MGMA Week in Review: AI Compliance, Clinician Burnout, and Prior Authorization in 2025 Healthcare
Download MP3Well, hi, everyone. Daniel Williams here, senior editor at MGMA and host of the MGMA Podcast Network. We are back with another MGMA week in review podcast along with cohost Colleen Luckett, editor and writer at MGMA, and we're gonna share some news with you on this April. So Colleen, what is going on?
Colleen Luckett:Yeah. Happy April, everyone. Well, if you've ever felt like AI is moving faster than your compliance officer can say business associate agreement, you are not alone. Indeed, one of the biggest questions healthcare leaders are facing right now is how do you harness the promise of AI without triggering a HIPAA headache? To help answer this question, let's turn to insights from the recent twenty twenty five HIMSS Global Conference, where MGMA's own Chris Harrop and my manager was on the ground reporting.
Colleen Luckett:Chris sat in on a session led by Adam Green, a former HIPAA regulator at HHS and now a partner at Davis Wright Tremaine. The session jumped in with both feet addressing one of the thorniest issues in health tech right now, how to develop and deploy AI tools while staying compliant with privacy laws written long before AI was on the scene. Green explained that while HIPAA may be technology neutral, it was enacted in 1996, meaning it wasn't exactly built with machine learning or predictive algorithms in mind. Yet HIPAA still governs how, when, and why protected health information, or PHI, can be used. One of the biggest sticking points, the minimum necessary rule.
Colleen Luckett:In other words, when using or sharing PHI, you have to limit it to what's truly necessary for the task at hand. And that's in direct tension with AI, which typically thrives on as much data as it can get. Another myth Green debunked is the idea that simply removing names or direct identifiers makes data HIPAA compliant. That's not the case. HIPAA requires either an expert statistical determination that the risk of re identification is very small, or the removal of 18 specific identifiers under the safe harbor method.
Colleen Luckett:And even then, some states, like California, add further restrictions on the use of sale or de identified health data. Green emphasized that just because data is de identified under HIPAA doesn't mean you're in the clear, though. AI systems often use unstructured data, like imaging, doctor's notes, audio that can be incredibly hard to fully de identify. When data sets are combined from different sources, the risk of re identifying individuals increases significantly. One of the most important warnings from the session came around HIPAA's prohibition on the sale of PHI.
Colleen Luckett:If a health system shares PHI with a tech company, in exchange for intellectual property or AI tools, that can be interpreted as a prohibited transaction, even if no money changes hands. That's a key compliance risk for practices partnering with AI vendors. This session also dug into the fine line between healthcare operations and research. Green explained that helping your own patients with AI assisted tools usually falls under operations, while efforts to generalize or commercialize those tools may trigger HIPAA's research requirements, like IRB approvals or data use agreements. It's a gray area with real implications.
Colleen Luckett:And finally, Green reminded attendees that compliance isn't just about checking boxes. Ethical considerations matter. He pointed to Google's Project Nightingale as a case where a technically compliant partnership still resulted in massive public backlash. His advice, appoint someone on your team to play the role of ethical watchdog. Someone who asks the question, would we be comfortable seeing this on the front page of the newspaper?
Colleen Luckett:For medical group leaders exploring AI, this is your reminder to go beyond the tech, check your policies, revisit your agreements, and think carefully about how your data is being used. And maybe update that dusty old HIPAA training while you're at it. Thanks again to Chris Harrott for bringing back this critical insight from HIMSS twenty twenty five. MGMA members can check out Chris's full session recap on the MGMA website under practice resources and then articles. And hey, MGMA is here to help with your cybersecurity needs.
Colleen Luckett:Head to MGMA.com and check out our new MGMA cybersecurity and medical practices playbook. It's a handy member exclusive resource that provides all kinds of practical advice about understanding HIPAA compliance and frameworks for protecting secure data against those threats or accidental exposure. Alright, Danielle, over to you.
Daniel Williams:Yeah. Our next article really stuck with me. It's called The Critical Link Between Provider Wellness and Its Impact on Patient Satisfaction. It was written by Randy Baldiga and published on April 1 over at Physicians Practice. It is not an April Fools' joke.
Daniel Williams:The title really does say it all. The real impact is in how clearly the author connects the dots between clinician burnout and the overall patient experience. The author cites some pretty eye opening data, including a 2023 AMA survey showing that sixty three percent of physicians reported at least one symptom of burnout. That number has jumped significantly from just a few years ago, and the ripple effect is real. When providers are stressed, exhausted, or emotionally drained, it shows up in patient care.
Daniel Williams:Communication suffers, empathy takes a hit, and trust, which is so foundational in health care, starts to erode. What I appreciated about this article is that Boldiga doesn't just stop at describing the problem. He points towards real solutions. One of the biggest shifts he advocates for is moving away from this idea that individual resilience is the answer. Instead, he calls on organizations to create environments that actively support wellness through things like flexible scheduling, team based care, and smarter EHR workflows.
Daniel Williams:The bottom line, if you're seeing dips in your patient satisfaction scores, you might want to look upstream. Provider wellness isn't just a wellness issue, it's a performance and quality issue. As Boldiga puts it, the patient experience begins with the provider experience. And that's a fine line I think a lot of readers need to hear right now. This kind of research should be front and center in leadership meetings.
Daniel Williams:We often get caught up in the numbers, RVUs, throughput, satisfaction scores, but it's easy to forget that behind all of those metrics are human beings showing up to care for others. And if we want to improve those numbers in a sustainable way, we have to invest in the people behind them. Provider wellness isn't just a moral imperative. It's a strategic one. Colleen, I'll turn it over to you.
Colleen Luckett:Alright. Well, if prior authorization were a person, it'd be the coworker who makes you fill out three forms, get a signature from your past self, and wait two weeks just to use the copier. We all know the process is frustrating, but for some patients, it's not just annoying. It's life altering. So we're looking next at a furious healthcare story from April 2, originally published by KFF Health News called, They Won't Help Me.
Colleen Luckett:Sickest Patients Face Insurance Denials Despite Policy Fixes. It opens with the story of a 30 year old woman living with small fiber neuropathy, a condition that causes excruciating, burning pain in her limbs. Her specialist recommended IVIG therapy, a plasma based treatment that could dramatically improve her quality of life. But her insurer, Anthem, has repeatedly denied the request, citing insufficient evidence of effectiveness for her condition, even though multiple doctors support it. She pays over $600 a month in premiums and still can't access the treatment she needs.
Colleen Luckett:Her only hope now lies in a pending appeal to the Virginia State Corporation Commission. Her case isn't unique. According to patient advocates and health economists, prior authorization, originally designed to reduce waste and avoid unnecessary care, has become a major obstacle for some of the sickest patients. The system is opaque, inconsistently applied, and often delays or blocks care for those who need it most. Even when insurers claim to be improving the process, healthcare leaders remain skeptical.
Colleen Luckett:Judson Ivey, CEO of Ensemble Health Partners, said many so called reforms look more like PR moves than meaningful fixes, leaving high cost services like imaging and infusion therapy still stuck in limbo. One example, a resident physician had to fight his own father's insurer to approve a PET scan for staging lymphoma. The approval finally came weeks late after multiple delays and cancellations that added stress during an already terrifying time. There's growing public outrage too. After the killing of UnitedHealthcare CEO Brian Thompson last December, social media exploded with stories of treatment denials and prior auth nightmares.
Colleen Luckett:A somewhat understandable poll, depending on whom you speak to, found forty one percent of young adults considered the killer's actions at least somewhat understandable. While no one really condones this violence, this reflects the level of unified anger among patients, doctors, and advocates who feel trapped in a system built more for profit than care. Both the Trump and Biden administrations attempted reforms, and bipartisan efforts continue in Congress and state legislatures. Some states have passed gold card laws to ease the burden for providers with strong approval track records. But for many patients, those changes haven't come fast enough or reached the most critical care decisions.
Colleen Luckett:And the fundamental issue remains: can a system designed to control costs ever truly prioritize the sickest patients? As one advocate put it, trying to reform prior authorizations sometimes feels like playing whack a mole. Insurance companies always seem to find another way to say no. At the end of the day, no patient should have to plead with a drug company for charity while paying hundreds of dollars a month for coverage. The system may not be easy to change, but the stories that are being shared louder and more publicly than ever are pushing us closer, hopefully, to a reckoning.
Colleen Luckett:We will, as usual, drop that full article into the show notes. Check out that link there. And if your practice is seeing the impact of prior authorization delays on care delivery, we'd love to hear from you over at MGMA Connection Magazine for an article. You can reach us there at connection@mgma.com or email Daniel or me if you wanna join us on the podcast. Okay, Daniel.
Colleen Luckett:Back to you.
Daniel Williams:Alright. Thank you so much, Colleen. This next one, a little bit personal. I'd lived in the LA area for almost a decade and was up in the Pasadena area in there, and so nearby were the fires. So when I came across this next article in Becker's Hospital Review, really connected with it.
Daniel Williams:So it was written by Kelly Gooch, published March 29, and it's called responding to disaster, lessons from Maui wildfires can help LA recover. And it really draws some powerful parallels between the devastating wildfires that swept through Maui last year and the wildfires that have since impacted the Los Angeles area. So what stands out here is the emphasis on learning from past disasters, not just in theory, but in how hospitals and health care leaders actually put those lessons into practice. Gooch highlights examples from Hawaii Pacific Health and Kaiser Permanente, Hawaii, where leadership focused on clear communication, staff support, and agile problem solving to keep care delivery moving under incredibly challenging conditions. One of the biggest takeaways, relationships matter.
Daniel Williams:Leaders who had already built strong internal teams and external partnerships before the crisis were able to respond more quickly and effectively. It's a reminder that trust and coordination don't just happen overnight. You build them in the quiet times so they're there when it counts. There's also a strong human element in the piece. It's not just about emergency protocols and logistics.
Daniel Williams:It's about how leadership shows up, being visible, listening, supporting your team emotionally while helping them navigate the chaos. Gooch makes the point that leadership presence can carry people through moments when there are no perfect answers. And when it comes to preparation, it's clear that waiting until the fire is on your doorstep is too late. Having a plan, training your team, stress testing your systems. These aren't just boxes to check.
Daniel Williams:They're what make the difference between reacting and responding. The article suggests LA's Health Care Leaders have a real opportunity to learn from Maui's experience and apply it to their own long term recovery and resilience planning. Again, this this article really touched me. It is called, again, Responding to Disaster, Lessons from Maui Wildfires Can Help LA recover by Kelly Gooch. It was published in Becker's Hospital Review.
Daniel Williams:It is well worth a look if you're thinking about disaster preparedness and the role leadership plays in the thick of it. Colleen, what's next?
Colleen Luckett:Yeah. I have a feeling those are going to come fast and furious. Yeah. Coming years, unfortunately. Thanks for that.
Colleen Luckett:So, everyone, Daniel talked about it earlier. And if you're in health care, it may make your eyes glaze over at this point. It's been said, studied, surveyed, and strategized to death. What is it? Clinician burnout.
Colleen Luckett:Yeah. We get it. But here's the thing. It's still happening. And as long as clinicians are quietly, or not so quietly, slipping out the side door of the profession, it's a topic we can't afford to ignore.
Colleen Luckett:So, in our latest MGMA stat poll, we wanted to know what, if anything, medical group practices are doing to address clinician burnout right now. So on April 1, we asked, Has your organization added or updated any strategies for addressing clinician burnout in the past year? Here's what we heard from two ninety five healthcare leaders: 20 four percent of you said yes, sixty six percent said no, and 11% of you just weren't quite sure. So about one in four groups are taking action, but the majority haven't made recent changes, which is a little surprising considering the ongoing risks. A previous poll showed 27% of medical groups had already seen a physician retire early or leave due to burnout.
Colleen Luckett:The good news? For those who have made updates, they're getting creative. According to our full article, addressing clinician burnout with a focus on their calling to medicine, the stop the top strategies include AI tools to reduce documentation and billing workloads, scheduling fixes like four day work weeks, fewer weekend shifts, and real time off. Mental health and wellness offerings, everything from therapy and coaching to the Calm app subscriptions and massage chairs. Training and engagement, such as therapist led workshops, leadership groups, and interview, state interviews.
Colleen Luckett:Operational tweaks like hiring additional support staff and making lean process improvements. And here's the broader context. With the AAMC forecasting a shortage of up to 86,000 physicians by 02/1936, Keeping today's clinicians connected to their work and wanting to stay isn't just a culture issue. It's a workforce emergency. The article also explores new research from Jackson Physician Search and LocumTenens.com, which shows that while 90% of physicians and APPs entered the field with a strong sense of calling, over half say that sense of purpose has faded.
Colleen Luckett:That loss is being driven by, you guessed it, admin overload, regulatory fatigue, and lack of autonomy. Still, 81% of clinicians say being a provider is central to who they are, and 77% say the positives of the job still outweigh the negatives. Clinicians with a strong sense of purpose report lower burnout and greater satisfaction. So what can healthcare leaders do? The report offers two key takeaways.
Colleen Luckett:Number one, reduce the admin burden so clinicians can spend more time connecting with patients. Two, protect work life balance so they can recharge with family, friends, and purpose driven tasks. And one more idea, mentorship across generations. Baby boomers tend to express the highest joy and sense of calling in their roles. Sharing that perspective with younger clinicians could be part of the solution.
Colleen Luckett:So yes, the word burnout may be overused, but it still hits hard, and it's not going away until more organizations rethink what it takes to keep their clinicians engaged, not just employed. You can read the full article at MGMA.com. And as always, if you want to help shape future resources, sign up for MGMA STAT by texting stat, s t a t, to 33550. And that does it for me today, Daniel.
Daniel Williams:And that's gonna do it for us this week, everyone. Thank you so much for listening to the MGMA weekend review podcast. We're still getting a little bit of snow here in Colorado, so hopefully, y'all are getting some sunshine. So until then, thank you all for being MGMA podcast listeners.
Colleen Luckett:Thanks, everyone. See you next week.
