The shutdown is over — now what? A conversation with Anders Gilberg of MGMA

After the longest federal shutdown in U.S. history, the government is finally open again. For medical practices, the relief is short-lived.

In this episode, Physicians Practice editor Keith Reynolds sits down with Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association (MGMA), to talk about what the reopening actually means for medical groups.

Gilberg breaks down the temporary deal that extends key health policies only through January 30, including Medicare telehealth flexibilities and the geographic work floor. He explains the ripple effects practices are already feeling — from underpaid Medicare claims that now need to be reprocessed to renewed uncertainty around ACA premium tax credits heading into 2026.

Don't miss our recent episodes about the state of claims, our 100 episode special, lifestyle medicine and fighting burnout.

Music Credits:
Tempting Conversations by Frequently Asked Music/MusicRevolution - 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.

0:00 – Cold open
Anders on key issues for medical practices being delayed only a few months.

0:18 – Intro
Austin introduces the show, Keith, and Anders, and sets up the shutdown, short-term deal, ACA credits, telehealth, and Medicare underpayments.

1:22 – Setting the scene
Keith welcomes Anders and notes the government reopening after a historic shutdown.

1:49 – 6:13 | What’s in the deal?
ACA premium tax credits, short-term telehealth extension, 1.0 work floor issues, Medicare underpayments, and avoided PAYGO cuts.

6:13 – 7:36 | Immediate impact on practices
Reprocessing guidance, telehealth coverage, and the 2.5% conversion factor bump for 2026.

7:36 – 9:02 | How hard did the shutdown hit?
Different effects depending on Medicare volume, telehealth use, and location.

9:02 – 13:37 | 2026 Medicare fee schedule
Conversion factor increase, work RVU “efficiency” cut, practice expense changes, and which specialties may see real hits.

13:37 – 18:11 | Shutdown politics and ‘health care extenders’
How short-term budget bills, telehealth, rural floors, and APM incentives keep getting tied together and delayed.

18:11 – 18:59 | P2 Management Minute promo
Keith invites listeners to share practice tips and workflow hacks.

18:59 – 22:59 | Looking ahead to 2026
Telehealth flexibilities, ACA tax credits in an election year, and a historically unproductive Congress.

22:59 – 26:46 | Noncompetes
FTC interest in noncompete bans, state patchwork, and MGMA’s balanced view for employed physicians vs independent groups.

26:46 – 30:41 | Policy horizon
Physician payment reform, new prior auth rules, value-based care concerns, and what MGMA will push for next.

31:22 – 31:58 | Outro
Austin closes the episode, plugs subscriptions, and gives production credits.