Latest / Off the Chart: A Business of Medicine Podcast / S1 Ep177: What's really keeping practices independent, with Aaron Ledbetter of Veradigm
Transcript
- Speaker 1 0:00 I think EHRs in particular are going to move from a system of of record, so capturing the history of the patients and treatments and all of that, to a system of work where it takes all of that, and the EHR can help them with coding, with claims, with prior auths, real time. Austin Littrell 0:32 Welcome to Off the Chart, a business of medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders, and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Letrell. I'm the associate editor of Medical Economics, and I'd like to thank you for joining us today. In today's episode, I sat down with Aaron Ledbetter, solutions and growth strategist at Veradim. He spent years in value-based care policy and payer contracting before moving to the technology side, and he spent the last several months with the findings of Veridom's 2026 State of Independent Practice report. Today, we get into why 26% of practices surveyed reach serious acquisition talks before deciding to stay independent. Why a denied claim still takes one to two weeks to surface, and what he means when he says the electronic health record has to stop being a system of record and start being a system of work. And a quick note before we start: Medical Economics and Veradim are hosting a live virtual event on the same subject on Wednesday, August 26 at 2 p.m. Eastern. Registration link will be in the show notes below. But with all that said, Aaron, thank you for joining us. Let's get into the episode. Aaron Ledbetter, thank you so much for joining me today. Speaker 1 1:33 Austin, thank you for having me. It's a pleasure to be here. Austin Littrell 1:35 Before we get into everything today, could you take a second to introduce yourself and Veridom? Speaker 1 1:40 Absolutely. So I'll start with Veridim. Veridim is a leading provider of clinical and revenue cycle solutions for independent practices. And myself, I am Aaron Ledbetter. My background is in value-based care. You know, I've worked in DC at a boutique consultancy and lobbying agency, and you know we've worked directly with CMS, CMMI on building, developing their various value-based care models and providing feedback directly from both independent and employed practices. Before that, I worked at a large ACO in New England, where I was responsible for managing payer relationships and negotiating contracts on behalf of oh around 1600 providers or so. Austin Littrell 2:27 Today we're going to jump into Veradim's state of state of independent practice in 2026 report, which surveyed 360 healthcare leaders from independent ambulatory practices, including 210 physicians. So to kind of just dive into it. 79% of the respondents said technology is essential to staying independent, but only 64% are confident in their current tools to deliver on that. Could you kind of explain what's driving that gap? Speaker 1 2:53 Yeah, you know. So I think it's a really good question. I think one of the pieces there is just the speed of technological change too. So the the pace is now fast enough that some of the tools can actually age out before a practice has finished adopting them. You know they're trying to keep up also with the pace that the payers' tools are advancing. So it's almost like you know it's it's almost like an arms race, if you will, between the various technological features that that both sides are deploying, the other aspect there I think is just the complexity of the payer contracts. So keeping up with those and keeping the terms straight across a growing book of payers is its own administrative workload, and I think you see that in the survey itself, as practices grow from you know solo practitioner, you know two practitioner practices, all the way up to the 40 plus range, they unlock a whole host of new administrative complexities. Oftentimes, a lot of that is related to the growing number of payer contracts they have, and making sure that they're meeting all the terms of the arrangements across those payers, so that's that's what I would say today. Is that's why it's sort of you know 64% are only confident in their current tools. Austin Littrell 4:16 26% of practices reach serious acquisition negotiations before deciding to stay independent. What's getting them to the table there, and then what's ultimately pulling them back? Speaker 1 4:27 I think it's strain. I think it's the administrative complexity. I think for some of these practices, it's also operational complexity. It is the financial strain. You know, a lot of these practices, they. are dealing with what I would call difficulty to project their revenue because of lag in data, because of lag in claims. You know, because the tools maybe aren't as real time. As they need them to be, to operationalize fixes whenever you know a claim gets sniped or whatever it may be. So really, for for a lot of these practices, it's it's just that strain. I think that gets them to the table. What pulls them back? I really believe it's their desire to continue to practice medicine in the way that's best for their patients and their community, and I think there's an inherent resolve of, you know, we can figure this out. We can come back together. We can investigate additional tools. We can work with our vendors that we have today on modernizing the technology that will enable us to stay independent, and I think you can see that with AI, right? Like in some of the technological change that's coming, they will be empowered to stay independent in the next two three years. Austin Littrell 5:52 41% of practices don't learn about a denied claim for one to two weeks. Why hasn't that problem been solved, and what does fixing it realistically look like? Speaker 1 6:04 Yeah, you know, I think it's a symptom of a lagging operating model. It's kind of it persists because the work is so fragmented and it's so manual. So detection, root cause analysis, and resolution of these issues-they're sitting across different people and systems, and and I think you see that from the survey, right? 58% of practices run a hybrid revenue cycle, split between their internal staff and outside vendors, which has its own complexities on the back end as well. So those systems don't always play nice together, and I think all parties involved are working on on fixing that. You know, whoever the vendors may be. Realistically, I think fixing it means moving detection earlier, making sure that data is more near real time rather than weeks later. You know, when it comes back as like a denied claim or or whatever it may be, that's that's my perspective, at least from the survey. Austin Littrell 7:06 Denial drivers in the survey are scattered across the entire revenue cycle. That's eligibility, coding, documentation, prior auth, payer policy. How do you begin to approach a problem that fragmented? Speaker 1 7:18 Yeah, I think it has to be a coordinated approach across the whole revenue cycle, rather than aimed at one stage. Because if you aim at one stage, there are going to be much like anything else you would do. There's going to be other outcomes at other stages that you maybe don't predict. So I think the common thread underneath all of this, it's it's not just the single workflow. It's a lack of early visibility and too much manual handoff. So there's eligibility errors. There's missing data. There's coding mismatches. It all kind of traces back to the information that either wasn't captured or was captured incorrectly, or wasn't surfaced early enough. So I think any solution that is developed needs to be focused on the entire revenue cycle picture and all of the parties involved and what their work streams look like. Keith A. Reynolds 8:17 Hey there, Keith Reynolds here, and welcome to the P2 Management Minute. In just 60 seconds, we deliver proven, real-world tactics you can plug into your practice today. Whether that means speeding up check-in, lifting staff morale, or nudging patient satisfaction north, no theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom. They come from you. Got a clever workflow hack, an employee engagement win, or a lesson learned the hard way? I want to feature it. Shoot me an email at k. Reynolds at mjhlifesciences.com with your topic, a quick outline, or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next P2 Management Minute. Austin Littrell 9:08 The data suggests larger and smaller practices are experiencing pressure differently. Bigger financial volatility on one end, a disproportionate administrative burden on the other. Are those fundamentally different problems requiring different solutions, Speaker 1 9:23 I think they're different expressions of kind of the same underlying problem. I think the margin for error has has shrunk. I think for independent practices, honestly, it's probably shrunk for employed practices as well. So the diagnosis is kind of shared, even if the symptom isn't. So for the larger practices, it's it's financial volatility, right? So the 82% reported increased financial pressure, and 60% called that increase kind of significant. That looks like from our survey that it's been driven by payer relationships and more complex workflows. So, you know, to simplify. That scale that some of these physician practices achieve, it adds additional exposure, and the exposure is complexity of a wide variety of payer contracts. So it doesn't really insulate them, which you would think would happen for a larger practice. It actually makes it more complex for the solo practice side of things, you know, oftentimes you have one one doc, two docs doing the prior off, the follow-ups after hours. So it's it's very difficult there from a people perspective. You know, if one person is out, that can really diminish their ability to serve their patients. So there, I think again, it's very much a technology aspect. The technology needs to work for them. It needs to reduce the burden that they have both during clinic hours and after. Austin Littrell 10:56 88% say that AI and automation could meaningfully improve efficiency. Physicians have heard that before, you know whether that's any kind of different technology, EHRs to name one. What's actually different this time? Speaker 1 11:11 Yeah, and you know I would say they're right to be skeptical. I mean, there's been a lot of promises of technology fixing their problems, and frankly, I think they're probably at a point where some of it does fix their problems, but the application, the number of applications that are out there is probably driving app fatigue. To be totally honest with you, not all the apps play well together. I think it's coming where they will, but honestly, I would say some of the solutions that are coming or that are out there and are developing, like ambient documentation from an ambient scribe, automation of some of the repetitive administrative work, whether it's prior auths, reporting, denials, follow up. That's going to happen in the background of workflows in the future state. I would say in the next two to three years, rather than adding steps to it, right? So I think EHRs in particular are going to move from a system of of record, so capturing the history of the patients and treatments and all of that, to a system of work where it takes all of that and the EHR can help them with coding, with claims, with prior auths, real time, and that will really, I think, be a game changer for independent positions. Absolutely, but honestly, the entire industry. Austin Littrell 12:31 Nearly half respondents cite administrative requirements as the top barrier to value-based care participation. That's ahead of things like clinical complexity and financial risk. A lot of that is a payer design problem. So, what can technology realistically do about that? Speaker 1 12:45 Yeah, so I think that's actually where the EHR comes into play too. So, moving to that system of work, I think it can flag patients that are in different value-based care arrangements. I think it can help them to understand, and frankly, all their vendors should help them understand some of the complexities of the arrangements that they're in. I would say one thing that I know from working in an ACO and negotiating these contracts-they're all slightly different. It's very, very difficult to track the differences between them, and you do need almost a small army of people to do so, so that you're successful. But practically, I think it means automating some of the quality measure tracking across contracts. You know, reporting data without all the the manual abstraction and giving practices invisibility into their care gaps real time. So before a patient comes in, you know what the care gap is that you're trying to close. The providers are doing this work, right? They're just not getting the credit for it, and so the system needs to enable them to receive that credit so that they can a get paid for closing quality gaps, for achieving reductions in total costs of care, for shared savings, and we're moving toward that, I would say rapidly. Austin Littrell 14:03 Physicians ranked as the hardest position to both recruit and retain. If a practice can't solve its staffing problem, how much does the technology conversation actually matter? And alternatively, what role could technology play in that solution? Speaker 1 14:18 Yeah. So, and I think this is actually a problem that we're seeing across the healthcare landscape. Physicians certainly very difficult to recruit. I would say you see this even with with MAs, with RNs, with PAs and NPs across the board. It's very very difficult to recruit. It's a super competitive industry at the moment, you know. Obviously, with physicians, there is an aspect from the independent provider organization where you're competing with employed, where you have that guaranteed paycheck. But the independents offer the ability to practice medicine in a way that. Is you know the best for their patients in their beliefs. So I think here, what can set the independent physicians apart is automating many of those administrative tasks, whether it's documentation, again the denials, follow up, and prior off. That's going to make them more competitive, right? If a physician can choose between somewhere where that isn't automated and where it is. They're going to go to where it's automated, and they have more work-life balance. So I think that ultimately is going to be a competitive driver for the independent practices. Austin Littrell 15:34 Sure. The white paper describes independence as an operating model that must be actively managed for small practices without dedicated operations teams, what does that actually look like on a day to day? Speaker 1 15:47 Yeah, I, you know, I think it means the clinical and administrative sides, if they even have an administrative side. To your point, right? Because solo docs often don't. That they're working from the same information real time instead of discovering misalignment of information months later, which causes a lot of friction and problems, especially you know to the revenue. And your point is like you know the realistic version for them isn't hiring more people; it's choosing technology that surfaces the right signals automatically at the right time, which is you know days instead of weeks, so they have the operating discipline where it becomes sort of a property of the the system of work that they have, rather than you know another administrative job on either the physician's plate or on, for many of these independent practices, the small administrative staff that they have. I think another aspect here that you will see in the future is there are a number of independent provider associations and organizations where they band together. I think you could see more of that across the across the country for the independents. You know, there's there are benefits there from a vendor standpoint when you're negotiating contracts, from a payer standpoint negotiating contracts because together you can combine resources, and you know you could have an administrative staff sort of at a higher level that supports all of the practices, but you can also get you know better rates and better deals with vendors. So I would assume that you'll see even more of too. Austin Littrell 17:30 Is there anything that we haven't talked about that that you want to share? Speaker 1 17:34 I would say like the key takeaway here is how interconnected all these challenges are, and a lot of it will be solved. I think with with technology making workflows more efficient and optimized. You know, I think in healthcare, we for a long time we've tended to throw people at a problem that's already very manual, which can add additional complexity and, frankly, administrative burden and barriers. Whereas now, I think that we're at a point where technology is developing so rapidly that it can look at the entire system of work that they are doing on a day-to-day basis and make it super efficient, reducing those challenges. So providers can ultimately spend more time with their patients, practice medicine the way they want to, and administrators can focus on being successful in these value-based care contracts, and frankly, even in their fee-for-service contracts. So that's that's where I think we're moving, and it's a really exciting time to be in healthcare. I will say that like people have been saying that for the past decade, especially around automation. But it it feels like something's different this time. Like we're at an inflection point where AI can actually have a meaningful. It can be a meaningful driver of change in the day to day lives of these practices. Austin Littrell 19:02 Absolutely. Well, it's a great report, and I really appreciate your insights, Aaron Ledbetter. Thank you so much again for taking the time today. Speaker 1 19:09 Absolutely, Austin. Thank you for having me. Enjoyed it. Austin Littrell 19:26 Once again, that was a conversation I had with Aaron Ledbetter, Solutions and Growth Strategist at Veradim. You can find our full Q&A with him, along with Veradim's 2026 State of Independent Practice report, linked in the show notes below. And one more reminder: Medical Economics and Veradim are hosting a live virtual event on the same subject, the state of independent practice in 2026 on Wednesday, August 26th at 2 p.m. Eastern. The link to register is below. I highly recommend checking this one out. But with that said, my name is Austin Latrell, and on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show and ask you please subscribe so you don't miss the next episode. As always, be sure to check back on Monday. Thursday mornings for the latest conversations with experts sharing strategies, stories, and solutions for your practice. You can find us by searching "Off the Chart" wherever you get your podcasts. And if you'd like the best stories that Medical Economics and Physicians Practice publish, delivered straight to your email six days of the week, subscribe to our newsletters at medicaleconomics.com and physicianspractice.com. Off the chart, a business and medicine podcast, is executive produced by Chris Malini and Keith Reynolds, and produced by Austin Latrell. Medical economics and physicians practice are both members of the MJH Life Sciences family. Thank you.