Health system CIOs at Epic’s UGM reached for the same new word: tokenomics. Ochsner’s Amy Trainor, BSN, RN, cannot forecast the bill because the per-feature cost dashboard is only now being built — “It could be $10. It could be $10,000.” Four orders of magnitude is not a forecast, it is the absence of one, and the reason the range is that wide is that the bill is a product of two numbers: a price nobody has published and a volume everybody already knows. Here is the volume. 194,080,306 Medicare office visits across 550,570 clinicians in 73 specialties, every one of them an encounter a scribe or chart-prep agent fires on, as a brushable scatter of visits-per-clinician against annual meter cost on a log axis framed by Trainor’s own $10 and $10,000 rules. Two dials: price per AI call and the one nobody budgets for, calls per encounter. A second chart draws the newsletter’s own advice — the 1×/3×/10× slide — for the twelve busiest specialties, where Dermatology’s contract runs $2,416 at plan and $24,161 if the thing is actually loved. The critical lens is built in three ways: CMS suppresses cells under 11 beneficiaries, so push the clinician floor and Nuclear Medicine (n=43), Undersea and Hyperbaric Medicine (n=31) and Peripheral Vascular Disease (n=44) evaporate as small-n artifacts; the price axis is explicitly fiction, because that is the honest state of the world; and switching the y-axis to % of the visit fee flattens the scatter into a rank order, revealing that a flat per-call price is regressive — it eats the largest share of the cheapest visits, which are Nurse Practitioner ($93.27), Physician Assistant ($90.91) and Podiatry ($95.71). What it says about itself: Medicare fee-for-service only, office place-of-service only, allowed amounts not charges — a floor, not a census.
D3 data explorer
Oracle Health’s clinical AI agent now reads the visit conversation and suggests professional-fee charge codes for ambulatory visits, with the clinician confirming before submission. The obvious worry is that a suggestion engine pointed at charge capture pushes levels up. It probably does — but here is what makes that hard to prove: the levels have been going up the whole time anyway. Twelve years of Medicare established office visits animate as a stacked area, and the level-4-and-above share climbs from 44.6% in 2013 to 60.0% in 2024, monotone across eleven of eleven year-over-year steps, including through the 2020 volume collapse. Then the arithmetic: Medicare allowed $85.43 for a 99213 and $119.77 for a 99214 in 2024, a $34.34 gap across 63,712,067 level-3 visits, so a slider that re-levels 5% of them adds $109M and delivers 1.3 years of drift at once. Below it, all 65 specialties at once as 100%-stacked level-mix bars sorted by headroom — Advanced Heart Failure at 93.7% level 4+, Podiatry at 13.5%. The critical lens is the spine, not a footnote: the 2021 E/M documentation overhaul is the single largest confounder for anyone attributing the next few points to an agent; a higher level is not automatically a wrong level, and claims data cannot tell you which; and the small specialties at the top of the ranking are noise in a signal’s costume — Nuclear Medicine at 86.4% on 43 clinicians, Neuropsychiatry on 108 — so push the floor to 2,000 and a genuine clinical gradient appears underneath. What it says about itself: Medicare FFS office visits only, which is the right shape and the wrong size for a feature scoped to one vendor’s ambulatory book.
Graphical narrative