The realities of running a medical practice, with David N. Gans, MSHA, FACMPE

David N. Gans, MSHA, FACMPE, retired senior fellow at MGMA, joins the show to talk about the real pressures facing practices today — rising costs, flat reimbursement, staffing strain and the push for efficiency.

Gans breaks down the key metrics leaders should watch in 2026, the compliance gaps he sees most often, and how to evaluate new technologies like automation and artificial intelligence. He also shares why private-practice profits may have peaked and what that means for administrators planning ahead.

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Music Credits:
SEDUCCION by Bopper Beats - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

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

00:00 — Introduction
Austin opens the episode and tees up the conversation with David Gans, retired senior fellow at MGMA.

01:15 — Setting the stage
Keith greets David and dives straight into the big-picture question: which operational and financial trends practice leaders are still underestimating.

01:38 — The real cost pressures
David breaks down rising costs, static reimbursement, wage competition, and why efficiency is now non-negotiable for practices.

03:19 — The reimbursement squeeze
How Medicare, commercial insurers, and Medicaid leave little room for negotiation—and what that means for practices of different sizes.

04:22 — Efficiency or bust
Why “doing more with less” has become the only path forward, and how automation, workflows, and scheduling changes help practices stay afloat.

05:00 — Primary care vs. surgical pressures
David explains why cognitive specialties feel revenue constraints differently than procedural ones.

06:34 — What can practices actually control?
Coding accuracy, revenue cycle discipline, and the push to optimize every minute.

06:55 — What data should leaders watch in 2026?
David lays out the essential metrics: top-line revenue, encounter mix, RVUs, staffing costs, and net income trends.

07:33 — Productivity & expense alignment
Why practices need to understand revenue drivers and compare staffing benchmarks against peers.

08:52 — Quality and safety without more admin burden
David shares a framework: right staff, right tasks, right incentives, right outcomes.

09:46 — Technology and environment matter
How COVID reshaped expectations for clinical environments and cleanliness standards.

10:40 — Accreditation realities
David describes Triple-A-HC and where practices most often fall short in compliance.

12:23 — The metrics administrators misinterpret
David explains why FTE calculations are often flawed—and how job-sharing, varied schedules, and workload mismatches distort perceptions.

14:54 — Tech adoption: what’s really new?
Keith asks about telehealth, automation, and artificial intelligence. David places today’s tech challenges in a 100-year historical context.

16:31 — Practices have always adapted
From telephones to punch-card records to EHRs, David highlights the through-line of efficiency.

18:00 — How to evaluate AI today
Use case frequency, patient impact, niche opportunities, and reimbursement potential.

19:49 — Leadership in uncertainty
David identifies the core leadership trait that matters most: cultivating a healthy work environment that boosts efficiency.

20:02 — Staff morale as a performance driver
How workplace culture alone can lift productivity by up to 20%.

20:54 — The surprising trend in private-practice profits
David breaks down his recent Data Mine column on revenue after operating expenses and why private practices may have hit “peak profits.”

22:39 — A 15-year look at the numbers
Inflation-adjusted revenue trends, productivity gains, and why the recent plateau is worrisome.

25:00 — Why profits finally dropped
Payment constraints, supply-chain fallout from COVID, and shifts in patient services.

25:40 — Closing thoughts
Keith and David wrap up and agree to revisit the data when the next column comes out.

26:16 — Outro
Austin closes the show and promotes upcoming episodes, newsletters, and subscription options.