Becker’s Healthcare Podcast

Guest: Dr. Stephen Teitelbaum, Senior VP & Chief Medical Finance Officer, Mount Sinai Health System
Host: Scott Becker
Date: November 26, 2025

Episode Overview

This episode features a deep-dive interview with Dr. Stephen Teitelbaum, a respected leader at Mount Sinai Health System, on the intersection of clinical leadership and financial realities in healthcare. The conversation covers Mount Sinai’s history and mission, the transformation of healthcare leadership, the impact of payer-driven policies, and what it will take for physician leaders to reclaim influence in the system. Dr. Teitelbaum shares his personal journey, thoughtful analysis of healthcare finances, and challenges facing both clinicians and patients.

Key Discussion Points & Insights

Dr. Teitelbaum’s Background and Mount Sinai’s Legacy

[00:17–04:29]

• Personal Introduction:
  • Brooklyn-born, 30-year clinical urologist career.
  • Leadership focused on improving quality and integrity in clinical care.
  • Now bridges clinical practice with financial realities as Chief Medical Finance Officer.
  • Passionate about how policies and payment systems impact clinicians, hospitals, and patients.
  • “When those worlds collide, patient care is often caught in the middle.” — Dr. Teitelbaum [00:45]
• Mount Sinai Health System:
  • Founded in 2013 via a merger; nonprofit integrated system.
  • 7 hospital campuses including the flagship Mount Sinai Hospital (est. 1852).
  • Historical roots in expanding care for marginalized populations.
  • 48,000 employees, 9,000 physicians, 3,000 beds.
  • Extensive outpatient, ambulatory, and joint venture centers.
  • Icahn School of Medicine at Mount Sinai: academic and research engine, highly ranked in NIH funding, training thousands of physicians and researchers annually.

Healthcare Leadership and the Shift to Payer Control

[05:01–07:44]

• Erosion of Physician Leadership:
  • Historically, physicians drove care and policy.
  • Now, administrative and financial decisions prioritize cost containment, often at clinical autonomy’s expense.
  • Physicians increasingly limited by payer-driven policies (insurance companies, managed care).
  • Administrators and payers now dictate care pathways, leading to an overload of documentation and challenges in revenue retention.
  • “We once held the reins of healthcare policy and clinical decision making. Today, that leadership has shifted dramatically to payers through policies that override medical judgment.” — Dr. Teitelbaum [05:51]
• Contributing Pressures:
  • Aging populations, complex and chronic care needs.
  • Rapidly rising drug prices and expensive technology adoption.
  • Conflicting stakeholder interests in limited healthcare resources.

How We Got Here: Policy, DRGs, and Administrative Complexity

[07:57–17:04]

• Advent of Prospective Payment & DRG System:
  • 1980s move to prospective payment; Medicare DRGs.
  • Hospitals reimbursed per admission (by diagnosis group), not per service.
  • Recalibration annually to reflect resource usage.
  • Initially aimed to encourage efficiency and limit overuse.
  • “This annual recalibration is meant to keep payments aligned with actual practice patterns and costs. Originally the system was designed to reward efficiency without compromising care, but over time payer driven policies have undermined that integrity.” — Dr. Teitelbaum [08:35]
• Proliferation of Payer-Driven Policies:
  • Pre-authorization: Expanded from utilization management to stifling clinical care, increased delays and provider workload.
  • Medical necessity redefined: Now dictated by insurers with proprietary algorithms, undermining clinical judgment.
  • Observation status and 25-hour categories: Used to minimize reimbursement, eroding DRG-based benefits even for efficient hospitals.
  • The Two Midnight Rule: Created for clarity, now inconsistently applied, especially by Medicare Advantage plans.
    • “The irony of ironies is that Medicare Advantage plans ostensibly required to provide the same coverage… have been denying inpatient admissions based on medical necessity even if the inpatient stays more than two midnights.” — Dr. Teitelbaum [11:50]
  • Clinical validation audits: Payers questioning the clinical basis of provider diagnoses, even when documentation meets coding standards.
    • Quote from official guidelines: “The provider’s statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria…” [13:07]
  • All combined, these policies have transformed healthcare into a system led by compliance and payer policies—not by clinical expertise.

Impact on Hospital-Physician Relationships and Patient Care

• Misaligned Incentives:
  • Hospitals face financial penalties for administrative or payer-related denials.
  • Increases documentation demands, shifting focus from patient care to “defensive documentation.”
  • Strains trust and collaboration between hospitals and medical staff.
  • “These layers of bureaucracy strain relationships, erode trust, and shift the focus from collaborative patient care to defensive documentation and compliance. This is not a formula for success.” — Dr. Teitelbaum [15:11]

Path Forward: Physician Leadership and Advocacy

• No Easy Fix—But Change Starts with Recognition and Advocacy:
  • Physicians must acknowledge the shift to payer-centered decision-making; cannot ignore this reality.
  • Reversing the trend requires coordinated, persistent advocacy and policy engagement.
  • Action Steps:
    • Awareness and education on payer policies and their impact.
    • Build coalitions—collaborate with hospitals, professional societies, patient advocacy groups.
    • Active participation in committees, legislative processes, and payer negotiations.
    • Leverage data to prove that physician-led care improves quality and cost-effectiveness.
    • “Leadership means having a seat at the table where the rules are written.” — Dr. Teitelbaum [16:23]
  • The future depends on whether clinicians accept the current system or fight to regain leadership.
    • “Ultimately, physician leaders must decide: Do we accept a system where payers dictate care or do we commit to reclaiming leadership, even if it means years of advocacy and structural change? That decision will define the future of our profession and the quality of care our patients receive.” — Dr. Teitelbaum [16:50]

Memorable Moments & Quotes

• “When those worlds collide, patient care is often caught in the middle.”
  — Dr. Teitelbaum [00:45]
• “We once held the reins of healthcare policy and clinical decision making. Today, that leadership has shifted dramatically to payers through policies that override medical judgment.”
  — Dr. Teitelbaum [05:51]
• “This annual recalibration is meant to keep payments aligned with actual practice patterns and costs. Originally the system was designed to reward efficiency without compromising care, but over time payer driven policies have undermined that integrity.”
  — Dr. Teitelbaum [08:35]
• “Leadership means having a seat at the table where the rules are written.”
  — Dr. Teitelbaum [16:23]
• “Ultimately, physician leaders must decide: Do we accept a system where payers dictate care or do we commit to reclaiming leadership, even if it means years of advocacy and structural change? That decision will define the future of our profession and the quality of care our patients receive.”
  — Dr. Teitelbaum [16:50]

Lighthearted Segment: Brooklyn Accent & Sports Teams

[04:29–05:01 and 17:04–17:55]

• Teitelbaum jokes about his effort to lose his Brooklyn accent in youth, now “really proud of it.” [04:48]
• Reveals sports loyalties: Mets and Jets—not Yankees or Giants. [17:25]
  • “As a Jets fan, I’m looking forward to the draft, because clearly this year is not a year that we’re going to do much.” — Dr. Teitelbaum [17:39]

Conclusion

Dr. Stephen Teitelbaum delivered a passionate, nuanced analysis of how payer-driven finance and policy have wrested control from clinicians in American healthcare, threatening both autonomy and quality of care. He calls for renewed advocacy, education, and coalition-building to return physician leadership to the center of healthcare decision-making. His perspective is rooted in rich historical knowledge and a commitment to patient care, making this episode essential listening for current and aspiring healthcare leaders.