Ep. 79: The state of health care policy, with Anders Gilberg, SVP of government affairs at MGMA

Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association (MGMA), joins the show with updates from Washington on the most important topics affecting medical groups and health care policy.

Speaking with Keith A. Reynolds, editor of Physicians Practice, Gilberg talks about the impact of recent health care legislation on Medicaid and Medicare payments, the administrative and financial challenges facing medical groups, upcoming policy deadlines (e.g., telehealth, ACA subsidy expirations) and MGMA's ongoing advocacy efforts to support physicians and improve health care policy.

Don't miss our previous episodes on remote patient monitoring, what's broken in health care, what AI can do for prior authorizations and the 60 year anniversary of Medicare.

Music Credits:
Summer Chilling by SONIC MYSTERY - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

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

Introduction and Episode Overview (00:00:13) Host introduces the episode, guests and main topics: healthcare legislation, Medicaid/Medicare payments, administrative challenges and upcoming conference.

Introducing the "One Big Beautiful Bill Act" (00:01:34) Explanation of the bill’s name and focus on healthcare provisions relevant to medical groups.

Medicaid Cuts and Implementation Timeline (00:02:11) Discussion of predicted Medicaid cuts, administrative issues and the delayed implementation until 2027-2028.

Medicare Payment Adjustments and Ongoing Advocacy (00:04:37) Covers Medicare reimbursement increase, unaddressed 2025 cut and the need for a permanent solution.

Administrative Workload and Revenue Cycle Management (00:05:40) Addresses administrative challenges, eligibility verification and the impact of ACA subsidy expiration.

Legislative Productivity and Administrative Simplification (00:07:18) Talks about Congress’s productivity, legislative process and prospects for administrative simplification bills.

Prior Authorization Reform and Medicare Advantage (00:08:18) Focus on prior authorization issues in Medicare Advantage and the need for legislative reform.

Physician Fee Schedule Changes (00:09:38) Explains major changes in the physician fee schedule, including specialty vs. primary care payment shifts.

Impact of Fee Schedule on Specialties (00:10:54) Details how the new methodology may affect different specialties, especially non-primary care practices.

Promoting Patient Care Online (00:13:28) Brief mention of Patient Care Online as a clinical resource for primary care physicians.

Technology, EHR and Interoperability Initiatives (00:14:00) Discussion of AI in healthcare, interoperability and voluntary pledges for IT standardization.

Government Data and Physician Payment (00:16:21) Explores the potential impact of politicized economic data on physician payment calculations.

P2 Management Minute: Morale Boosters (00:18:25) Segment on practical tips for boosting staff morale and emotional intelligence in medical practices.

Upcoming Policy Deadlines: Telehealth and Rural Payment Parity (00:19:40) Overview of key policy issues expiring at end of September: telehealth flexibilities and rural payment parity.

Affordable Care Act Subsidies and Political Implications (00:22:32) Discusses the expiration of ACA subsidies, potential premium increases and political ramifications.

MGMA Leadership Conference Preview (00:24:44) Preview of the upcoming MGMA Leadership Conference, its content and networking opportunities.

Episode Wrap-Up and Closing Remarks (00:26:40) Host thanks guests and listeners, promotes newsletter and closes the episode.