The Center for Medicare and Medicaid Innovation is launching a demonstration project in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington requiring prior authorization for conventional Medicare coverage of 17 health services, starting Jan. 1, 2026. Inpatient-only, emergency and urgently needed services are excluded. The CMS is seeking companies with experience using AI and other tools to manage prior authorization and clinicians who can review coverage determinations.

A number of hospitals have started using AI to streamline the hospital discharge process, potentially improving the patient experience and reducing clinician burnout. Qventus' Inpatient Capacity Solution uses AI to predict optimal discharge timing, Vital integrates patient data into a user-friendly app for personalized care instructions, and Northwell Health's Ascertain streamlines administrative tasks for clinical staff.

An evidence-based management tool embedded in the EHR system improved headache care in a primary care setting in rural Vermont, where patients may wait a year or longer to see a neurologist. The tool increased headache documentation and primary care clinician confidence, potentially helping to bridge the gap between primary and specialty care, says University of Vermont doctoral student Makayla Fikrat, who presented study results at the American Headache Society's annual meeting.

National health expenditures are projected to grow 5.8% annually from 2024 to 2033, reaching $8.6 trillion and representing 20% of the US economy, according to a report in Health Affairs. The aging population is expected to drive spending, with the highest growth in Medicare at 7.8% annually. Medicaid and private insurance spending are also expected to rise, though at slower rates.

A study in the Journal of General Internal Medicine found that using a rubric with 15 gradable items improved the quality of patient progress notes created by hospital physicians. The study involved 26 hospitalists, and significant improvements were noted in 8 of the 15 graded items.

AI is being viewed as a potential tool to tackle various operational challenges in hospitals, but it's not plug-and-play technology and requires investments in time and resources, says Prashant Karamchandani, a senior partner in financial transformation at Chartis. When choosing AI products, it's important to distinguish between tasks best suited for human intervention and those that can be automated safely, with revenue cycle management being a prime AI application.

The Supreme Court has upheld the Affordable Care Act's requirement for insurers to provide coverage with no cost-sharing for certain preventive services. The 6-3 decision maintains access to services recommended by the US Preventive Services Task Force. The ruling also affirmed the HHS secretary's authority to fire and appoint USPSTF members.

Expanding eligibility recommendations for preventive screenings may improve health equity, according to a study in JAMA Network Open. The research focused on lung cancer screenings and found that reducing smoking requirements for screening could increase the number of detected cancers and expand screening for more women, Black people and people from socially disadvantaged groups.