WEBVTT NOTE This file was generated by Descript 00:00:04.658 --> 00:00:05.618 Daniel Williams: Well, hi everyone. 00:00:05.618 --> 00:00:11.468 Daniel Williams here, senior editor at MGMA host of the MGMA Podcast Network. 00:00:11.888 --> 00:00:16.808 Join today as we always are on Fridays with co-host Colleen Luckett, 00:00:16.808 --> 00:00:22.088 editor and writer here at MGMA and on Fridays we are back with another, uh. 00:00:22.448 --> 00:00:23.828 MGMA weekend review. 00:00:23.858 --> 00:00:28.628 So, so glad to share, uh, the latest healthcare industry news with y'all. 00:00:29.048 --> 00:00:33.008 Sometimes some policy updates, expert insights, and just 00:00:33.008 --> 00:00:35.228 stories that catch our fancy. 00:00:35.228 --> 00:00:39.008 So, Colleen, what has, uh, got your attention this week? 00:00:40.178 --> 00:00:41.018 Colleen Luckett: Hi everyone. 00:00:41.078 --> 00:00:45.608 So first up, I'm just here with your weekly reminder that healthcare 00:00:45.608 --> 00:00:47.408 isn't just about healing anymore. 00:00:47.408 --> 00:00:51.038 It's about also hackers, havoc and hipaa. 00:00:52.058 --> 00:00:53.108 So here's the deal. 00:00:53.108 --> 00:00:57.218 If your organization is still treating cybersecurity like it's an IT only 00:00:57.218 --> 00:01:01.388 problem, I have some really bad news from the future and that future is. 00:01:01.728 --> 00:01:05.538 Basically now, well, the first article we're breaking down today is titled 00:01:05.598 --> 00:01:09.828 Healthcare Leaders Prepare for a very Different HIPAA Security Rule. 00:01:10.068 --> 00:01:15.348 It's by Joe Olak, published in Chief Healthcare Executive on April 20th, 00:01:15.648 --> 00:01:17.448 so he lays it out pretty clearly. 00:01:17.448 --> 00:01:21.198 The US Department of Health and Human Services is proposing major 00:01:21.203 --> 00:01:23.148 updates to the HIPAA security rule. 00:01:23.268 --> 00:01:24.963 Here's what you all need to know. 00:01:25.498 --> 00:01:31.018 So the, the first big shift, say goodbye to quote addressable security measures. 00:01:31.348 --> 00:01:35.098 In the past, organizations could wiggle out of certain safeguards like data 00:01:35.098 --> 00:01:40.228 encryption or multi-factor authentication by labeling them quote, addressable 00:01:40.228 --> 00:01:45.028 instead of required, while that loophole is closing, the new rule makes those 00:01:45.088 --> 00:01:49.588 security practices mandatory, which means many orgs will need to completely 00:01:49.588 --> 00:01:51.748 overhaul their systems and policies. 00:01:52.318 --> 00:01:55.588 The second major change, executive accountability is 00:01:55.588 --> 00:01:58.138 going up a notch or five really. 00:01:58.408 --> 00:02:02.698 Cybersecurity will no longer be just the CIO's burden alone. 00:02:02.728 --> 00:02:06.148 The proposed rule directly holds executives and board members 00:02:06.148 --> 00:02:08.248 responsible for HIPAA compliance. 00:02:08.608 --> 00:02:11.998 If your system get breached and you didn't do your due diligence, 00:02:12.028 --> 00:02:13.888 that is going to be on you. 00:02:14.218 --> 00:02:16.978 Personal liability is officially on the table. 00:02:17.533 --> 00:02:23.353 So Oli sac outlines how this shift turns cybersecurity into a full on operational 00:02:23.353 --> 00:02:26.143 priority, not just a tech checklist. 00:02:26.173 --> 00:02:30.613 And if your group still has a quote flat network where everything talks 00:02:30.613 --> 00:02:34.693 to everything, that's basically like handing out a map and house keys 00:02:34.693 --> 00:02:36.943 to every hacker on the dark web. 00:02:37.333 --> 00:02:39.553 So what should medical groups do now? 00:02:39.883 --> 00:02:43.363 Number one, you can bring in the experts, not just techies, risk 00:02:43.363 --> 00:02:45.373 strategists who know operations. 00:02:45.433 --> 00:02:45.823 Two. 00:02:45.823 --> 00:02:50.563 Audit your org, not just your tech three encrypt and segment. 00:02:50.833 --> 00:02:53.353 Those two controls alone can save your systems. 00:02:53.353 --> 00:02:57.823 And four, create a culture of cybersecurity from the top down. 00:02:58.063 --> 00:03:01.033 And remember, compliance is the floor security. 00:03:01.048 --> 00:03:02.008 Is the ceiling. 00:03:02.308 --> 00:03:05.908 You don't want to be the cautionary tale in next year's headlines. 00:03:06.118 --> 00:03:09.988 It's a big wake up call, especially for outpatient and medical group leaders. 00:03:10.288 --> 00:03:14.458 If you're juggling vendors, managing staff access or handling sensitive 00:03:14.458 --> 00:03:19.618 patient data in any form, you are in the cybersecurity hot seat now too. 00:03:20.128 --> 00:03:22.618 And that's your HIPAA heat check for the week. 00:03:22.678 --> 00:03:23.848 Okay, Daniel, over to you. 00:03:24.238 --> 00:03:25.828 Daniel Williams: Alright, thanks Colleen. 00:03:25.828 --> 00:03:29.458 So the next story we're looking at comes from physicians' practice. 00:03:29.463 --> 00:03:34.863 It published April 21st, and it's titled 10 Key Dos and 00:03:34.863 --> 00:03:37.293 Don'ts for Direct Primary Care. 00:03:37.593 --> 00:03:42.633 The article was written by Margaret, a Barter Romo, and Stephen m Coward. 00:03:43.143 --> 00:03:47.013 Now, if you've been in healthcare leadership for any length of time, 00:03:47.013 --> 00:03:52.398 you've probably heard plenty of buzz around direct primary care or DPC. 00:03:53.223 --> 00:03:57.903 It's a model that cuts out insurance and third party payers entirely. 00:03:58.323 --> 00:04:03.303 Patients pay a flat monthly fee directly to their primary care provider, and 00:04:03.303 --> 00:04:06.123 in return they get greater access. 00:04:06.453 --> 00:04:11.463 Also, fewer administrative headaches and ideally a more personal 00:04:11.463 --> 00:04:13.413 relationship with their care team. 00:04:13.923 --> 00:04:19.653 But as bar Romo and Coard point out, just because the DPC model 00:04:19.653 --> 00:04:21.393 seems simpler on the surface. 00:04:21.643 --> 00:04:25.093 Doesn't mean there aren't a lot of moving parts to get right. 00:04:25.513 --> 00:04:31.333 In fact, they lead off by saying that when DPC works well, it's because the 00:04:31.333 --> 00:04:37.123 practice has been really intentional about how they set it up and how they 00:04:37.123 --> 00:04:39.283 communicate it to their patients. 00:04:39.703 --> 00:04:44.563 One of their big dos is about clearly defining what's included 00:04:44.713 --> 00:04:46.903 in that monthly membership fee. 00:04:47.463 --> 00:04:48.663 Are labs covered? 00:04:48.903 --> 00:04:50.493 What about vaccines? 00:04:50.703 --> 00:04:52.623 Specialty care referrals? 00:04:52.983 --> 00:04:57.693 The authors emphasize that the more transparent you can be upfront, the 00:04:57.693 --> 00:05:02.193 less chance there is for confusion or frustration down the road. 00:05:02.523 --> 00:05:05.253 And that's both for patients and your team. 00:05:05.973 --> 00:05:10.563 They also stress the importance of doing your homework on the regulatory side. 00:05:11.133 --> 00:05:14.043 Just because you're outside the insurance system doesn't 00:05:14.043 --> 00:05:15.903 mean you're outside the law. 00:05:16.293 --> 00:05:22.533 There are still compliance issues around state licensure, scope of practice, and 00:05:22.533 --> 00:05:25.533 patient privacy that have to be addressed. 00:05:25.803 --> 00:05:32.703 So one of the key don'ts here is don't assume you can just launch a DPC model. 00:05:33.048 --> 00:05:35.388 Without a careful legal review. 00:05:36.228 --> 00:05:39.228 Another point that stood out to me was their advice on 00:05:39.228 --> 00:05:41.748 patient education and marketing. 00:05:42.348 --> 00:05:46.938 This is not the traditional model most patients are used to, so it takes some 00:05:46.938 --> 00:05:51.978 thoughtful messaging to explain how it works and why it might be a better fit 00:05:51.978 --> 00:05:54.948 for certain individuals or families. 00:05:55.428 --> 00:05:59.208 They recommend being proactive and answering those basic questions 00:05:59.213 --> 00:06:04.158 patients are going to have, like what happens if I need hospital care? 00:06:04.573 --> 00:06:09.463 Or if I move out of the area, and a word of caution from the authors, 00:06:09.763 --> 00:06:14.083 DPC may not be the right move for every practice or every market. 00:06:14.473 --> 00:06:15.853 They suggest practices. 00:06:15.853 --> 00:06:20.053 Take the time to run the numbers, talk with patients, and understand 00:06:20.053 --> 00:06:24.703 the demand before jumping in again, the article is 10 key do's and 00:06:24.703 --> 00:06:30.133 don'ts for direct primary care, and it appears in physician practice. 00:06:30.558 --> 00:06:31.398 It's worth the read. 00:06:31.398 --> 00:06:35.808 If your practice has ever considered making the switch to DPC, we'll put a 00:06:35.808 --> 00:06:37.788 direct link to this story in the episode. 00:06:37.788 --> 00:06:38.568 Show notes. 00:06:38.838 --> 00:06:40.698 Colleen, back over to you. 00:06:41.331 --> 00:06:43.911 Colleen Luckett: So you know when someone texts just. 00:06:44.226 --> 00:06:47.856 Okay, and suddenly you're spiraling and questioning everything 00:06:47.856 --> 00:06:49.356 in your entire relationship. 00:06:49.716 --> 00:06:53.826 Well, now imagine that energy applied to an important health screening reminder. 00:06:53.886 --> 00:06:54.276 Yeah. 00:06:54.366 --> 00:06:58.086 Nothing says we care, like a message that feels like a breakup. 00:06:58.596 --> 00:07:02.361 So my next article's from Med City News, it was published April 00:07:02.361 --> 00:07:04.656 23rd and written by Bob Ferrell. 00:07:04.866 --> 00:07:07.146 It's called Improving Patient Trust with. 00:07:07.161 --> 00:07:08.691 Digital communication. 00:07:09.081 --> 00:07:13.671 Ferrell, who's currently CEO of impulse, a digital health company focused on 00:07:13.671 --> 00:07:18.261 patient engagement lays out a growing problem that too many healthcare 00:07:18.261 --> 00:07:22.611 leaders are still underestimating declining trust in the health system, 00:07:22.611 --> 00:07:27.285 and how digital communication or lack thereof, is playing a major role. 00:07:27.440 --> 00:07:33.050 Between April, 2020 and January, 2024, patient trust dropped by 30%. 00:07:33.110 --> 00:07:34.280 That's huge. 00:07:34.640 --> 00:07:39.050 According to a big part of this erosion is tied to poor communication, so 00:07:39.050 --> 00:07:43.280 missed messages, confusing outreach, lack of follow-up and outdated 00:07:43.280 --> 00:07:47.030 engagement methods that lead patients feeling frustrated and ignored. 00:07:47.420 --> 00:07:50.510 And let's be clear, this isn't just a marketing problem. 00:07:50.750 --> 00:07:53.870 Ferrell points out that quality communication between patients 00:07:53.870 --> 00:07:56.780 and healthcare teams can actually influence health outcomes. 00:07:57.200 --> 00:08:00.500 Better communication leads to better understanding, more patient 00:08:00.500 --> 00:08:04.190 motivation, and more active involvement in treatment decisions. 00:08:04.520 --> 00:08:07.310 But once a patient walks out of the doctor's office, that 00:08:07.310 --> 00:08:09.260 engagement often just falls apart. 00:08:09.680 --> 00:08:12.620 Nearly half of patients say clearer communication would help 00:08:12.620 --> 00:08:14.180 them trust their providers more. 00:08:14.300 --> 00:08:17.390 And when it comes to health plans, the story is the same. 00:08:17.660 --> 00:08:20.600 Patients want updates on coverage, appointment reminders, 00:08:20.600 --> 00:08:24.050 medication info, and they want it in a way that makes sense. 00:08:24.050 --> 00:08:29.750 Text, email, apps, not confusing, phone calls they weren't expecting, but there's 00:08:29.750 --> 00:08:32.480 a new wrinkle coming in April, 2026. 00:08:32.915 --> 00:08:36.845 A new rule under the telephone Consumer Protection Act goes into effect. 00:08:37.235 --> 00:08:41.585 It gives patients the ability to more easily opt out of automated calls and 00:08:41.585 --> 00:08:46.145 texts, and that has big implications for healthcare communications right now. 00:08:46.145 --> 00:08:48.455 Most patients aren't even aware the change is coming. 00:08:48.505 --> 00:08:52.315 If providers and health plans aren't proactive about educating patients on 00:08:52.315 --> 00:08:56.875 what these changes mean and giving them real informed consent options, they risk 00:08:56.875 --> 00:08:58.855 losing a critical communication link. 00:08:59.225 --> 00:09:03.035 Awards that without the right strategy in place, healthcare organizations could end 00:09:03.035 --> 00:09:05.075 up pulling back on essential messaging. 00:09:05.410 --> 00:09:08.620 That keeps patients connected to their care just to avoid 00:09:08.620 --> 00:09:10.270 crossing a regulatory line. 00:09:10.780 --> 00:09:12.910 So what's the takeaway for healthcare leaders? 00:09:13.150 --> 00:09:16.510 Well, first, build consent and communication into your strategy. 00:09:16.540 --> 00:09:17.410 Don't wait. 00:09:17.680 --> 00:09:20.440 Make sure patients know their options and understand what 00:09:20.440 --> 00:09:21.671 they're opting in or out of. 00:09:22.810 --> 00:09:26.410 Second, tailor communication by topic, language, and channel. 00:09:26.470 --> 00:09:27.490 Generic blast. 00:09:27.520 --> 00:09:28.840 Don't build trust. 00:09:29.230 --> 00:09:34.480 Personalized, relevant outreach does and finally, involve the right stakeholders, 00:09:34.720 --> 00:09:37.330 from providers to payers, to tech vendors. 00:09:37.360 --> 00:09:41.200 Everyone needs to be a part of the conversation about how new regulations 00:09:41.200 --> 00:09:42.970 will impact patient engagement. 00:09:43.545 --> 00:09:46.605 Farrell's final message is clear in the digital age. 00:09:46.605 --> 00:09:49.275 Trust isn't just earned in the exam room. 00:09:49.455 --> 00:09:51.285 It's earned in the inbox. 00:09:51.345 --> 00:09:54.975 And maintaining that trust takes a thoughtful, proactive strategy that 00:09:54.975 --> 00:09:59.895 balances personalization, compliance, and respect for the patient's preferences. 00:10:00.255 --> 00:10:03.255 We'll throw a link to that article in the show notes for you. 00:10:03.315 --> 00:10:04.245 Daniel, back to you. 00:10:04.675 --> 00:10:05.515 Daniel Williams: All right. 00:10:05.905 --> 00:10:08.455 Our next story comes from Healthcare dive. 00:10:08.695 --> 00:10:13.365 It was actually published April 16th, but when I came across it this week, I just 00:10:13.365 --> 00:10:15.225 decided I had to share it with y'all. 00:10:15.645 --> 00:10:17.745 It's titled for Medical Debt. 00:10:18.205 --> 00:10:18.925 Care now. 00:10:19.015 --> 00:10:21.205 Pay later models abound. 00:10:21.505 --> 00:10:24.895 It was written by their senior reporter, Justin Bachman. 00:10:25.585 --> 00:10:29.215 Now, if you spent any time looking at the patient payment landscape 00:10:29.215 --> 00:10:34.795 lately, you know medical debt remains a massive challenge in the US and is 00:10:34.795 --> 00:10:37.045 healthcare costs continue to rise. 00:10:37.285 --> 00:10:41.935 Patients are often left scrambling for ways to pay, sometimes 00:10:41.935 --> 00:10:43.405 choosing between their health. 00:10:43.870 --> 00:10:45.010 Their finances. 00:10:45.580 --> 00:10:50.290 Bachman takes a deep dive into how FinTech startups are jumping into 00:10:50.290 --> 00:10:55.570 this space offering what's being called care now, pay later options. 00:10:55.930 --> 00:10:58.270 And this is exactly what it sounds like. 00:10:58.480 --> 00:11:02.200 A growing number of companies are providing financing plans 00:11:02.410 --> 00:11:05.410 that let patients spread out the cost of their care. 00:11:05.830 --> 00:11:11.560 Over time, the goal is to make payments feel more manageable for patients. 00:11:11.680 --> 00:11:14.680 But of course there's a business side to it too. 00:11:15.130 --> 00:11:19.300 These companies are also looking to make healthcare payments more profitable. 00:11:19.930 --> 00:11:24.310 The piece points out that this model is starting to look a lot like the buy now 00:11:24.310 --> 00:11:26.590 pay later trend We've seen in retail. 00:11:26.880 --> 00:11:28.800 But apply to medical bills. 00:11:29.100 --> 00:11:32.760 And while these options might reduce the immediate financial hit for 00:11:32.760 --> 00:11:35.850 patients, they also introduce new risks. 00:11:36.300 --> 00:11:42.420 Like patients taking on debt they may not fully understand or stacking up multiple 00:11:42.420 --> 00:11:45.660 payment plans across different providers. 00:11:46.050 --> 00:11:49.860 One thing Bachman highlights is how these plans are being offered 00:11:50.100 --> 00:11:51.630 right at the point of care. 00:11:52.085 --> 00:11:55.115 Sometimes before the patient even gets the bill. 00:11:55.475 --> 00:11:59.065 It's positioned as a way to make healthcare more accessible. 00:11:59.485 --> 00:12:04.105 But there's debate over whether patients, especially when they're under 00:12:04.105 --> 00:12:09.205 stress, have the capacity to fully process the long-term implications 00:12:09.535 --> 00:12:11.875 of these financing arrangements. 00:12:12.645 --> 00:12:17.325 Consumer advocates quoted in the article raise concerns about transparency, 00:12:17.685 --> 00:12:21.855 asking whether patients are getting all the information they need upfront. 00:12:22.425 --> 00:12:23.745 Are the terms clear? 00:12:24.105 --> 00:12:27.435 Are there fees or penalties if payments are missed? 00:12:27.735 --> 00:12:33.765 And what happens when the debt piles up across several providers or procedures? 00:12:34.410 --> 00:12:39.360 For practice leaders, especially those in revenue cycle or patient experience 00:12:39.360 --> 00:12:42.270 roles, this is a space worth watching. 00:12:42.750 --> 00:12:48.030 Whether your practice is directly offering payment plans, considering a partnership 00:12:48.030 --> 00:12:52.740 with one of these FinTech companies, or simply trying to understand how these 00:12:52.740 --> 00:12:55.950 models are reshaping patient expectations. 00:12:56.430 --> 00:13:00.300 These are conversations that aren't going away anytime soon. 00:13:00.540 --> 00:13:02.490 As a reminder, the article is. 00:13:02.580 --> 00:13:06.420 For medical debt care now pay later models abound. 00:13:06.600 --> 00:13:10.710 It was written by Justin Bachman over at Healthcare Dive, and 00:13:10.760 --> 00:13:14.180 as we always do, we'll provide a direct link to this article. 00:13:14.180 --> 00:13:16.400 So Colleen, back over to you. 00:13:16.837 --> 00:13:17.797 Colleen Luckett: Thanks, Daniel. 00:13:18.057 --> 00:13:21.927 You know, you've entered dystopian territory when an insurance denial 00:13:21.927 --> 00:13:26.127 feels like it came from a Magic eight ball, but the ball is ai and it's been 00:13:26.127 --> 00:13:28.617 trained to say outcome, unclear, deny. 00:13:28.617 --> 00:13:29.187 Anyway. 00:13:29.877 --> 00:13:34.827 Well, my last story comes from Dark Daily, published April 23rd, and it's titled. 00:13:34.877 --> 00:13:40.607 States pursue legislation limiting AI's growing role in payer prior authorization, 00:13:40.607 --> 00:13:42.377 denials and claims processing. 00:13:42.677 --> 00:13:43.997 Here's the situation. 00:13:44.057 --> 00:13:48.617 Multiple states are responding to what they see as a growing threat, insurance 00:13:48.617 --> 00:13:52.757 companies using artificial intelligence to automate the denial of healthcare claims. 00:13:53.092 --> 00:13:56.902 Including critical medical and lab testing, and it's gone far 00:13:56.902 --> 00:13:59.002 beyond some periodic complaints. 00:13:59.032 --> 00:14:03.562 There are now class action lawsuits and proposed legislation in at least 00:14:03.562 --> 00:14:06.772 11 states aiming to curb this practice. 00:14:06.892 --> 00:14:11.272 At the heart of these proposals is the same concern that AI, when left unchecked. 00:14:11.312 --> 00:14:15.002 Could lead to mass denials of lifesaving care based on pattern 00:14:15.002 --> 00:14:17.372 recognition, not clinical judgment. 00:14:17.612 --> 00:14:20.042 And it's not just lawmakers sounding the alarm. 00:14:20.072 --> 00:14:23.822 The Arizona Medical Association issued a strong statement saying 00:14:23.822 --> 00:14:28.352 healthcare decisions should be based on compassionate human expertise, not 00:14:28.352 --> 00:14:30.902 algorithms optimized for cost savings. 00:14:31.442 --> 00:14:33.872 Now, here's why this matters for healthcare leaders, and 00:14:33.872 --> 00:14:36.812 especially for those in outpatient care and lab management. 00:14:37.477 --> 00:14:41.317 AI is already being used at both the prior authorization stage 00:14:41.347 --> 00:14:43.087 and during claims reimbursement. 00:14:43.597 --> 00:14:47.647 Lab tests are being denied routinely, sometimes even when providers know they 00:14:47.647 --> 00:14:51.967 won't be paid, but run the test anyway to maintain provider relationships. 00:14:52.477 --> 00:14:56.287 If your organization relies on timely claim approvals, automated denials 00:14:56.287 --> 00:15:00.457 could disrupt patient care, delay treatment, and eat into your revenue. 00:15:01.072 --> 00:15:03.022 At the same time, there's nuance here. 00:15:03.082 --> 00:15:06.832 AI can still serve a positive role in healthcare, streamlining 00:15:06.832 --> 00:15:10.552 documentation, transcribing notes, even assisting in diagnosis. 00:15:11.092 --> 00:15:16.372 But what this article underscores is that AI should support care, not overwrite it. 00:15:17.002 --> 00:15:22.012 For our MGMA members, this is a time to, number one, audit your 00:15:22.012 --> 00:15:26.182 claims processes and flag patterns that suggest automated denials. 00:15:26.242 --> 00:15:29.872 Two, review your payer contracts, what kind of AI tools are 00:15:29.872 --> 00:15:31.492 being used behind the scenes? 00:15:31.612 --> 00:15:37.402 And three, engage in advocacy because how AI is regulated now could reshape 00:15:37.402 --> 00:15:39.742 your revenue cycle for years to come. 00:15:40.282 --> 00:15:45.622 Bottom line, use AI to fight burnout and streamline operations, not to rubber stamp 00:15:45.622 --> 00:15:48.232 denials from behind a digital curtain. 00:15:48.622 --> 00:15:51.052 Again, we will drop that link in the show notes. 00:15:51.052 --> 00:15:53.062 And Daniel, that does it for me today. 00:15:53.452 --> 00:15:54.142 Daniel Williams: All right. 00:15:54.192 --> 00:15:56.382 That's gonna do it for this week, everyone. 00:15:56.382 --> 00:16:00.192 So thank you for listening to another episode of MGMA Week. 00:16:00.192 --> 00:16:03.462 In review, if you like what you heard, be sure to follow and 00:16:03.462 --> 00:16:08.382 subscribe to the MGMA Podcast Network wherever you get your podcast. 00:16:08.442 --> 00:16:13.377 And you will also find all the, uh, sources and resources to these 00:16:13.377 --> 00:16:15.582 articles in our episode show notes. 00:16:15.582 --> 00:16:18.312 So, until then, wishing y'all a happy weekend.