HITshow Daily: November 20, 2025 (Thursday)
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Today on HITshow:
Hospitals are feeling the squeeze from payer audits, state cost-growth oversight, and big expansion moves, even as they lean on AI and data to deliver better experiences. We’re tracking how rising audits and denials are quietly eating into margins, WVU Medicine’s push into western Pennsylvania with the Independence acquisition, and Oregon’s very public call-out of hospital cost growth. After the break, an AI-powered virtual front door for primary care, what’s likely to be on center stage at HIMSS 2026, and a Bright Spot on why truly knowing who is who across your systems matters more than ever.
HOST: RHONDA BROOKS
📍 Payer Audits & Denials — Logan Stokes
Audits and denials are up, and the dollars at stake per claim are climbing. Even a small uptick in denials can translate into millions of dollars in delayed or lost revenue. Revenue cycle leaders are tightening documentation, medical necessity support, and prior authorization workflows to keep from sliding backwards.
📍 Regional Expansion — Teresa Vaughn
WVU Medicine is stepping in to acquire Independence, which operates five hospitals in western Pennsylvania. The move brings capital investment and specialty support, but raises questions about competition, physician alignment, and whether local care stays local or shifts to a distant hub.
📍 State Cost Oversight — Xavier Banks
Oregon’s cost-growth program is putting pressure on hospitals. State officials called out St. Charles Health System for cost increases described as “unacceptable.” More states are experimenting with cost-growth benchmarks and transparency rules that put hospital numbers in public view.
📍 AI Virtual Primary Care — Jade Romero
K Health is expanding partnerships with major health systems. Northwell Health is using AI to power 24/7 virtual primary care, routing patients from AI-assisted intake to human clinicians when needed. The model promises faster access and better ability to keep patients inside the health system’s ecosystem.
📍 HIMSS 2026 Preview — Nate Collier
HIMSS 2026 is signaling that AI-powered diagnostics, new care models, and interoperability will be front and center. Leaders can expect mature case studies on AI in clinical workflow, command centers, and care redesign that crosses hospital, ambulatory, and home settings.
Bright Spot:
Verato’s Nick Orser explains why knowing “who is who” across every system and every step of the patient journey has become 10 times harder—and 10 times more important. Master data management and identity resolution are now foundational to delivering connected experiences. Jalen Cross reports.
