S1 Ep72: Medicare reform with Susan Dentzer of America's Physician Groups
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S1 Ep72: Medicare reform with Susan Dentzer of America's Physician Groups
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Download the full report: https://www.apg.org/wp-content/uploads/2025/04/Medicare-Done-Right-Final-4.1.25.pdf
Music Credits:
PARIS DINNER by Bopper Beats - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
COCKTAIL by Mythical Audio - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction and Episode Overview (00:00:00) Austin introduces the episode, guest Susan Dentzer, and the focus on Medicare reform and accountability.
Biggest Issue with Medicare and Key Fix (00:01:18) Susan discusses the main problem with Medicare and the report’s top recommendation: increasing accountability in both Medicare arms.
Accountable Relationships in Practice (00:02:25) Explains what it means for every beneficiary to have an accountable relationship with a healthcare professional, especially for small practices.
Importance of Care Coordination and Outcomes (00:03:47) Highlights the value of primary care teams, care coordination, and minimizing unnecessary hospital use for better outcomes.
Problems with MIPS and MACRA (00:04:16) Critique of the current MIPS/MACRA system, why it hasn’t worked, and the need for system-level reforms.
Restoring and Expanding Incentives (00:06:24) Calls for restoring and expanding advanced alternative payment model bonuses to better reward clinicians in accountable models.
Challenges for Small and Independent Practices (00:07:28) Addresses the risks and complexities of two-sided ACOs for small practices and suggests partnership solutions.
How At-Risk MA Arrangements Save Money (00:10:04) Explains how Medicare Advantage at-risk models achieve better outcomes and could save $22 billion if replicated in traditional Medicare.
Improving Medicare Advantage: Prior Authorization and Star Ratings (00:14:00) Discusses the popularity of MA, issues with prior authorization and star ratings, and visions for improvement.
Dental, Vision, and Hearing Coverage in Accountable Models (00:17:10) Proposal to offer extra benefits to traditional Medicare patients who join accountable care models and how it could work.
Top Medicare Policy Change for 2025 (00:20:51) Susan’s pick for the most impactful policy change: updating the Medicare physician fee schedule to reflect practice cost inflation.
Clarifying Medicare Advantage Misconceptions (00:23:31) Emphasizes the diversity within MA, the benefits of delegated risk models, and the importance of understanding risk adjustment.
Conclusion and Report Access (00:26:37) Wrap-up, thanks to Susan, and information on where to find the full report and subscribe to the podcast.
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