Monday Morning Update 6/30/25

Top News

CMS announces a six-year pilot in six states to test tech-enabled prior authorization for traditional Medicare, which has traditionally avoided prior authorizations.

Participating organizations will be paid based on reducing inappropriate utilization. CMS is looking for companies that have implemented AI-powered PA programs for other payers.

CMS says that no new provider documentation will be required, but information must be submitted in advance.

CMS calls the program WISeR, the Wasteful and Inappropriate Service Reduction model.

Reader Comments

From Lou Lazuli: “Re: hospital sterilization methods. What’s your take on UVC light augmenting other methods for battling MRSA and VRE outbreaks? Is there a market need?” I’m far from an expert, but hospitals seem to be interested in using it to disinfect rooms after normal cleaning, where it reduces the transmission of superbugs. Hospitals are the target market due to the clinical and financial cost of hospital-acquired infections, which include CMS financial penalties. UVC robots like the one developed by Xenex might be an attractive offering if a business case can be made to offset the increased cycle time and capital investment that is required. It would be an easier sell if UVC replaced existing methods instead of augmenting them, but the expensive machines could be selectively deployed for use in vacated isolation rooms, surgery and procedure areas, and critical care units where any HAI could be especially disastrous.

From Chart Thief: “Re: VA scheduling and Oracle Health. It’s a management failure, not a tech problem, if the VA can’t implement the system it bought and instead continues to run legacy ones.”

HIStalk Announcements and Requests

Most poll respondents aren’t too worried about AI encroaching on their employment.

New poll to your right or here: What is the remote patient monitoring takeaway of Best Buy’s divestiture of Current Health?

Sponsored Events and Resources

None scheduled soon. Contact Lorre to have your resource listed.

Sales

• Trinity Health (ND) will implement Epic, replacing Oracle Health.
• QHIO SacValley MedShare joins the KONZA Health QHIN.

Announcements and Implementations

Optum launches an AI marketplace of products developed by the company and its third-party partners.

Former grocery store bagger turned self-styled medical entrepreneur and disruptor Ryan Egypt El-Hosseiny asserts that he has resurrected the lab testing firm Theranos after validating the fraudulent claims of former CEO and federal inmate Elizabeth Holmes. He made the announcement at a Miami nightclub, where he was flanked by rappers, fake cops, and a Holmes impersonator wearing an orange jumpsuit. El-Hosseiny, who is pushing RFK Jr.’s Make America Healthy Again platform and lobbying for President Trump to pardon Holmes, calls himself “the Steve Jobs of medical labs” and is among the Grade D actors who appear in his cringeworthy YouTube film titled “Just Blood: The United States vs. Elizabeth Holmes,” where his fake mustache appears to be summiting his external nares and his fellow thespians are repeatedly caught by the camera trying to suppress grins of participatory embarrassment. Records indicate that the Theranos trademark was abandoned when the company dissolved in 2018, so I assume he’s a squatter.

A new KLAS – Arch Collaborative report finds that ambient speech is improving provider EHR satisfaction and allowing more face-to-face interaction with patients. It is also boosting the EHR experience metrics of Epic-using ambulatory care providers. However, most users say that they aren’t willing to squeeze in more patient visits to justify the technology’s cost, preferring instead to improve patient care or their own work-life balance.

Government and Politics

Federal prosecutors indict 11 members of a Russia-based crime ring who allegedly used stolen information from 1 million Americans to bill Medicare $11 billion for medical equipment that was never ordered or delivered, netting $300 million.

Other

SCAN Health Plan President and CEO Sachin Jain, MD, MBA describes what he calls the “value-based delusion”:

Every conference deck, consulting proposal, and startup pitch has claimed to be “bringing value to healthcare.” But let’s be honest: in most cases, very little has actually changed in how care is delivered. Instead of reimagining the patient experience, many organizations have simply reengineered their revenue models. Networks get narrowed. Risk gets shifted. Coding intensity rises. But does care feel more human, more seamless, more dignified for patients? Too often, the answer is no.

Sponsor Updates

• Black Book Research announces a revamped RCM KPI framework that incorporates critical areas like AI integration, transparency, and automation.
• Surescripts VP of information security and CISO Judy Molenaar joins the DirectTrust Board of Directors.
• Nordic announces its ISO 9001 Quality Management Systems certification in Europe.
• Nym names Aya Weinstein VP of product, Amir Cohen senior software engineer, Alvera Abouseif customer success manager, Michal Attias bookkeeper, and Debra Whitley senior manager of product and coding compliance operations.
• Redox welcomes Ferry Health to the Redox Connection Network.
• Rhapsody Health offers a new customer story titled “Qventus achieves 10X performance and reduces customer onboarding time by 50%.”
• VitalChat announces the availability of a ProConnections Conversion Kit for those providers left with unsupported virtual care infrastructure following the closure of tele-ICU vendor ProConnections.

Blog Posts

• Spotting the Red Flags in Your Analytics and How to Fix Them (FinThrive)
• How Mobile Scheduling Software Solves Healthcare Staffing Chaos (Inovalon)
• From Pilot to Practice: 10 Keys to AI Adoption in Behavioral Health (Netsmart)
• Simple, obvious, ignored: The real work of improving patient experience (Nordic)
• Preparing Your Staff for a Cerner-to-Epic Conversion in 5 Key Steps (Optimum Healthcare IT)
• For patient education, place evidence at the center of care (Wolters Kluwer Health)
• When Not to Automate: Lessons from the Front Lines (VisiQuate)
• Healthcare Integration for Startups: A Scalable Guide to EHR Interoperability (Zen Healthcare IT)

Contacts

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