Medical Groups
Physicians want compensation boost from AI productivity gains: survey
A latest physician compensation survey released by health tech company Doximity shows that over 40% of surveyed doctors believe that if artificial intelligence (AI) helps them improve work efficiency, they should receive most of the resulting cost savings. The survey also found that most doctors already use AI weekly or even daily for clinical or administrative tasks, but doctors are divided on whether AI should change their service compensation.
Specialty providers refute hefty Georgetown estimates of No Surprises costs
Researchers at Georgetown University released a report estimating that the independent dispute resolution process established by the No Surprises Act has caused over $22 billion in unnecessary spending over the past four years. The American Society of Anesthesiologists, the American College of Emergency Physicians, and the American College of Radiology jointly refute this, stating that the estimate is based on a flawed QPA benchmark and that insurer-calculated QPAs are often inaccurate and too low.
Humana-owned Villages Health agrees to $542M settlement for overbilling Medicare
The U.S. Department of Justice announced on Wednesday that Villages Health (TVH), a central Florida healthcare provider, has agreed to pay $541.5 million to settle allegations that it submitted false diagnosis codes to Medicare Advantage plans between 2020 and 2024, improperly increasing reimbursements. TVH self-disclosed the overbilling issues in late 2024 and filed for bankruptcy last summer. Humana completed its $68 million acquisition of the company in late last year.
Most Americans want providers to disclose AI use, report says
A survey released by the Pew Research Center on August 25 shows that about 72% of American adults consider it "extremely" or "very important" for healthcare providers to disclose AI use. The survey also found that although AI is already widely used in hospitals and clinics, 46% of respondents are unsure whether they have encountered AI in medical care, and only 17% believe they have significant control over it.
No Surprises dispute resolution has generated $22B in extra costs, research finds
A latest report released by Georgetown University indicates that the independent dispute resolution (IDR) process established under the No Surprises Act has accumulated over $22.4 billion in additional costs from 2022 to 2025, with 2025 alone reaching $16.6 billion, a nearly 3.5-fold increase from 2024. The number of disputes surged by 77%, payment amounts rose by 264%, and award amounts in certain specialties far exceeded in-network rates. Researchers urge policymakers to revisit the Act.
Healthcare was built around specialties. Patients experience it as one journey.
The healthcare system is divided by specialties, organ systems, and diseases, while patients experience a continuous personal journey. This article explores how integrated coordination, navigation support, and technology empowerment can make healthcare revolve around the 'person' rather than the 'department'.
CVS adds JPMorgan data executive to board amid AI push
CVS Health announced on Monday that Teresa Heitsenrether, JPMorgan's Chief Data and Analytics Officer, will join its board of directors, effective November 18. With four decades of experience in financial services, Heitsenrether will help drive CVS's innovation in data, analytics, and AI. Meanwhile, board member Larry Robbins departed earlier this month.
Why the first 24 hours after discharge matter for star ratings
Medicare Advantage会员出院后的24小时是护理团队影响星级评定相关质量指标的关键窗口。许多指标的时间窗口短至7天，实时可见性至关重要。领先的保险计划正从按指标管理转向围绕会员过渡的组织模式，通过一次协调的随访同时推动多项指标的改善。
Health advocacy group sues AMA to make billing codes public
患者权益组织PatientRightsAdvocate.org于周四起诉美国医学会，指控其对CPT计费代码的版权阻碍公众获取医疗计费信息，要求法院裁定代码进入公共领域。该组织称代码已被联邦和州法律引用，不应受版权保护。
Fifth Circuit Overturns No Surprises Act QPA Methodology, Favoring Providers in Arbitration Disputes
The 5th U.S. Circuit Court of Appeals ruled on Tuesday that the federal methodology for calculating qualifying payment amounts (QPA) under the No Surprises Act is partly unlawful. The court sided with the Texas Medical Association and other plaintiffs on two of three challenges, finding that insurers improperly included 'ghost rates' and excluded bonus and incentive payments. The ruling is expected to raise provider payouts in arbitration, while the court allowed existing QPAs to remain temporarily to avoid disruption.