Navigating the No Surprises Act and Strengthening Physician Practices with Dr. Thomas Shaffrey

Summary

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Episode Overview

Podcast: Becker’s Healthcare Podcast
Title: Navigating the No Surprises Act and Strengthening Physician Practices with Dr. Thomas Shaffrey
Date: October 28, 2025
Featured Guest: Dr. Thomas Shaffrey, Primary Care Physician and Physician Leader
Host: Scott Becker

In this episode, Dr. Thomas Shaffrey joins Scott Becker to share a seasoned physician’s perspective on the impact and controversy surrounding the No Surprises Act. Dr. Shaffrey discusses the challenges of healthcare contracting, the pressures facing physician practices and hospitals, and the critical importance of physician involvement in business and leadership. The episode blends policy analysis, hard-won wisdom, and calls for stronger physician advocacy in the evolving healthcare landscape.

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Key Discussion Points & Insights

Dr. Shaffrey's Background and Rationale for Joining (00:31 – 03:58)

• Multifaceted Career:
  Dr. Shaffrey describes his path from IT and chemical research to a 30-year practice in medicine, emphasizing how his diverse background informs his approach to insurance contracts and advocacy.

  • Quote: "Prior to this I was in the IT field and before that chemical research...I found that it has helped me in looking at what we do to contract with insurers." [00:36]

• Experience With Contract Negotiation:
  As president of an Independent Physician Association (IPA), Dr. Shaffrey negotiated crucial contract provisions, such as prompt payment clauses, after experiencing a major contract breach from a national carrier.

  • Quote: "If you have a preferred customer you will give them a discount, but that discount will have a time limit...we enforced in our contract was a 30 day payment was required for any clean claim and if it was not paid in 30 days...full bill charges would apply..." [02:16]

• Philosophy on Government Intervention:
  He contends that many issues targeted by the No Surprises Act could be addressed by proactive physician contracting, rather than relying on increased government regulation:

  • Quote: "People are looking to go to the government to somehow correct things...when in fact people should really take it upon themselves." [01:43]
  • Borrowing Reagan's Maxim: "The nine scariest words in the English language are, I'm from the government and I'm here to help." [03:45]

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Analysis of the No Surprises Act and Its Consequences (04:08 – 05:10)

• Effect on Negotiating Power:
  Scott Becker highlights how the Act diminishes providers' leverage in negotiations with insurers; previously, the threat of going out-of-network was a bargaining tool—now constrained by arbitration processes.
  • Quote (Scott): "The no Surprises act...put a lever or a ceiling on out of network claims...ultimately took away a lot of leverage for a lot of providers..." [04:12]
  • Dr. Shaffrey concurs and reinforces the need for better up-front contracting by providers.

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The State of Healthcare & Prospects for Reform (05:11 – 07:47)

• Mounting Pressures on Physicians and Hospitals:
  Dr. Shaffrey expresses concern over wide-ranging challenges:

  • Surging healthcare costs ($4 trillion/year)
  • Hospital closures and service reductions
  • The fallout from large organizations' financial instability (e.g., his own experience with a hospital bankruptcy)
  • Quote: "Physician practices, hospitals are under such pressure from every direction...I was...employed by the Stewart Medical Group...went through the process where they filed for bankruptcy...the facility where I was at ended up closing and that was an enormous blow to the local community." [05:12 - 06:24]

• Need for Policy Response:
  He acknowledges that some government involvement is "really important" to maintain community safety nets, even if he's wary of overreach.

• Hope for Change:
  Dr. Shaffrey expresses cautious optimism that current crises might spur legislative action to "revamp much of the healthcare process."

  • Quote: "Maybe, hopefully we're at the point where we can get enough legislators to wake up to the reality of what's going on..." [06:55]

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Advice for Young and Emerging Leaders (07:48 – 10:15)

• Importance of Involvement & Education:
  Dr. Shaffrey urges physicians to engage deeply with professional societies and learn the business aspects of medicine—especially contract law:

  • Quote: "Be involved with your professional societies...even with things such as IPAs...gain knowledge in terms of business and what's necessary..." [07:50]
  • He compares reading legal contracts to deciphering IT code, emphasizing personal responsibility and diligence:
    • "Reading legal contracts was almost like reading...code, where you would go along and you'd have to leave for a little bit to go read about a subroutine..." [08:17]

• Advocacy to Prevent Service Losses:
  He stresses the need for a unified physician voice against closures and service reductions, referencing continuing news about at-risk facilities.

• International Perspective on Primary Care Investment:
  Inspired by a conference at the Australian Embassy in DC, he underscores how Australia's focus on primary care yields better results at half the U.S. cost:

  • Quote: "The Australian system...promoted significant investment in primary care...actually was spending one half per capita on health care than what was happening here in the United States." [09:14]
  • He envisions that similar reforms could dramatically ease economic pressures in the U.S.

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Memorable Quotes & Shout-Outs (10:16 – End)

• Personal Anecdote on Physician Health:
  Dr. Shaffrey shares a friend's wisdom:

  • Quote: "I can't keep my patients healthy if I'm not healthy." [10:24]
  • This applies both to physical well-being and the ability to maintain a financially viable practice.

• Recognition of Family Support:
  Dr. Shaffrey acknowledges his wife, previously his office manager, and plans to share the podcast with family across the country.

  • Quote: "Particularly my wife, who had been my office manager, who's still involved with medicine...I think she would greatly appreciate knowing that she's been recognized." [11:29]

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Timestamps for Important Segments

• Introduction and Dr. Shaffrey's background: [00:30 – 01:42]
• Contracting insights and the No Surprises Act’s impetus: [01:43 – 03:58]
• Discussion of policy impacts and provider leverage: [04:07 – 05:11]
• Industry financial pressures and the need for reform: [05:12 – 07:47]
• Advice to rising healthcare leaders: [07:48 – 10:15]
• Personal stories and shout-outs: [10:16 – End]

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Summary Takeaways

• The No Surprises Act, though well-intentioned, may have inadvertently disadvantaged physician groups by limiting their negotiating leverage; Dr. Shaffrey argues for stronger, more proactive contracting as a solution.
• There is widespread financial strain across the healthcare landscape, with closures and cutbacks threatening patient access and community health.
• Physicians should engage in both clinical and business leadership, learning the intricacies of contract negotiation and organizational governance.
• International models, especially emphasizing primary care—as seen in Australia—suggest promising reforms for controlling costs and improving outcomes.
• Maintaining the health of individual providers is inseparable from their ability to serve patients and communities.

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Transcript

[A]

This is Scott Becker with the Becker's Healthcare Podcast. We're thrilled today to be joined by a brilliant physician leader. We're joined today by Dr. Thomas Schaffrey and we're really going to talk about the no Surprises act and a lot more. The no Surprise act of course has been highly controversial and we'll talk about that. Dr. Shafry, can you take a moment to introduce yourself and tell us a little bit about your career? And now let's talk about your perspective on the no Surprises Act.

[B]

Well, good morning Scott, and a big shout out to your your newsletter. I read it daily. I have picked up a great deal of very timely information on it. As you mentioned, there was an article a while back about the no Surprises act that kind of prompted me to contact you. Folks. I'm a primary care physician. I've been in practice oh 30 some odd years. This is actually my third career. Prior to this I was in the IT field and before that chemical research. So have done a number of things other than just being a physician and found that it has helped me in looking at what we do to contract with insurers. But I often find that a lot of my colleagues don't have the same experiences. I have been a involved with my professional organization. I've been president, chairman of the board for my state academy. I've also been involved with two independent physician associations as vice president, President. And the reason that I I contacted your office is after reading the no Surprises act, it struck me that once again people are looking to go to the government to somehow correct things that probably was the government's fault to begin with when in fact people should really take it upon themselves to do those corrections. What I cited in reading the article about the no Surprises act and now the request for the Enforcement act is there are things there that physicians should really do on their own in doing contracts. And what I cited in my letter to you was as the president of a ipa, we had a national carrier actually breach our contract. And I called them on the breach and in fact they did not cure the breach in the specified time. So at the end of that, that cure period, they were locked out of a significant part of the state because they didn't have any contract. And in recontracting with them I convinced the rest of my board members that we needed to put in a prompt payment clause in any contract that we had with any carrier. And that goes back to just being business. If you have a preferred customer you will give them a discount, but that discount will have a time limit. So if they're going to get a discount, you expect payment in 30, 60 or 90 days. And what we enforced, oh, this was 20 some odd years ago. What we enforced in our contract was a 30 day payment was required for any clean claim and if it was not paid in 30 days and full bill charges would apply and every 30 days after that, interest was also applied. So in reading about the no Surprises act and the request for enforcement, it seems like my colleagues are looking for extra steps, extra government intervention for something that they should already be doing on their own. I don't know how others would feel about that. What I had also mentioned in the my letter to you folks was the famous Reagan quote. The nine scariest words in the English language are, I'm from the government and I'm here to help. Why would you want somebody to come in and try and enforce terms on a contract that you should have negotiated properly in the first place?

[A]

No, thank you very, very much. And, and I think the point is very well taken. The no Surprises act, in some ways being a, arguably a sop to the insurance companies that now could put a lever or a ceiling on out of network claims. And so it made it much harder for anesthesia groups, other groups, to bill insurers out of network. It also ultimately took away a lot of leverage for a lot of providers on their ability to use as a negotiating tactic the fact that they'll go out of network because now there's an arbitrated way for the insurer in the practice to agree on ultimately to come to terms if they can't. But no, your point on better contracting up front for practices would be a really positive thing, is really well taken. Dr. Shafry, could not agree with you more on that. Thank you. Talk a bit about what you're most focused on and excited about as we move forward, the end of 2025 and into 2026. Where are you most focused and excited?

[B]

Well, Scott, right now with all that's going on, it's hard to focus on any one thing. My gosh, health care, physician practices, hospitals are under such pressure from every direction. What's going on now with the budget battle? The overall cost of health care in the US is, I believe, at this point somewhere. What, about $4 trillion per year? What an enormous burden that is on the economy overall. But then on top of it, you know, what we have now, the government shutdown, the political divide, insurance companies making even greater pressures. And from your own newsletter I'm reading routinely about practices closing about hospitals having very significant problems and potentially closing or dropping off services. I was actually employed by the Stuart Medical Group at one of their hospitals here in the US and went through the process where they filed for bankruptcy and what happened to the facility where I was at ended up closing and that was a enormous blow to the local community. So in looking at what's positive, I don't know if we're getting to a point of no return. But again, at this time it is really important that there be government action to say these are the things that are the safety net for communities. They cannot be allowed to close because that's just going to be devastating. So again, what I'm positive about is maybe, hopefully we're at the point where we can get enough legislators to wake up to the reality of what's going on and really sit down and revamp much of the health care process in.

[A]

The U.S. yeah, no, your point is so well taken. So many facilities at risk of closure, so many facilities closing services, hospital margins. I think 60% of hospitals have some margin, 40% don't. Hospitals and physicians really and nurses really serve as a safety net and backbone of our nation health care situation. So we really need them to be healthy. But you're absolutely right, we're spending enormous amounts on health care and we're increasingly finding it to be a very fractured system. Thank you so much for joining us today. Anything else you want to share? Any advice to young leaders, emerging leaders that you would give?

[B]

Tom There was something that I was told when I was in residency then unfortunately I didn't pay attention very well. Be involved with your professional societies, not just the medical aspects, but even with things such as IPAs and stuff like that and gain knowledge in terms of business and what's necessary. I am not an attorney, but when I was president of the ipa, I read every single contract. And it was kind of strange in a way that reading legal contracts was almost like reading it code where you would go along and you'd have to leave for a little bit to go read about a subroutine and come back and continue. But I found that somewhat easy for me to do. And in doing so I thought I had a fairly good grasp of what my organization was contracting for. And with that we had the knowledge to know that, okay, this one particular carrier had actually breached the contract, voided it and gave us the opportunity to make a legitimate difference. Be involved, pay attention, read what you need to read. And again, in talking with you and reading about your, your newsletter about all the differences in the closings and, and facilities at risk. This is something that we can't allow to happen. And physicians really need to have a strong voice. As part of what I did in my professional career, I fortunately was invited about 10, 12 years ago to a number of international conferences down in D.C. at various embassies. And one of the conferences that made the greatest impression on me was at the Australian Embassy, where the Australian system, which is not that different than the US system, but really promoted significant investment in primary care, actually was spending one half per capita on health care than what was happening here in the United States. And if we were able to do that, to drop a 2 trillion out of the 4 trillion spent on U.S. health care, what would that do to the economy? That would just allow things to settle down, to take off. And I think it would be a dramatic overall improvement just to the US environment.

[A]

Tom, what a great pleasure to visit with you today. Is there anybody particular that you think you should give a shout out to today?

[B]

Well, I'll tell you, yes, as a matter of fact, one of my closest friends going back to residency in the list of my best friends has a great saying, I can't keep my patients healthy if I'm not healthy. And that has a double meaning. I mean, one, your physical health as well. But he was also talking about his practice ability, ability to survive and be available to patients and supply what was needed. He needed to pay for all the extraneous expenses. He needed to pay for his staff and taxes and everything else like that. But if he could not keep his practice financially viable, he wouldn't be able to be there for them when they needed care. And that is to my buddy Sale.

[A]

God bless it. And Dr. Shaft, we're going to give you one more opportunity. Is there anybody close at home that you'd like to listen to this, who deserves a shout out to.

[B]

Well, yes, of course, as I said, when, when we're done, I'm going to have my family take a listen to it and all my family scattered across the US but particularly my wife, who had been my office manager, who's still involved with medicine, working at another colleague's office. I think she would greatly appreciate knowing that she's been recognized.

[A]

Tom, Dr. Shaffrey, God bless you. Thank you for joining us today on the Becker's Healthcare Podcast. We'll release this in a week or two. Thank you so much for joining us.

[B]

Thanks, guys.