HITshow Daily: November 24, 2025 (Monday)
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Today on HITshow:
Today we’re looking at how regulators, risk, and AI are shaping the year ahead for hospitals and health plans. CMS gives hospitals a bit of breathing room in the new outpatient rule with a slower recoupment path on prior 340B clawbacks. UnityPoint Health teams up with Mayo Clinic on a big data and AI play. A Wisconsin health system puts AI to work in the revenue cycle. Abbott makes a $21 billion bet on at-home cancer screening with the Exact Sciences acquisition. We zoom out on the Medicare Advantage coding wars, and Optum Rx says prior auth can shrink from hours to seconds.
HOST: RHONDA BROOKS
📍 CMS Outpatient Rule — Logan Stokes
CMS finalized the 2026 outpatient and ASC rule, avoiding worst-case scenarios on 340B clawbacks—at least for now. The agency sticks with a slower recoupment path and punts any bigger adjustment to 2027. Drug acquisition cost surveys will keep pressure on hospital pharmacy margins, but 2026 feels like a small sigh of relief before the bigger fight comes due later.
.📍 UnityPoint Joins Mayo Platform — Jade Romero
UnityPoint Health becomes the first health system partner on Mayo Clinic’s Platform_Insights, a shared data and analytics environment. The move signals that multi-system data collaboratives will be a bigger part of the landscape going into 2026, raising stakes for everyone still treating data strategy as an IT side project.
.📍 AI in Revenue Cycle — Teresa Vaughn
Sauk Prairie Healthcare in Wisconsin is using AI with Jorie AI to automate repetitive billing and coding work—flagging claims likely to be denied, pre-populating appeals, and surfacing payer patterns. A glimpse of where practical AI is actually taking hold: reducing the cost of getting paid, not replacing frontline staff.
📍 Abbott Buys Exact Sciences — Anika Shah
Abbott is acquiring Exact Sciences (maker of Cologuard) in a $21 billion deal, betting big on at-home cancer screening. Health systems need a strategy for how at-home tests fit with their GI, oncology service lines, and population health targets as the front door to early detection moves from endoscopy centers to kitchen tables.
📍 Medicare Advantage Coding Wars — Peter Betterworth
CMS’s RADV audit rule was vacated in court, KFF analyses show heavy reliance on chart reviews that increase risk scores, and the American Academy of Family Physicians is pushing back on algorithm-driven downcoding. For hospitals in MA risk deals, plans are under revenue pressure and regulators are pushing back on coding and payment—leaving contracts caught in the middle.
📍 Prior Auth Gets Faster — Logan Stokes
Optum Rx has deployed automated prior authorization workflows reducing average turnaround from 8.5 hours to roughly 30 seconds for low-risk requests. Systems like Cleveland Clinic are seeing many routine requests go straight through without manual review, setting a clear benchmark for the rest of the industry.
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