Caribbean. This enables earlier, more accurate call blocking and reduces the risk of false positives or missed fraudulent traffic. Looking ahead, Halko emphasized that DNO is only one part of a broader trust framework that also includes analytics, traceback, authentication (STIR/SHAKEN), and Know Your Customer practices—all working together to protect network integrity. Learn more: https://tnsi.com/
Randy Dillard, Sales and Transaction Tax Lead at TaxConnex, joined Doug Green, Publisher of Technology Reseller News, for a Cloud Communications Alliance (CCA) podcast focused on one of the most complex—and often underestimated—issues facing cloud communications providers today: telecommunications tax compliance. Dillard explained that TaxConnex serves as a specialized outsourcing partner for telecom and transaction tax compliance, working closely with regulatory experts to deliver a unified approach that spans sales and use tax, telecom-specific taxes, and state and local filing obligations. Unlike general accounting firms, TaxConnex is purpose-built for the telecom and cloud communications industry, where tax requirements can extend far beyond state-level filings into counties, cities, and even ZIP-code-level jurisdictions. He emphasized that telecom taxation is fundamentally different from standard sales tax, with layered obligations that can include “tax on tax,” recurring billing changes, credits, and constant regulatory updates. With more than 50 states, thousands of local jurisdictions, and frequent filing deadlines, providers face significant risk if compliance processes are not handled accurately and consistently. Dillard also stressed the importance of timing, noting that providers should engage a telecom tax specialist before launching new services or expanding into new markets—not after revenue is already flowing. “It often makes sense to pause and speak with a telecom tax advisor before you open that honeypot,” Dillard said. “Understanding your obligations upfront can save you from costly penalties, audits, and surprises down the road.” TaxConnex's role, he explained, goes beyond filing returns. The company provides monthly tax liability reporting that shows what has been collected, where it is assigned, and how it will be remitted—giving providers visibility and confidence that nothing is slipping through the cracks. This becomes even more critical as AI-driven services and usage-based models create unexpected spikes in transactions and tax exposure. As an active member and sponsor within the Cloud Communications Alliance, TaxConnex views its role as helping demystify telecom tax compliance so providers can focus on growth, innovation, and customer success—while staying compliant in an increasingly complex regulatory environment. Learn more: https://www.taxconnex.com/
“Effective Marketing for Pelvic Floor Providers”If you're a pelvic floor provider who's tired of waiting on referrals, feeling invisible online, or wondering why your marketing isn't bringing in consistent, paying clients… this episode is going to shift everything.Today, we're breaking down the exact marketing strategies cash-based providers are using to grow profitable, purpose-driven practices — without relying on insurance, physicians, or word-of-mouth luck.Inside this episode, you'll learn:
Longevity, Cash PT, and Skating Where the Puck Is Going In this episode of the PT Entrepreneur Podcast, Doc Danny talks about why he keeps coming back to one big theme: longevity. He looks at how the market around proactive health, functional medicine, and long-term performance is exploding and why cash-based clinics are perfectly positioned to play a major role. If you want to move beyond "fix the injury and discharge" and build an ongoing longevity offer, this episode lays out the opportunity and the mindset behind it. In This Episode, You'll Learn: Why patient experience is a competitive edge in cash-based practices How Claire gives you an operational advantage your patients can actually feel Why Danny has always tried to "skate where the puck is going" in healthcare How cash-based PT went from rare to common in a decade Why functional medicine and longevity clinics are booming The role PTs can play as movement-focused, accountability-driven "quarterbacks" How one training partner's transformation turned into a walking case study Why generational health change makes this work bigger than a single patient Ways to start building or partnering into a longevity offer inside your clinic Claire: The Patient-Experience Edge in a Cash Practice Danny opens by talking about what really matters in a cash-based clinic: patient experience. When people are paying out of pocket, they notice everything. He makes a simple comparison: While your competitors step out mid-session to catch up on notes, you stay fully engaged. While they stay late at the clinic finishing documentation, you are following up with patients and planning their next visits. That is the competitive edge Claire gives you. Claire is PT Biz's AI scribe, trained specifically for physical therapists. It handles your documentation instantly in the background, so your time and attention stay on your patient, not on your EMR. The result: Better in-room experience Better retention and follow-up Smoother, more efficient operations Try Claire free for 7 days: https://meetclaire.ai Skating Where the Puck Is Going Danny has always tried to pay attention to where health and wellness are headed, not just where they are today. Back in 2014, when he and his wife opened Athlete's Potential in Atlanta, cash-based PT clinics were rare. He only knew of one other in the city, but he saw more and more of them popping up on the West Coast, especially in California. That was his signal that a trend was forming. Fast forward more than a decade and there are now dozens of cash-based clinics in Atlanta alone. Many of them are true businesses with teams, multiple locations, and the kind of systems that support seven-figure revenue and even sales to private equity or hospital groups. That bet — skating to where the puck was going — paid off. The Next Wave: Longevity and Proactive Health Now, Danny sees a similar wave building around longevity and proactive healthcare. He shares the story of a training partner he has worked out with for the past couple of years. Together they have tracked: Blood panels year over year Body composition with tools like InBody Sleep and recovery data using wearables like Whoop The changes in that friend's biomarkers, physical capacity, and day-to-day energy have been dramatic. Friends who have known him for years almost do not recognize how much healthier and more capable he is. That kind of transformation is exactly what more people are starting to want. And the broader market is responding. Functional Medicine and Longevity Are Booming Danny points to the rapid growth of functional medicine, lifestyle medicine, and longevity-focused services as a sign this is not a fad. He has seen: Naturopathic and functional medicine clinics expanding quickly Providers leaving hospital systems to start proactive, integrative practices High-end gyms and programs charging tens of thousands per year for bundled health, testing, training, and recovery When he first looked for a functional medicine provider in Atlanta, there was one very expensive option. Today there are multiple. Even family members of his who were deeply rooted in traditional medical systems have shifted into functional and lifestyle medicine because they want to help people earlier, not just when they show up critically ill. The PT's Role in the Longevity Ecosystem Danny is clear: he is not saying physical therapists should try to become functional medicine doctors. Instead, he sees a natural lane where PTs can win: Movement and musculoskeletal health experts Accountability partners who help people actually implement changes Educators who can translate research and trends into safe, practical steps He has already tested this in small ways at Athlete's Potential — reviewing blood panels, talking through sleep data, adjusting training, and updating exercise programs over months and years as patients move from "out of pain" to "performing and staying healthy." For some people, that relationship has lasted for years, shifting from acute rehab to long-term physical and lifestyle coaching. Blue Ocean: Ongoing Longevity Coaching for the Right People Danny describes this longevity space as a "blue ocean" for the right clinics: There are more and more people who want proactive help with their health. There are relatively few trustworthy, movement-focused providers offering it in a structured way. He draws a line between evidence-based functional and lifestyle medicine providers and more fringe offerings that are heavy on hype and light on science. A clinical background, understanding of research, and experience with musculoskeletal care give PTs a strong foundation to cut through the noise for their patients. And you do not have to do it alone. You can: Build your own longevity-style continuity offer inside your clinic, or Partner with functional medicine or lifestyle medicine providers and stay focused on movement, strength, and physical capacity. Generational Health Change One of the most powerful parts of Danny's story is the ripple effect he has seen in his training partner's life. By changing his own habits — training, sleep, stress management, nutrition — that friend has also influenced his entire family and friend group. Kids see what their parents do and assume it is normal. Friends see what someone has done for their health and start asking questions. Danny calls this "generational health change." You are not just helping one person feel better. You are changing what feels normal for the people around them, including their kids. From "Your Knee Feels Better" to "What Do You Want Life to Look Like at 80?" So what does this look like in a practical way inside your clinic? Danny suggests starting with a simple shift in conversation once an injury is under control: Talk about how long they want to be functional and independent. Ask what they want life to look like in their 70s and 80s. Use the older adults you have seen on both ends of the spectrum as examples. From there, you can start to build ongoing support — programming, check-ins, movement testing, and education — that helps them move toward that long-term vision instead of just away from short-term pain. Is Longevity a Fit for Your Clinic? Danny is not saying every clinic has to add a longevity offer. If you like what you are doing now and your business is healthy, that is okay. But he does believe this is where a big part of the market is heading. People are more aware, more curious, and more willing to invest in staying capable longer. For clinics that want to play in that space, now is the time to start paying attention and experimenting. Resources Mentioned Try Claire free for 7 days: https://meetclaire.ai Talk with a PT Biz advisor about your clinic and offers: https://vip.physicaltherapybiz.com/discovery-call Join the free PT Biz Part Time to Full Time 5-Day Challenge: https://physicaltherapybiz.com/challenge
Okay. This show today is part of our Relentless Health Value "The Inches Are All Around Us" series. This Inches Talk is a metaphor for finding all those little places where there is healthcare waste as a first step in an effort to excise all these little pockets of waste. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. Shane Cerone said this phrase during episode 492, and I loved it because there are inches all around us for sure. And the thing with all these inches that we're gonna talk about today and last week and next week and the week after that, yeah, these are inches that actually you could cut them. And there are millions and billions of dollars, and you actually improve patient care. You improve clinical team experience. Also, you're cutting out friction and making it easier to do the right thing to care for patients. These are no-brainer kinds of stuff if your North Star is better and more affordable patient care, but they are also somebody else's bread and butter in a "one person's cost is another person's revenue" kind of way. So, yeah … what makes perfect common sense might not be as easy as it might look on paper, as we all know so well. So, last week we dug into all of the inches of expensive friction that develop when stakeholders interact—like, a clinical organization and a payer and a plan sponsor, self-insured employer. They try to get paid or pay. They try to direct contract because what will be found fast enough is that the data is not the data is not the data, as Mark Newman talked about last week (EP496); and a dollar is not a dollar is not a dollar. Again, you'll find this out fast enough. All of you know when you talk to entities up and down the patient journey or across the life of a claim, otherwise known as a healthcare transaction. It's mayhem to get a claim paid often enough. Each stakeholder comes in with their own priorities and views and accounting methods and various rollups. I like how Stephanie Hartline put it. She wrote, "Healthcare … moves through many hands without a rail that preserves truth along the way. Attribution breaks, and truth gets reassembled later. The difference isn't capability—it's infrastructure. Line-item billing ≠ line-item settlement." Or I also like how Chris Erwin put it. He wrote, "When the blueprint isn't standardized, you aren't scaling. You're just compounding chaos." And yeah, then all of a sudden when there's no through line, there's no rail that connects all the data to the data to the data, or all the dollars to the dollars to the dollars. Suddenly 30% of any given healthcare transaction goes to trying to straighten it all back out again—to reassemble it, as Stephanie said. It's like unleashing 100 chaos monkeys and then having to pay to recapture them all. Listen to the show with David Scheinker, PhD (EP363) from last year about "Hey, how about we all just use the same template and avoid a lot of this." Or read Zeke Emanuel's book about how the USA should potentially consider copying the Netherlands model because they have private insurance. But they cut admin costs 75% or something like that. Oh, right … through standardization. Jesse Hendon summarized this the other day. He wrote, "Providers don't need armies of coders to fight 50 different insurance rule books [when you have some standardization here]." I say all this to say after recording the episode with Mark Newman from last week, I have become intently fascinated by what goes on in this non-standardized or otherwise friction points between stakeholders. There are a lot of inches in this gray area land of confusion. This show today digs into one of them, which is what does it take to process a claim? Just technically. What are the pipes involved to submit a claim and, again, get paid for it, which is a healthcare transaction—just simply the technology moving the data around—even if everything in the pipes is a non-standardized hot mess. Because just fixing up the processing and the pipes here—again, while this doesn't solve the entire data isn't a data isn't a data or a dollar isn't a dollar isn't a dollar problem—if we can just cut out some of the processing and the moving the data around costs, just this all by itself is $6 billion a year worth of inches. Plus, as an added bonus, fix up the pipes for better data flow and now patient care can be faster if, for example, the prior auth or etc. processes transpire faster. And clearinghouses have entered the chat. But you know, when clearinghouses come up, at least in my world, when the clearinghouse word gets dropped, it's usually accompanied by like a puff of smoke because no one is quite sure what those guys do all day. So, we all sort of look at each other in the conversation and move on. Lucky for me and possibly you if I've managed to suck you into my web of intrigue, I ran into Zack Kanter from Stedi, a new clearinghouse, who agreed to come on the pod here and aid my exploration into this demarcation zone between stakeholders. So, let's start here. What is a clearinghouse? Well, a clearinghouse is the same thing as a switch when we're talking about pharmacy data transfers, if you're familiar with that terminology and that's helpful. But either way, in the conversation with Zack Kanter that follows, Zack will explain this better; but clearinghouses are like a hub, maybe, that connects all the payers with all the providers. So, if you want an eligibility check or you wanna submit a claim or do a prior auth of the payer, whatever you're trying to do, get paid, you as an EHR system or a doctor's office or an RCM (revenue cycle management) company, you don't have to set up your own personal data connection with every single payer out there. You don't have to go through all the authentications and the BAAs (Business Associate Agreements) and map all the fields and set up the 100 SOC 2–compliant APIs (application programming interfaces). Instead, you can hook up to one clearinghouse, and then that clearinghouse connects with everybody else. So, most medical claims transactions have a clearinghouse in the middle, like an old-timey telephone operator routing your claim or denial or approval of that claim or eligibility check or whatever to the right place. And unfortunately, old-timey telephone operator is a pretty apt metaphor, depending on which clearinghouse you're using. Anyway, Zack Kanter told me that the price to just send and receive an electronic little piece of data in healthcare through a clearinghouse costs about 1,000 times more than any other industry would pay. Like, if you do an eligibility check, that's gonna cost 10 to 15 cents per. The trucking industry pays that much for 1,000 such data transfers. They would riot if someone asked them to spend a dollar for 10 data transfers. That'd be ridiculous in their eyes. But in healthcare, all these dimes add up to, again, $6 billion a year—them's some inches there—which also equal delays in payment and patient care. Now you might be thinking, "Oh, well, maybe it costs this much because healthcare is so much more complicated than trucking or whatever." Well, turns out the opposite is true: Because of HIPAA, ironically enough, healthcare is, in fact, much more standardized (we were talking about standardization before); but healthcare is actually much more standardized than many other industries due to HIPAA's administrative simplification rules, which mandate a universal language for transactions—the pipes I'm talking about now. So, actually, for as much as I was just kvetching about chaos monkeys, compared to other industries, the baseline construct here is actually much more orderly than, for example, the trucking industry or whatever, like Amazon or Walmart has to deal with with their millions of vendors. Now—and here's a really big point, especially for self-insured employers—you know who the main customer is for a lot of the more programmatic, the newer kinds of clearinghouses? I'll tell you: newer digital entities who do RCM (revenue cycle management) for provider organizations, and that can be great if you're a practice just trying to keep up with payer denials and expedite patient care. But look, all you plan sponsors and self-assured employers and maybe unions out there, the more RCM purveyors start working with programmatic clearinghouses, the more you not doing programmatic prepayment integrity programs with unconflicted third-party prepayment integrity vendors who are as hooked into the data streams and the clearinghouses as the RCM vendors are, the more, as I said last week, increasingly you're bringing an ever more rusty knife to a gunfight. So, that is certainly something to consider. There's a whole episode next week about this with Mark Noel from ClaimInsight. Or if you just can't wait, go back and listen to the show with Kimberly Carleson (EP480) just for the gist of it, or the one with Dawn Cornelis (EP285) from a few years ago. They're talking post-payment integrity programs, but a lot of the same rules apply. The show today is sponsored by Aventria Health Group, as usual. But I do want to say that we got some very appreciated financial support from Stedi, the only programmable healthcare clearinghouse. And here is my conversation about all of the inches that are all around us, specifically in the healthcare data pipes, with Zack Kanter, who is the CEO and founder over at Stedi. Also mentioned in this episode are Stedi; Shane Cerone; Mark Newman; Stephanie Hartline; Chris Erwin; David Scheinker, PhD; Zeke Emanuel, MD, PhD; Jesse Hendon; Mark Noel; ClaimInsight; Kimberly Carleson; Dawn Cornelis; Aventria Health Group; Preston Alexander; Eric Bricker, MD; and Kada Health. For a list of healthcare industry acronyms and terms that may be unfamiliar to you, click here. You can learn more at stedi.com. You can also follow Zack and Stedi on LinkedIn. Zack Kanter is the founder and CEO of Stedi, the only programmable healthcare clearinghouse. Stedi has raised $92 million from Stripe, Addition, First Round, USV, Bloomberg Beta, and other top investors. He has previously appeared on podcasts, including In Depth by First Round Capital, Invest Like the Best, Village Global, and Rule Breaker Investing. 09:47 What things are being paid for that we might not be aware we're paying for in healthcare? 12:09 Why HIPAA actually makes healthcare more standardized than other industries. 15:35 How healthcare is ahead in some ways and behind in others. 18:03 Where do the 4 to 5 days come from in healthcare transaction processing? 20:39 Why these transaction delays affect care delay. 23:14 EP482 with Preston Alexander. 23:18 EP472 with Eric Bricker, MD. 27:10 How should the process work from the time a provider clicks "validate"? 30:19 Why is the clearinghouse the right place to solve all these issues? 31:41 Why are we where we are in terms of these issues? 35:28 Why people should be looking at their clearinghouse costs. 36:59 What to know about Stedi. You can learn more at stedi.com. You can also follow Zack and Stedi on LinkedIn. @zackkanter discusses #healthcaretransactions and #clearinghouses on our #healthcarepodcast. #healthcare #podcast #financialhealth #patientoutcomes #primarycare #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! Mark Newman, Stacey Richter (INBW45), Stacey Richter (INBW44), Marilyn Bartlett (Encore! EP450), Dr Mick Connors, Sarah Emond (EP494), Sarah Emond (Bonus Episode), Stacey Richter (INBW43), Olivia Ross (Take Two: EP240)
Send us a textOn this episode of Inside Medical Malpractice, Chris Rokosh sits down with U.S. attorney and nationally recognized thought leader Kyle Sweet, JD, to explore one of the most powerful tools in reducing both harm and liability: ethical, effective communication. With decades of experience guiding healthcare systems through litigation, risk management, and patient safety challenges, Kyle shares how openness and transparency can transform outcomes for patients, families, and providers alike. We'll discuss his collaboration with Leilani Schweitzer on the groundbreaking Certified Medical Harm Communicator (CMHC) course, designed to equip healthcare professionals with the skills to respond to adverse events with compassion and accountability — while also easing the fear and stress providers themselves carry after medical errors. This episode shines a light on how talking and listening can rebuild trust, promote healing on all sides, and reshape the culture of ‘deny and defend' in medicine and malpractice law. This is a great episode to share with every lawyer and healthcare provider you know!
A Trump administration decision to terminate hundreds of health services grants sent several Massachusetts mental health and addiction treatment providers scrambling for further details and plans to cover new funding gaps.
SummaryIn this episode, Sean Weiss and Terry Fletcher discuss the critical importance of complete and accurate medical documentation in healthcare. They explore the consequences of incomplete records, the role of electronic medical records (EMRs), and the need for accountability among healthcare providers. The conversation emphasizes that clinicians must take responsibility for their documentation to ensure compliance and support medical necessity. The episode also touches on the complexities of medical coding and the importance of clear communication in clinical records.TakeawaysIncomplete documentation can lead to compliance issues.Providers must accept accountability for their documentation.EMRs should not be blamed for incomplete records.Documentation must support medical necessity and clinical judgment.Auditors need complete records to defend against claims.Assumptions in documentation can lead to errors.Clear definitions in coding are essential for accurate billing.Providers should not rely on templates to convey critical information.Documentation standards change regularly and must be adhered to.Healthcare professionals must work together to ensure complete records.
Send us a textThis isn't a farewell, it's an evolution.Let's be honest, if you're listening to this podcast, you know basic postpartum protocols are falling short for clients battling postpartum depression, PPA, and autoimmune conditions, which is why we aren't quitting, we're going deeper in a different way. Maranda is pausing the podcast because the weekly format became a cage, limiting the essential unconstrained research and complex arguments needed for deep root-cause analysis. She's making a deliberate shift to a long-form writing platform dedicated to giving you what you really need: comprehensive functional health frameworks and searchable, in-depth holistic maternal health resources. If you're ready to stop relying on surface-level fixes and access the next level of dignified, research-based postpartum provider education that truly heals, the revolution is about to unfold.Check out this episode on the blog HERE. Key time stamps: 0:15: Acknowledging the failing care system and the urgent need for holistic root cause care.2:00: The podcast format is too limited for sharing complex health arguments.4:00: Why long-form writing offers superior depth and unconstrained research.5:30: The shift to a new, searchable writing platform for comprehensive resources.7:15: The continued growth of postpartum nutrition certification and perinatal mental health training.8:30: The final, crucial message: Question everything and trust the mother's body knowledge.NEXT STEPS:
SummaryIn this episode, Sean Weiss and Terry Fletcher discuss the new year and the importance of compliance in healthcare. They highlight the upcoming legislative changes affecting telehealth, the roles of medical students, and the challenges of documentation and accountability in healthcare practices. The conversation emphasizes the need for proper training, understanding of roles, and the importance of doing the right thing in healthcare to avoid risks and ensure compliance.TakeawaysJanuary 30th is a critical date for telehealth funding.Medical students have limited roles compared to licensed providers.Documentation must be accurate and compliant with regulations.Providers must personally perform key components of services.Using medical students for billing can lead to compliance issues.Training and understanding roles are essential in healthcare.Fraud and abuse can result in significant penalties.Healthcare providers must be proactive in audits and compliance.Integrity in healthcare is crucial, even when not being watched.Proper billing practices are necessary to avoid legal repercussions.
President Donald Trump's administration says it's freezing $185 million in child care funds nationwide this year amid allegations of potential fraud in Minnesota.State officials say they are continuing to investigate the allegations but have not substantiated them so far.MPR News guest host Catharine Richert will examine what the funding freeze could mean for children, families, child care providers and Minnesota politics.
PREVIEW: Bob Zimmerman questions Amazon's perplexing launch strategy for its LEO constellation, asking why the company is utilizing more costly, non-reusable launch providers like ULA and Blue Origin instead of the more cost-effective SpaceX reusable boosters. He speculates that historical contracts or potential personal conflicts between billionaires may explain the decision. 1958
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