Last week was quite a week:
- The U.S. announced a peace deal with Iran to which Iranian officials denied knowledge.
- The strait of Hormuz opened, then closed.
- The stock market soared then fell.
- The President signed an Executive Order to loosen restrictions on psychedelic drugs.
- Vax skeptic HHS Secretary Kennedy nominated vax supporter Erica Swartz, MD, to head the CDC.
- The Centers for Medicare and Medicaid Services (CMS) announced its proposed Medicare inpatient hospital services reimbursement would increase 2.4% in fiscal 2027.
- Two members of the House of Representatives announced their resignations—both due to sexual impropriety (stupidity).
- And pundits were busy justifying or challenging polling showing a Trump Slump.
That’s the context for meetings this week in DC between hospital leaders and Members of Congress as part of the American Hospital Association’s Annual Meeting. Though much of the legislative agenda for hospitals has shifted to states, federal issues still matter, especially funding in the FY 2027 federal budget and appropriations to key departments and programs.
Hospitals are on the defensive in DC. On behalf of its members and in concert with its peers (FAH, CHA, AEH, et al) they’re seeking…….
- Protection against 340B cuts.
- Protection against site neutral payments.
- Protection against competition from physician owned hospitals.
- Protection against “corporate insurer” business practices.
- Protection against unwanted regulation that disrupt their “normal” business practices
- Protection against price gauging by drug companies.
- Protection against reduced tax exemptions for not-for-profit hospitals.
- Protection against funding cuts in the FY2027 federal budget.
And others.
Per AHA President and CEO: “The timing of our presence and voice in Washington is especially important this year. Health care affordability remains in the spotlight. Congress is discussing the prospects of one or two more reconciliation packages this year, even as we are asking them to examine the overreach and mitigate certain health care provisions from last year’s package. And we are 199 days from the midterm elections…” (AHA Today April 17, 2026)
The reality is this: hospitals have lost much of the good will they earned during the pandemic. Pushback by AHA against hospital price transparency, site neutral payments, 340B changes et al. have been successful. But heightened visibility about executive compensation, profitability, tax exemptions, private equity ownership concerns and for-profit venture-development has eroded Congressional favor, exacerbated nurse and physician burnout and lessened community support. AHA is aware.
In 2024, AHA and its coalition changed the name of its public-relations campaign from the Coalition to Protect America’s Health Care to Coalition to Strengthen America’s Healthcare to “… support the Coalition’s expanded capacity as a proactive, always-on organization dedicated to positively shaping public perception of hospitals and health systems, neutralizing opposition attacks, and holding corporate payers accountable for their role in delaying and denying care while driving up overall health care costs.” For AHA and most hospitals, it’s been an uphill battle against think tanks (West Health, Lown et al), investigative journalists (WSJ, NYT, STAT, Modern Healthcare) and competing interests, especially insurers and private investors, who see hospitals as protectors of the past rather than designers of healthcare’s future.
To restore trust and garner good will among employees, employed physicians, local and national employers, elected officials and community leaders, hospital leaders in DC should engage Congress in several areas usually not discussed:
Proactive education targeted to key constituents explaining how hospitals operate including actual costs, AI applications, et al and notable inefficiencies. Asking for money or regulatory relief is not enough. The public’s ignorant about how hospitals operate!
Long-range planning: Hospital boards tend to plan for NOW and NEAR to but spend inadequate time on FAR. Understanding long-term changes in clinical care, technology, regulatory and economic realities are keys to preparedness. And, like capital and facility plans, executive compensation should be linked directly to organizational readiness for long-term changes along with short-term financials). Long-term planning is not a luxury or distraction; it’s necessary.
Systemness: Hospitals should lead in the design of local/regional “systems of health” that provide a full range of needed health services affordably, rationalizes resources appropriately, is connected includes health, social services and funding programmatically. They’re the logical partner with government to integrate health and social services and, as a result, reduce fragmentation and waste. No excuses.
Workforce: Hospitals should modernize workforce plans to maximize technology-enabled consumer self-care, expand mid-level opportunities, facilitate AI-enabled administrative and clinical process improvements and compensate based on merit and performance.
Consumers including patients: Hospitals and AHA should embrace “healthcare consumerism” actualize its centricity in interactions with individuals who use its services. Competition in a value-based system of health depends on customized engagement with consumers.
Positioning: And hospitals must temper the “blame and shame” game against insurers, drug companies and demonstrate leadership in affordability, administrative waste reduction and optimal resource rationalization. Being their target is understandable: hospitals are 31% of direct spending and, with employed physicians, ancillaries and diversified interests, responsible for at least 55% of the U.S. health economy.
I acknowledge hospitals are uniquely complex organizations—labor intense, capital intense and highly regulated by states and the federal government. Events like last week’s add to uncertainty about their future but efforts to “protect” their status quo are ill-conceived. It’s time for AHA and its followers to plan beyond clinical innovations, technologies and the current regulatory and political environment. Otherwise, most hospitals will be public utilities.
I do not think the future of the U.S. health system will be a repeat of its past. That’s good news and bad news for hospitals.
Paul
PS: Each week, I try to distill lag and lead indicators from the Clinical Care, Technology, Capital, Funding, Consumer and Regulatory environments of consequence to healthcare insiders. What’s abundantly clear is that outside forces—economic, political, global—will impact U.S. healthcare future more than its internal dynamics. The future for hospitals is not a repeat of their past: that’s clear. What’s unclear is who will shape that future and what role hospitals will play.
Resources
The AHA Annual Membership Meeting: Three Issues that Require Attention https://paulkeckley.com/the-keckley-report/2026/4/12/the-aha-annual-membership-meeting-three-issues-that-require-attention/
Boomers vs. Millennials: Who Had it Harder, in Charts – WSJ
Report-of-the-Committee-on-Trust-in-Higher-Education.pdf April 10, 2026
U.S. Economy Remains Resilient in Face of Iran War, Banks Say – WSJ
America’s corporate boards are under siege
Recession Warning: Walmart’s Stock Suggests More Economic Pain Is Coming – Business Insider
Sections in today’s report:
- Quotables
- Economy
- Hospitals
- Insurers
- Physicians
- Polling
- Prescription Drugs
- States
Quotables
Geer on transformation: “If price is the problem, incentives must be the solution: liability reform to reduce volatility, enforceable price transparency, real PBM net-pricing disclosure, and policies that restore competition. Americans don’t need less care; they need a system that prices care more rationally.
Brad Geer We Can Fix Healthcare Prices With Incentives – WSJ
Madden on leadership: “Organizations that will win over the next five years are the ones doing the enterprise math. Not the plan math. Not the hospital math. Not the pharmacy math. The whole picture.
And they’re building the communication structures, data infrastructure, and leadership alignment to actually act on what that math reveals.
Employers are demanding it. Technology is enabling it. And current economic margin pressure is requiring it (just look at how many PSHPs are being divested or downsizing). The only question is whether leadership is willing to do the uncomfortable work of disrupting their own organizations before someone else does it for them.”
HPA Spring Forum Takeaways 🏥 HPA Spring Forum Takeaways – pkeckley@paulkeckley.com – PaulKeckley.com Mail
Monahan et al on hospital facility fees: “It is clear that consumers have reached a breaking point as health care affordability continues to rank as a top household budget challenge. Facility fee reform is one policy option states can take to eliminate what many see as an unfair billing practice that results in both a surprise hospital bill and sticker shock for many consumers. Despite hospital claims to the contrary, facility fee reform may in fact be a scalpel approach to one health care affordability concern, as states tailor facility fee bans to settings and services that are unrelated to the infrastructure and staffing attached to a hospital campus…”
Rosenbaum et al on community engagement in Medicaid coverage determinations: “Because of the sheer complexity of Medicaid’s community engagement requirements under H.R. 1 (also known as One Big Beautiful Bill Act (OBBBA)), meeting these constitutional standards in the Medicaid context poses a real challenge going forward. Under H.R. 1’s community engagement standards, adult Medicaid beneficiaries ages 19–64 whose eligibility is based on the ACA Medicaid expansion must document 80 hours per month of work or community engagement activities unless they qualify for an exemption. Eligible activities include employment, job training, education, or volunteering; the exemptions span health considerations, family status (for example, being a parent of a child under 14), and certain living circumstances such as residence in a federally identified disaster area.
Moreover, the complex determinations that apply to community engagement are on top of the already-complex evaluation that goes into deciding whether an adult whose coverage is tied to the ACA expansion meets the financial eligibility test applicable to the expansion population group — that is, adults with incomes up to 138% of the federal poverty level made eligible for Medicaid by the Affordable Care Act (ACA) — to whom community engagement applies.
Thus far, the Centers for Medicare and Medicaid Services (CMS), which oversees implementation of the community engagement amendments, has not addressed the due process issue, other than mentioning hearing rights in a relatively offhand fashion…”
Economist on tech layoffs: “AMERICAN TECH firms are in lay-off mode. Oracle, a cloud-computing wannabe, has just sacked thousands. Block, a digital-payments darling, is slashing more than 4,000 roles—nearly half its workforce. Amazon and Meta are trimming. From 2022 to 2025 they and five fellow tech giants scarcely added to payrolls. Total employment, tech-related and not, in San Francisco, the world’s tech capital, has fallen by 3% since the start of 2023.
This, as bosses tell it, is not because the industry is in a funk. It is because the sector is in the midst of a generational boom, courtesy of artificial intelligence. Boosters argue that AI is getting really good really fast at the sort of work many tech employees perform—spookily so, as the latest model from Anthropic, a leading lab, shows. Humans are becoming redundant.
Fear of a tech-jobs AI-mageddon has spread beyond Silicon Valley. In America, technology’s share of overall employment has dipped from a peak of 2.5% in late 2022 to 2.3% …
Tech jobs aren’t going away. They are spreading through the economy. The route to riches used to run through Google or Meta. Now a young coder might apply to Starbucks—and not as a barista.”
The tech jobs bust is real. Don’t blame AI (yet) The Economist April 13, 2026
Stanford Profs on AI in medical practice: “The first era of digital health focused on digitizing medical records. The next era will be defined by something more difficult: deciding how the data of a human life should be structured, governed, and interpreted. Artificial intelligence will transform how medicine reasons, but the systems that organize the data will determine how far that transformation can go.
For centuries, medicine has scaled what it could measure and relied on clinicians to supply what could not be measured. That division is ending. Whether this moment becomes incremental or transformative will depend not only on the power of our tools, but on the discipline with which we build around them.”
Transformative medical AI faces a continuity problem | STAT
Citadel Securities on AI disruption: “For AI to produce a sustained negative demand shock, the economy must see a material acceleration in adoption, experience near-total labor substitution, no fiscal response, negligible investment absorption, and unconstrained scaling of compute. It is also worth recalling that over the past century, successive waves of technological change have not produced runaway exponential growth, nor have they rendered labor obsolete. Instead, they have been just sufficient to keep long-term trend growth in advanced economies near 2%. Today’s secular forces of ageing populations, climate change and deglobalization exert downward pressure on potential growth and productivity, perhaps AI is just enough to offset these headwinds. The macroeconomy remains governed by substitution elasticities, institutional response, and the persistent elasticity of human wants.”
The 2026 Global Intelligence Crisis – Citadel Securities
Stanford 2026 AI Index Report: “This is a technology that has reached mass adoption faster than the personal computer or the internet. Generative AI hit nearly 53% population-level adoption within three years. Leading AI companies are reaching meaningful revenue scale in a fraction of the time it took previous technology generations, and global corporate investment more than doubled in 2025. Organizational adoption rose to 88%, and early estimates suggest the consumer value of generative AI has grown substantially within a year…….
The United States hosts the most AI data centers, with the majority of their chips fabricated by one Taiwanese foundry. The United States hosts 5,427 data centers, more than 10 times any other country, and it consumes more energy than any other country. A single company, TSMC, fabricates almost every leading AI chip, making the global AI hardware supply chain dependent on one foundry in Taiwan—though a TSMC-U.S. expansion began operations in 2025
The United States leads in AI investment, but its ability to attract global talent is declining…
AI experts and the public have very different perspectives on the technology’s future, and global trust in institutions to manage AI is fragmented…
AI is transforming clinical care, but rigorous evidence remains limited. AI tools that automatically generate clinical notes from patient visits saw substantial adoption in 2025. Across multiple hospital systems, physicians reported up to 83% less time spent writing notes and significant reductions in burnout. Beyond certain tools, however, the evidence base for clinical AI remains thin. A review of more than 500 clinical AI studies found that nearly half relied on exam style questions rather than real patient data, with only 5% using real clinical data.”
Stanford 2026 AI Index Report: ai_index_report_2026.pdf
Trump on CDC leadership announcements: “I am pleased to announce the new leadership of the Centers for Disease Control and Prevention (CDC). It is my Honor to nominate the incredibly talented Dr. Erica Schwartz, MD, JD, MPH, as my Director of the CDC. Erica graduated from Brown University for College and Medical School, and served a distinguished career as a Doctor of Medicine in the United States Military, the Greatest and Most Powerful Force in the World, and then served as my Deputy Surgeon General during my First Term. She is a STAR! I am also pleased to announce the appointment of Sean Slovenski as the CDC Deputy Director and Chief Operating Officer, Dr. Jennifer Shuford, MD, MPH, as the CDC Deputy Director and Chief Medical Officer, and Dr. Sara Brenner, MD, MPH, as Senior Counselor for Public Health to Secretary Robert F. Kennedy, Jr. “
Note: Dr. Schwartz, a retired Coast Guard rear admiral, served as deputy surgeon general during President Trump’s first term. She graduated from Brown University’s medical school and has a law degree from the University of Maryland. Dr. Schwartz served as president of insurance solutions at UnitedHealthcare and a Director of Aveana Healthcare since 2021.
Truth Details | Truth Social April 16, 2026
Barnes on CMMI’ Access Model: “…the ACCESS model is a turning point in American health care financing. Until now, only direct-to-consumer and concierge doctor-type-shops have attempted what ACCESS is trying to do – getting a set amount of money every month per patient to continuously KEEP them healthy- not just treat them when they’re sick. Our financing system is normally all about paying for one visit, one procedure, one drug – which has incentivized everyone trying to get paid for more of those things and ignoring how to keep people from getting those things in the first place. The ACCESS model formalizes what only entrepreneurs have tried so far – monitoring people all the time so they can prevent bad health conditions from getting worse.”
Only What Matters on Health Information Policy
Economy
AI Investment: “Private AI companies raised $226B in Q1’26, surpassing the full-year total for 2025 in just a single quarter. A single round, OpenAI‘s $122B corporate minority, comprised 54% of funding. Outside of that, Q1’26 would have seen $104B in funding, a 45% QoQ increase in funding.
Mega-rounds dominated: $100M+ deals accounted for 94% of total funding (up from 80% last quarter), pushing the year-to-date average deal size to $160M — more than 4x the full-year $38M average in 2025.
Besides the dominance from LLMs (outside of OpenAI, both Anthropic and xAI raised multi-billion-dollar rounds), physical AI emerged as a key theme, with 11% of all AI deals going to companies building robotics, defense tech, and autonomous systems.
M&A activity remained elevated in Q1’26 with 266 deals closed, up 90% YoY.
Note: 7% of all AI deals in 2025 were in digital health—second only to physical AI (robotics).
State of AI Q1’26 Report – CB Insights Research
Fed on household debt: “Both families and employers are at a breaking point. The current state of U.S. healthcare costs is not sustainable and demands that we reassess how it’s administered, delivered and paid for.
Relatively small, unexpected expenses, such as a car repair or a modest medical bill, can be a hardship for many families, especially those without a financial cushion. When faced with a hypothetical expense of $400, 63% of all adults said they would have covered it exclusively using cash, savings, or a credit card paid off at the next statement (referred to, altogether, as “cash or its equivalent”).”
Report on the Economic Well-Being of U.S. Households in 2024 – May 2025 https://www.federalreserve.gov/publications/2025-economic-well-being-of-us-households-in-2024-savings-and-investments.
Mercer: Healthcare investment sentiment: “While we may have moved beyond the acute phase of past shocks to the global economy, we believe the current macroeconomic environment reflects a shift in the drivers of uncertainty — particularly with respect to evolving government policy. The prevailing sense then could be that we can no longer wait for the old days to return, organizations simply must adapt. The results of our 2025 Healthcare Survey appear to confirm this sentiment, but it also reveals a sector adapting to this transition — one defined by cautious optimism, strategic realignment, and growing divergence between institutions. Larger and higher rated health systems outperformed their peers in 2024, benefiting from broader access to capital and a greater ability to assume investment risk. Respondents to the 2025 survey included 77 hospitals and health systems,”
Cautious Optimism Mercer’s annual survey of healthcare asset owners
NYT on Producer Price Index: “The producer-price index rose by 0.5% in March, the same as in February. That yielded 12-month PPI inflation of 4%, the greatest since February 2023. Analysts polled by The Wall Street Journal were expecting a 1.1% increase on month.
March price increases were lifted by an 8.5% increase in energy costs. Wholesale inflation tends to be more volatile than the consumer-price index, which also accelerated in March as Americans paid more for gasoline and diesel.
Economists will be studying Tuesday’s numbers carefully in order to refine their estimates for what the Fed’s preferred inflation gauge will show in its March reading. The personal-consumption expenditures price index, which is largely based on data from the CPI and PPI, will be updated on April 30.
Rising inflation may strain the budgets of Americans who have already faced price increases above the Fed’s 2% annual target for the past five years. It also means a new economic challenge for the central bank, which is simultaneously contending with a slowing labor market.”
Producer-Price Index Climbed in March – WSJ
Hospitals
Medicare Wage dispute update: “Seventy urban hospitals sued the Health and Human Services Department earlier this month, alleging the government owes them millions of dollars after the agency changed how it calculates Medicare payments for hospitals based on local labor costs, which are reflected in the Medicare wage index. The lawsuit stems from longstanding Medicare payment discrepancies between urban and rural hospitals tied to how much hospitals pay staff….
The number of urban hospitals that also classify as rural facilities has increased dramatically since 2017, research shows. In 2017, there were three hospitals with urban and rural designations. The number increased to 425 in 2023, according to a study published last year in Health Affairs.
Urban hospitals that gain rural designation can benefit financially from programs intended to help hospitals in rural communities…Removing that regulation could require the federal government to significantly increase the number of hospitals it must pay as part of settlement agreements regarding Medicare reimbursement disputes.”
Medicare wage index lawsuit escalates urban hospital pay fight – Modern Healthcare
Study: Patient cost sharing and hospital financial impact: “Understanding the evolving composition of cost sharing and its interaction with shifts in inpatient and outpatient care delivery is essential for anticipating financial pressures on both patients and health care providers. This study leveraged eleven years of commercial insurance claims from the Health Care Cost Institute to investigate changes in the distribution of magnitudes of cost sharing owed and the share of allowed amounts anticipated as cost-sharing collections by hospitals. We found that despite declining or stable utilization rates during the period 2012–22, mean per enrollee spending and patient cost-sharing burdens grew substantially in more recent years. Cost sharing has notably shifted in composition toward both high-cost and zero-cost encounters, consistent with the adoption of high-deductible health plans on the one hand and out-of-pocket maximums and preventive or other services covered in full on the other. These trends may disproportionately affect rural hospitals, which face a higher share of patient-responsible revenue and likely greater challenges in collection.”
Kaufman Hall: Hospital M&A: “Hospital and health system M&A activity continued with momentum in the first quarter of 2026, with 22 hospital and health system transactions announced—the highest first-quarter activity since 2020. Activity this quarter continues a steady recovery in M&A activity that began in the second half of 2025. With three “mega-mergers” among the 22 announced transactions, deal size rebounded. The average size of the smaller party increased, and total transacted revenue reached $14.5 billion—a recent high.”
M&A quarterly activity report: Q1 2026 https://www.kaufmanhall.com/insights/research-
Peterson Study: AI use in prior auth, medical billing: “Of the estimated $350 billion in U.S. healthcare administrative waste annually, $266 billion is attributed to administrative complexity and $59–$84 billion to fraud and abuse……Though we are still in the early stages of administrative AI adoption, it has become clear that rapid AI deployment by both providers and health plans to support prior authorization and medical billing transactions risks increasing levels of system activity without reducing costs. ..
Of 5,000 procedure major codes requiring prior authorization across four major U.S. insurers; of those, only 3% required prior authorization across all four payers. Only 40% of prior authorization transactions are automated; the majority still rely on manual, phone- or fax-based workflows.” Across health plans, one in 10 prior authorization submissions are initially denied.7,8 Of the 12% of Medicare Advantage denials that are appealed, 82% are ultimately overturned…each prior authorization submission cycle is estimated to cost health plans $40–$50 and providers $20–$30…
The adoption of an AI scribe was associated with an increase in “relative value units” that translates to $3,044 annually per physician, one study published in JAMA Network Open this year found. A case study by KLAS Research found that AI platform Suki led monthly revenue gains of as much as $1,000 per provider. Another case study on leading AI scribe Abridge’s website found that “more accurate documentation has contributed to increased revenues and a significant return on investment” at one health system using the product. ..”
https://phti.org/wp-content/uploads/sites/3/2026/04/PHTI-Administrative-AI-Current-Use-and-Potential
CMS announces Access Model participants: “More than 150 leading health care organizations have been accepted to participate in the launch of the ACCESS (Advancing Chronic Care with Effective Scalable Solutions) Model.
Most of the organizations have not previously served Medicare beneficiaries and will bring additional technology-supported care options to help people manage chronic conditions like high blood pressure, diabetes, chronic pain and depression.
CMS is extending the initial application deadline to May 15, 2026, so that more organizations can participate in ACCESS when it launches on July 5, 2026; Medicare enrollment is required for participation but not to apply.
ACCESS empowers people with Medicare and their clinicians by offering services that are convenient, affordable and integrated with their existing care teams.”
Note: Access targets Medicare FFS enrollees.
ACCESS Model Accepted Applicants | CMS
Insurers
Wakely analysis: Subsidized coverage: “Nationally, around 14% of those who enrolled in ACA plans this year didn’t pay their first monthly bill for January coverage. In some states, the share was a quarter or more, according to a new analysis from the actuarial firm Wakely Consulting Group, provided exclusively to The Wall Street Journal.
Normally, the rate of falloff in ACA plan membership early in the year is in the midsingle-digit range.
ACA enrollment was already declining. Sign-ups fell to 23 million in 2026, from a peak of more than 24 million last year. This new data shows that millions more are at risk of losing ACA insurance. Some enrollees have a grace period, allowing them to retain their plans for three months even if they don’t make a payment…
The Wakely actuaries projected that overall ACA enrollment in 2026 is likely to sink by between 17% and 26%, compared with last year.”
Exclusive | Around 14% of Enrollees in ACA Plans Failed to Make Payments, Data Shows – WSJ
Physicians
AMA on Physician Compensation models: “This American Medical Association Policy Research Perspective analyzes trends in physician compensation methods from 2014 to 2024 using novel data from the AMA Physician Practice Benchmark Survey. The findings reveal a marked shift toward blended compensation models, with a growing prevalence of salary, productivity and bonuses in physician compensation structures. In 2024, 70.5% of physicians received compensation from salary (up 9 percentage points since 2014), 55.0% from productivity (up 2 percentage points), and 39.0% from bonuses (up 9 percentage points)….Over the decade, there has been a decline in the proportion of physicians paid solely based on productivity (down 5 percentage points) or practice financial performance (down 4 percentage points), and an increase of over 10 percentage points in those primarily compensated by salary, often with bonuses and/or productivity as secondary components. On average, salary was 58.2% of physician compensation and productivity was still significant at 28.1%. “
Medscape 2026 Physician Compensation survey: Excerpts:
“Doctors practicing in the US told Medscape their compensation rose by around 3% on average in 2025… average pay gain outpaced the annualized core inflation rate for the US of 2.7% at the end of 2025.
Practitioners in eight specialties topped $500,000 in total annual compensation. All of them except otolaryngology also reported $500,000-plus in income for last year’s report…
When Medscape asked in last year’s report whether doctors felt fairly compensated for their work, only 48% answered “yes” (45% of PCPs; 49% of specialists). That was the most dispirited response we had received in 10 years of posing that question in surveys.
Interestingly, pathologists and public health specialists were among the medical specialties we examined that most often answered “yes” to this question (69% and 66%, respectively) even though they ranked in the bottom half of compensation growth in 2025.
53% of physicians…felt fairly compensated individually. But a bigger share — 61%, the same as in last year’s report — believed that the medical profession generally in the US is underpaid.”
‘A Return to Normalization’: Medscape Physician Compensation Report 2026https://www.medscape.com/p11/return-normalization-medscape-physician-compensation-report-2026
Physician practice setting trends: “Between 2019 and 2023, the share of independent physician practices owned by hospitals, health systems or other corporate entities jumped from 39% to 59%. Over the same period, physician employment by these entities rose from 62% to 78%…
In 2024, just 42% of physicians worked in private practice, down from 60% in 2012. Nearly half (47%) were employed by or affiliated with hospitals, according to a Government Accountability Office report…
Corporate entities, including insurers and private equity firms, employed 23% of physicians in 2024, up from 15% in 2019, according to the GAO report. Private equity-owned practices now account for 6.5% of physicians and control more than 30% of physicians in specialties such as gastroenterology, dermatology and ophthalmology.
In 2025, CMS cut the Medicare conversion factor by 2.83% for the fifth consecutive year, a 10% decline since 2020. In 2026, the conversion factor for practitioners participating in a qualified alternative payment model jumped to $33.56, a 3.77% increase from 2025. Non-QPM practitioners’ conversion factor is $33.40, a 3.26% increase from 2025.”
The renaissance of physician-owned practices – Becker’s ASC
Study: primary care coordination in Medicaid mental health: “Medicaid beneficiaries frequently use emergency departments (EDs) and have high 30-day ED revisit rates. Living with mental health (MH) conditions or substance use disorders (SUDs), including alcohol use disorder (AUD), is among the factors strongly associated with frequent ED use, and US Medicaid is the primary payer for a large proportion of ED visits for these conditions Indeed, 30-day ED revisit rates have been found to be approximately 25% among Medicaid beneficiaries and as high as 40% for individuals with SUD- and AUD-related ED visits. Prior studies have demonstrated that primary care follow-up, often associated with multidisciplinary behavioral health programs, can reduce recurrent ED use and hospitalizations. Primary care follow-up is essential because it provides the sustained, comprehensive care necessary to manage MH conditions, SUDs, and AUD and support long-term recovery.”
Polling
Gallup on consumer acceptance of AI in care management: Per the survey of 5,500 U.S. adults conducted Oct. 27-Dec. 22, 2025, using the Gallup Panel. “As artificial intelligence becomes increasingly embedded in daily life, the West Health-Gallup Center on Healthcare in America reports that 25% of Americans have used an AI tool or chatbot for health information or advice, mainly as a supplemental tool for their care. Over half of recent users say they have used AI because they prefer to research on their own before or after seeing a doctor. “Other highlights:
- 59% who use AI for health info are researching before doctor visits
- About 14 million adults report skipping a provider visit after using AI
- Only 4% who use AI for health info strongly trust its accuracy
Americans Turning to AI to Supplement Healthcare Visits
2025 Retirement Confidence Survey: Per the survey of 2,767 adult Americans 25+ was conducted online January 2 through February 3, 2025:
- 67% feel confident in their ability to have enough money to live comfortably throughout their retirement, with 24% feeling very confident Neither of these levels were statistically significantly different from the levels in 2024.
- 78% of retirees report feeling either very or somewhat confident about having enough money to live comfortably throughout their retirement years, which is up from 74% in 2024. Nearly feel very confident 32% feel very confident.
- “73% report feeling very or somewhat confident about being able to afford basic expenses in retirement, including 31% who feel very confident. Workers’ confidence in their ability to afford basic expenses is higher than the confidence they report regarding their ability to pay for medical expenses in retirement. Just over one in three workers (38 percent) are not too or not at all confident they will have enough money for medical expenses in retirement. A similar but smaller share is not too or not at all confident that they are doing a good job in preparing financially for retirement (30%).”
Prescription Drugs
RFKJ on FDA review process: “We now have over 90% of reviewers at FDA using AI. We’re using it to detect fraud. We’ve changed the system under the Biden administration. it was called the pay‑and‑chase system, and we’ve ended that now.”
RFKJ testimony: House Ways and Means Committee April 15, 2026
Study: Prior authorization (PA) of prescription drugs: “In this cross-sectional study of 205,896 medication dispensations initially rejected, 35% were processed in 1 day and 54% were eventually approved. Prescriptions with multiple PA reviews, additional rejection reasons, and refills were delayed and patients with Medicaid coverage or multiple disease conditions experienced fewer prescription approvals.
When filling a branded medication that was initially rejected by PA, most patients experienced treatment delays and/or eventual denials, outcomes that were associated with claim adjudication complexity, prescription type, and patient characteristics.”
NBC News on Trump Rx drug prices: Here are five notes from the April 16, 2026 report:
- Prices have risen despite agreements: Drugmakers that signed deals with the administration increased prices across hundreds of medications, including those for cancer and multiple sclerosis.
- New drugs launch at high prices: The companies introduced new therapies at an average price of $353,000 per year, reflecting continued upward pressure on launch pricing.
- Profits climb sharply: The companies generated $177 billion in profits in 2025, up from $107 billion the year prior.
- Blockbuster drugs see increases: Merck’s cancer treatment Keytruda rose by 6% to about $210,000 annually, while Bristol Myers Squibb’s immunotherapy Opdivo increased by 4% to $260,000 per year.
- High-cost pipeline persists: The report highlights new gene therapies and specialty drugs entering the market with prices reaching as high as $2.59 million.
Drugmakers raised prices on hundreds of meds despite Trump deals, Senate Democrats’ report finds
Megerlin on Impact of Most Favored Nation drug pricing:” Buffet’s maxim (attributed to Ben Graham), “Price is what you pay, value is what you get,” is true everywhere—in trade, governance, and alliances. In both the US and the EU, the role of “value” in drug pricing is changing: The most favored nation proposals do not consider drugs’ additional benefits according to cost-effectiveness analyses, as well as the related willingness to pay within a specific national environment. The debate is shifting from drugs’ value being a national conversation to a mechanical convergence of prices under pressure (and under threat of coming high-tech but low-cost competition). European nations’ policies should be driven by a much more holistic and strategic approach of what “value” means, and registered clinical outcomes as well as the nations’ sovereignty and trust are obvious components of it.”
Most Favored Nation’ Policies and Value-Based Drug Pricing: A European View | Health Affairs
Executive Order on psychedelic drugs: “Psychedelic drugs, including ibogaine compounds, show potential in clinical studies to address serious mental illnesses for patients whose conditions persist after completing standard therapy. Indeed, the Food and Drug Administration (FDA) has granted Breakthrough Therapy designation to specific psychedelic drugs, and there are numerous products currently in the clinical trial pipeline for review of safety and efficacy. It is the policy of my Administration to accelerate innovative research models and appropriate drug approvals to increase access to psychedelic drugs that could save lives and reverse the crisis of serious mental illness in America.”
ACCELERATING MEDICAL TREATMENTS FOR SERIOUS MENTAL ILLNESS April 18, 2026 https://www.whitehouse.gov/presidential-actions/2026/04/accelerating-medical-treatments-for-serious-mental-illness/
States
Connecticut is one of many U.S. states increasingly using cross-sector data-sharing to improve public health outcomes, with the Prevention Data Portal.
Launched in 2018 by Connecticut’s State Epidemiological Outcomes Workgroup (SEOW), PDP houses data from local, state, and federal sources to advance health promotion and substance use prevention in the state.
Improving Connecticut’s Public Health Through Cross-Sector Data-Sharing | The Pew Charitable Trusts
Indiana Gov. Mike Braun approved a 3-month requirement to satisfy HR1 Medicaid work requirements for eligible enrollees.
