From Capitol Hill to the Clinic: Incoming MGMA Board Chair Jeff Smith on Burnout, Prior Authorization, and the Future of Care
Download MP3MGMA has long advocated for reducing administrative burden and routinely surveys our members on administrative hurdles they face. In our 2026 survey with over two thirty respondent physician practices, more than half of the practices report losing a physician to burnout in the past three years. And among those, over 75% say regulatory burden played a substantial role. I think what you're going to see is more prior authorizations needed. That's going to add burden to the staff.
Jim Smith:There'll be more denials that will add burden to the physician to to either fight the denial or just to decide it's just not worth the fight. Right. Now you have patients not receiving care. Patients don't receive care. I believe that they will get sicker.
Jim Smith:End up in the emergency room, ultimately the hospital. And we're going to drive the cost of health care up. You know, spend a lot of time telling doctors, you know, you're in charge, you're the quarterback of care. We actually increased the EM codes. But every step of the way, we question what they do.
Jim Smith:Any addition of physicians into the market would increase access to care. There would be more appointment time and more availability. The challenge we have is convincing those doctors to go into primary care, internal medicine. Most of them nowadays, they say, you know, I want to become a neurosurgeon or, you know, I want to become an EP doc in cardiology because there's more money there. So we don't see a significant amount of docs wanting to be family practice doctors anymore And I think somehow we've got to incentivize that in this program to make that more attractive.
Jim Smith:Make that the noble position that it used to hold in the community. Take some of this administrative burden off of them and let them be doctors again. Health care is not for the faint of heart. It is incredibly difficult, and I believe our front desk folks have the toughest job in health care. Not the doctors.
Jim Smith:It's it's the front desk. They need to be psychiatrists, insurance experts, best friend. I mean, it is incredibly challenging all working working under HIPAA, obviously.
Daniel Williams:Well, hi, everyone. I'm Daniel Williams, senior editor at MGMA and host of the MGMA Podcast Network. We're back today with another MGMA Insights Podcast, and I'm really excited to bring our guest on today. Today joining us is Jeff Smith. He's the CEO of Piedmont Healthcare.
Daniel Williams:He is also MGMA's incoming board chair. It's really exciting to get to spend some time with Jeff today. I'm going to bring up one more thing that we're going to be talking about. Jeff recently testified before the US Senate Special Committee on Aging. And I've got questions for Jeff about that, what that what that's like to be testifying before congress.
Daniel Williams:So, Jeff, I just want to welcome you to the show.
Jim Smith:Thanks, Daniel. I greatly appreciate the opportunity to talk with you and to share my thoughts on MGMA. I look forward to our discussion today.
Daniel Williams:That is wonderful. Now you were telling me offline that you are, I believe, just north of Charlotte, North Carolina, so we're excited, to come over to your area. We're gonna have our MGMA operations conference coming up in April. And, so a lot of us are gonna be there and hope to get to meet you in person when we're in that Charlotte area.
Jim Smith:Yeah. That'd be great. If you haven't registered, please do so. It's a it's a great conference. Our spring conferences have been going very well, we so certainly look forward to everybody coming to to the Charlotte market, experience a little southern charm and some barbecue.
Daniel Williams:That is wonderful. I have to agree. I've been to Charlotte once that I know of. I actually came there about twenty years ago for a job interview. The Sports Business Journal is headquartered there, and I was one of two finalists.
Daniel Williams:Didn't get it, but it was one of those sliding door moments because I met my future wife about a week later. So that would not have happened. So things work out. Things work out. But we did have some amazing barbecue when we were there.
Daniel Williams:So I do wanna congratulate you. You are, as I mentioned, the incoming MGMA board chair. If you don't mind just sharing with us your thoughts on that being, the incoming board chair and some initial thoughts you have about your role, as incoming board chair.
Jim Smith:Yeah, absolutely. First and foremost, it's an incredible honor. I've worked in the physician side of health care for too many years to mention. But, you know, to me, the MGMA is is really the association that that really handles and and, you know, it's it's our it's our voice in Washington. It's our data.
Jim Smith:It's our our community as we go to conferences. So to sit in a position of board chair, I I I just I'm really overwhelmed, but I will tell you that it's actually my second stint. I was board chair from 2022 until 2024 as we came out of COVID, so I may be the only person who will serve three years as board chair. And I know some of you are probably thinking, oh my gosh. Can't we find anybody else?
Jim Smith:But, again, MGMA obviously is in a a transition phase. The board thought it was very important that, we maintain some stability. But even with that, honored that that they asked me to to return to the role, and I look forward to that.
Daniel Williams:Yes. And as you mentioned, it is a monumental time as well for MGMA. We are gonna be celebrating our hundredth anniversary. We're gonna really kick that off at our fall conference in San Antonio. You're gonna be brought in as that board chair at that moment, so that is gonna be exciting.
Daniel Williams:As you're preparing for all of this, just from the even at 30,000 feet, are there some just big picture ideas that you want to really focus in on as board chair once you're in place there?
Jim Smith:Absolutely. And I hope the membership is already hearing this. We want not just the one hundredth anniversary, but we want MGMA to refocus on the members. We really have to get back out there and and give people a reason to give us their their money for membership. I think in the past, we've distanced ourselves from the membership, not intentionally, but but I think that now we we need to reconnect.
Jim Smith:We we need to get out there and, you know, shake hands and kiss some babies and say thank you. Thank you for being a member. What else can we do for you? And I hope that the membership will come, whether it's to a spring conference or to the annual meeting, and really see that warmth come back. All the things that are important, whether it's celebrating fellowship, certification, all the folks who volunteer and just being a member and the value that you get for being a member.
Jim Smith:We need to celebrate and refocus on that and make people understand and get excited again about coming to our meetings. If we can accomplish that through my term, I will be thrilled.
Daniel Williams:I totally agree with you, and we talk about that internally as MGMA employees that let's really turn this lens to the members themselves. So all of you who are listening, that is where our dedication and focus is, whether it's from Jeff's side of the aisle or if it's from people like myself who do a podcast or a webinar. We wanna put you all at center stage here. And so if you don't feel like we're doing that, let us know. Send a letter to Jeff.
Daniel Williams:Send a letter to me. Call us. Let us know and see what we can do.
Jim Smith:Absolutely. And I'm one of you. You know? I work I work in this every day, so so please let us You know, I came I came to the board from the data solutions committee, you know, the group that does the surveys. So I you know, I've seen the underbelly.
Jim Smith:But, you know, MGMA is such a a great group. When I when I switched from the hospital side to the physician side, this was the group that I thought, This is what I need to be a part of. So let us know how we're doing. We want to hear from you, we will listen.
Daniel Williams:Absolutely. All right, Jeff. Well, some other people have been listening to you, and this is the US Senate Special Committee on Aging. I made a joke about it earlier because I don't know if it's like jury duty where you just get a letter in the mail and suddenly you're in DC testifying. I joke a little bit about that, but tell us about this surreal experience of testifying.
Jim Smith:Well, that's a great way to describe it, and I think MGMA was offered a seat at the table. And I think that's what's important to remember, is that our strength in Washington allowed us to be invited to sit and testify in front of this committee. As a result, they went out and they said, okay, who who can represent membership? Is it is it somebody from a big health system? Is it somebody from a large independent, a small independent?
Jim Smith:So we kind of went with the sweet spot and said, all right, let's get, you know, a large independent in Piedmont, you know, 230 providers, you know, a quarter of $1,000,000,000 company. So they thought, okay. That that represents what doesn't represent the super large and doesn't represent the super small, but but can really speak to the challenges that, hopefully, all of us are facing. So I was fortunate enough to be asked to be that representative. Anders, who handles the Washington office and all of our advocacy work, gave me a call.
Jim Smith:Know, it's kinda like winning the game show. Right? It's it's like, you you want me to do what? I I was just so thrilled and honored and and a little bit scared to to be offered that opportunity. So I had to go buy a suit.
Jim Smith:You know, we we work in an industry anymore that really doesn't get dressed up every day. So I said I said, you know, hey. What what's the attire? You know? Should I should I go kinda casual?
Jim Smith:And they they're like, well, he's just a regular guy. Or And they're like, You better wear a suit. I'm like, Okay. So off I went and bought a suit. But yeah, a great experience.
Daniel Williams:That is incredible. What I picture, and maybe you said a little bit of fear going into it, we've all seen these clips that they show on TV or either as documented in movies where they're basically slamming a gavel and screaming at the person. And I don't know. Maybe this particular topic didn't get there, but you tell us what was what was the mood like? What was the tone in which they engaged with you?
Jim Smith:So it was very interesting. Senator Scott got there a little bit early. Senator Gillibrand got there a little bit early and actually came down and spoke. There were four of us that testified. So they they shook our hands.
Jim Smith:They thanked us for our time. They realized that, you know, we were volunteering, taking time about out of our day to come and talk to them and and hopefully educate them. They kinda set us at ease. They said, you know, look. Just just talk to us.
Jim Smith:And what you don't know is that beforehand, we we had to speak to both the Republican and Democrat side. So we had meetings with their aides. They went through our our paper. You have to submit a paper, which is, you know, the long version of your testimony. And I guess just to see what you're going to talk about, they asked some questions, and both sides got that opportunity.
Jim Smith:And then they had the opportunity to submit questions. And we didn't get a lot of questions, so a lot of them we weren't aware of what they were going to ask. So you kind of had a feeling going in that this was a bipartisan issue. Everybody was trying to to come up with an answer on how do we deal with physician burnout, the loss of physicians. So they kind of set you at ease before.
Jim Smith:But then you sit down, and there's a box in front of you with a timer on it and a microphone. You got to push a button, and it's like, holy smokes. The fellow sitting next to me said, have you ever testified before? I said no. He said, I'm gonna give you a piece of advice.
Jim Smith:I said, oh, great. He said, don't drink the water. I'm like, it's in a bottle. You know what? He said, I don't know how long this is gonna last, but you can't leave, so don't drink the water.
Jim Smith:I'm like, alright. Great great advice. Thank you.
Daniel Williams:That well, this really sets the stage for what was being talked about. So it is a special committee on aging. You're brought in representing MGMA, representing all those MGMA members, all those practices out there. What was the main message you wanted to get across to that committee that you were testifying before?
Jim Smith:Their main focus was burnout. We've all read that in ten years we're going to have a shortage of about 170,000 doctors. And and what can we do to change that? What are things that are driving physicians out of out of practice? So we talked about the prior authorizations.
Jim Smith:We so so that's the current. We talked about the people going into medical school and why aren't they going into primary care, internal medicine, family medicine. But I think the message that I wanted to convey was we can change things. We can change the burden of prior authorizations. We have to start respecting physicians.
Jim Smith:We call them the quarterbacks of care. We've increased the amount of money that we give to them, Yet every step of the way, we question what they do. And I think that's what has to change. We have to understand that most of them are not looking to to game the system. They are looking to take care of their patients in the way that they feel is appropriate.
Jim Smith:We can't treat them like we're all trying to get over on the system. So I think if we do that, and we have so much data to help us do that, let's start utilizing And and if we do that, I think doctors' job satisfaction will start to go up. And we've seen that the the burnout numbers decrease slightly, but it's nowhere near enough. We still have significant problems with doctors leaving practice.
Daniel Williams:Right. Now you've had a lot of experience on the, administrative side at Piedmont, but you also brought in some other personal side on the clinical side. Your wife, with her career in nursing, now you have a daughter practicing primary care. So you were able to share some real life experiences and also your better understanding of what it's like for those clinicians. Tell us about that.
Jim Smith:Yeah, I'm very fortunate. My wife was a clinical nurse for twenty years, worked med surg, worked ER orthopedics, and then transitioned and worked in the clinical research world for the balance of her career. My daughter is a primary care doctor. She has a good family medicine practice, and in total transparency, she works here at Piedmont. Wow.
Jim Smith:So she's an owner of the practice, which makes it a little weird because she's actually my boss. So imagine how those Thanksgiving dinner conversations go. But what it provides me is the clinical side. I mean, my background, I'm an accountant. So I get the bean counter jokes and you don't know anything about medicine, but I have them grounding me in that world.
Jim Smith:They help me understand what truly happens in the practice, what their staff is facing. Because here's one thing that we need to understand. Physicians don't corner the market on burnout. The front desk folks, and I and I will say this to anybody who will listen, they have the hardest job in this practice. That includes doctors, includes me.
Jim Smith:I mean, here here are folks probably, you know, most of them don't have more than a high school education, and that's fine. But we ask them to be insurance experts and psychiatrists and best friends. It is such a challenging position. And turnover rates in health care are huge. So so I get that that insight from my daughter to really help me be a better administrator of the practice.
Jim Smith:So it's challenging at times, but I'm very fortunate.
Daniel Williams:Yeah. You made me laugh so much because when you said your daughter's now your boss, and I was thinking, I have a 21 year old and she's my boss too, and we don't even work at the same place. But I totally get it, anybody that has a daughter. But I did want to ask, do y'all have guidelines, boundaries, guardrails in your family where you you don't talk about it, or you just say, hey. We're gonna take we're gonna keep the gloves on and be kind and just express a few things?
Daniel Williams:How do you how do y'all navigate that?
Jim Smith:Yeah. It's it it gets challenging at times. Look. There's there's a lot of pressure, and and it's a unique situation where where she gets to sit at the table and say, dad, I need to talk about this. And, you know, I've
Daniel Williams:Yeah.
Jim Smith:I've had a conversation when I when I would say, hey. Look. You wouldn't talk to the CEO of a company like that. That's the role I'm in, so let's keep those boundaries in place. Look, she's a great kid.
Jim Smith:She has a great practice, and she's an incredible doctor, and she's passionate. So I appreciate that. I mean, she's no different than anyone else who works here, but we do try to keep the holidays as sacred ground and limit those conversations.
Daniel Williams:For sure. When you shared this information on burnout with, the committee, how did they receive it? What is that give and take like? What was it like for you?
Jim Smith:Yeah, that's a great question. There was a lot of head nodding when we talked about it, I don't know how many folks listened to the whole meeting. There was a woman there who spoke from the medical school standpoint. There was a fellow there who spoke from the concierge medicine standpoint, and to me that's that's somebody who's already bailed on the system. They've kind of said, look, I'm out.
Jim Smith:And then there was a fellow who has a foundation who's who wants to raise money, keep raising money, as his sister was a doctor and committed suicide due to burnout. So four very different points of view. Right. I appreciate them trying to come at this from from all different angles. I think they listen.
Jim Smith:But what's concerning is you you look at what's happening in Washington. We have the Wiser bill right now that is being trialed. That's just putting more prior authorizations in place. So I think what they what they have to do is really take a step back and go, are we really headed in the right direction even with current legislation? Mhmm.
Jim Smith:And hopefully, what they heard was maybe we're not. We need to rethink this and really start to back off a little bit on some of the things that we're doing. I hope so. After testimony and the cameras were turned off, they all came back around and said, We really appreciate you being here. We appreciate what you said.
Jim Smith:And with 100 senators, it's always tough. They're incredibly busy. I hope it makes a difference. I know that our folks in Washington with the MGMA are hammering these points. They do listen.
Jim Smith:So please, if they ask you to write a letter or testify or do something, participate. It's our chance to really make our feelings heard. I think it was good. It was good to get in front of them, and now we'll see what happens. And just I've been fortunate enough a couple of years ago, I went and met with the surgeon general and the head of Medicare Medicaid about prior authorizations, and we did see some change.
Jim Smith:So I think it is possible that what we do and say makes a big difference in Washington.
Daniel Williams:Right. I wanted to ask you that question because about twenty years ago as a journalist, I followed the financial services industry as they sort of marched on Capitol Hill and they spoke. And I was there as a reporter taking notes, but I could tell a lot of the information that was being shared, it was just a glazed over. They had no idea what they were talking about. Now in your case, at least when you're talking about burnout, that's so universal as people, particularly in healthcare, but just as people, we're getting ground down, so to speak, in many, many industries, not just in healthcare.
Daniel Williams:So perhaps there was an opportunity to connect there, but you probably you also talked about MIPS and the quality payment program. I'm not sure if there was a glazing over in certain instances, but tell us what how did that go over when you did talk about those issues and those programs?
Jim Smith:I would say they were listening. I'm not sure they were understanding. Right. Right. I mean, it's a complicated system that some of us in the field aren't really sure what the best steps are.
Jim Smith:So I think, fortunately, they have a lot of people that work for them. Every senator had three, four, five aides working behind them. I hope that those are the ones that read the paper in-depth that told the senator, look. You know, here are the things we really need to focus on based on what we're hearing. You're right.
Jim Smith:You know, as we talked about burnout, lot of head nodding. But but when we got into the details Right. Not the same not the same response. So I think it's going to take a lot of time and a lot of effort on their part to really understand what it is we're going through as a result of the programs that they've put in place. I like to say it's who moved my cheese, because the industry, as we figure it out, they go, Oh, they're getting good at this.
Jim Smith:Let's do something else. Because they want to pay us too much money, so let's make it harder or let's change a measure that we're looking at. And I think we have to stop doing that and get to a point where the industry can be successful. And I know there's limited money. We can't fix every problem with money, but I think we can make it fair.
Jim Smith:And when you look at the hospital industry that gets an inflationary adjustment every year, and then when you look at the physician side of it where we don't, it's just not fair. So we need to really take a hard look at those payment triggers and figure out how we can move this forward so we can all be successful. Because hospitals are great, but they're bricks and mortar. Without doctors, you don't have hospitals. We've got to take care of the folks who are driving this industry.
Daniel Williams:Yeah, you were mentioning the inadequate Medicare reimbursement. You brought it up when you testified. Talk about that operationally, the strain it presses there. And also, you also mentioned physician well-being, the strain it can cause there. What did you mean by that?
Jim Smith:Yeah, so physician well-being, and I'll use my daughter as an example, I mean it's a well known pajama time for doctors. They take their work home, they're finishing charts at home, some till one, two in the morning, and then we expect them to be back in the office at 07:30, 08:00 seeing patients bright eyed and bushy tailed. It's just not realistic. And then compound that by the fact that we had the SGR problems for years and sustainable growth rate and the laws that surrounded that finally they were abolished. But we're still dealing with factors where we're not seeing increases in the Medicare program that come anywhere near inflation.
Jim Smith:We have to give employees, even though it's a cost of living adjustment of a couple percent, that's more than what the program is giving to physicians. And everybody follows the Medicare fee schedule. So it's a compounded problem that ultimately drives, especially in our world where we don't have the operating rooms and the inpatient beds to drive additional dollars into our pockets to cover those shortcomings so the physicians take less money home at the end of the year. That has to stop. Honestly, it's been going on for twenty years.
Jim Smith:So when you look at those factors, it doesn't take much to stop scratching your head going, Gee, why is there burnout? I have to see more patients. I'm on the hamster wheel and I can only go so fast. And if you want me to see 20 patients a day, that's great. I can take care of them in high quality way.
Jim Smith:But if I need to go to thirty, thirty five just to make the numbers work, and then we go, Gee, why are all these independent practices selling out to the big health systems? They can't manage the finances anymore. They don't have the adequate size. You look at the solo practitioner, the two, the three, the four doctor practice, it just gets to be overwhelming. And even if the older doctors want to stay in that world, the new doctors don't.
Jim Smith:So once they hit retirement age, that practice is gone. And it's picked up by whether it's hopefully an independent practice, but in most cases a big health system.
Daniel Williams:Yeah. You brought up the topic about consolidation. You are that incoming board chair for MGMA, so you're going to be thinking about these bigger issues about independent practices. How do we keep them viable in this state of consolidation?
Jim Smith:Well, I'll go back to an earlier point. I think we have to make medicine fair. Most doctors do not go into this business for money, but you have to be paid a reasonable compensation to be able to pay your staff, earn a living, pay off your medical school debts. I mean, have kids coming out of medical school with $203,104 $100,000 of debt. How can they pay that off?
Jim Smith:Have a have a family, have a mortgage, and expect them to go, gee, I love my job. It's a difficult world. I think we need need that fairness in medicine. So whether it's the MIPS program, whether it's just an annual increase, whatever it is, think we need to make it look like something that makes sense to doctors. They can't be asked to just sit there and click a computer so we can gather data that we use for I don't know what.
Jim Smith:I mean, when you look at when you look at the MIPS measures, are they truly driving quality? I don't think so. I I think it's yeah. We've set this up, and it's just a game of data collection. And and I wish I could say it.
Jim Smith:It was great. And and look, the quality is so much better, but I don't think it is. I think we need independent practices. I think there are kids coming out of training who have that entrepreneurial spirit, who who want to run their own business and have a say in what goes on. I also think that there are people who are better at nine to five employees and wanna work in a health system.
Jim Smith:Both are are perfectly fine, but we need both. I think we can we can provide high quality service at a lower cost. I think we're important to the health system. That needs to be recognized. Probably shouldn't say this, but I always say when we're negotiating with insurance companies, hey.
Jim Smith:Look. I'll just sell the practice to a health system, and and you can pay them a higher rate because I know their rates are higher than mine. That usually works. So there's your tip of the day. But but it's true.
Jim Smith:Yeah. And, it's a tough industry, but I just think if fair, I think we can keep this going for a long time.
Daniel Williams:Yeah. I want to ask you one more question then. If Congress could move on one reform from your testimony, what would you put at the top of that list?
Jim Smith:Yeah. I read that question, and I went, boy, that's a great question. I think it has to be a reasonable pay update every year. I think if doctors could stop worrying about money, at least to a certain degree, then I think they could get really focused on the practice of medicine, taking care of their patients. Because I will tell you, hands down, all my doctors, nurse practitioners, PAs, all they want to do is take care of patients.
Jim Smith:That's what they went to school for. That was their calling. Nobody said, I want to be a doctor, but I really love the accounting side of medicine. Nobody. So if that annual struggle about numbers would stop, I think we would see job satisfaction improve.
Jim Smith:Think yeah. Do we have to work on prior auths and making these quality programs mean something? Absolutely. But I also think that overriding just struggle is a basic inflationary increase to these guys, similar to what hospitals get, and I think it would go a long way. So if that's the place they start, I think that would be wonderful.
Daniel Williams:All right. Well, Jeff Smith, I want to thank you so much for joining us today.
Jim Smith:Absolutely. I appreciate the opportunity, chance to chat. I hope you come to Charlotte.
Daniel Williams:I sure plan to. Look forward to shaking your hand there. Hope this was a little less painful than your experience on Capitol Hill.
Jim Smith:This was great. This was great. I'll tell you, I sit in on a radio show every Tuesday morning, a local radio show, so it's it's it's given me a little experience, behind the camera. So I I love this. In retirement, I hope I hope I have a radio show.
Daniel Williams:That is wonderful. That is wonderful. We'll keep that in our memory banks then for any time when that comes up down the road. So for now, I just wanna thank you for the work you're doing at Piedmont and the work you're doing for MGMA as the incoming board chair. Thank you again.
Jim Smith:Daniel, thank you.
Daniel Williams:All right. Well, everyone, we're going to have this with a lot of show notes and resources for you that you can click right through, learn more. You can read Jeff's full testimony on Congress. Until then, thank you all for being MGMA Podcast listeners.
