The US government is preparing to trial the use of artificial intelligence, large language models, and machine learning in a prior authorization review process for medical procedures under the Medicare program.The New York Times reports (Reed Abelson and Teddy Rosenbluth, "Medicare Will Require Prior Approval for Certain Procedures," NY Times, August 28, 2025):"The federal government plans to hire private companies to use artificial intelligence to determine whether patients would be covered for some procedures, like certain spine surgeries or steroid injections. Similar algorithms used by insurers have been the subject of several high-profile lawsuits, which have asserted that the technology allowed the…
Nonprofit Hospitals and Charity Care
November 7, 2024 Two new reports throw light on the level of charity care actually provided by nonprofit hospitals in the US.As noted in US Nonprofit Hospitals Have Widely Varying Criteria To Decide Who Qualifies For Free And Discounted Charity Care (Luke Messac, Alexander T. Janke, Lisa Herrup Rogers, Imani Fonfield, Jared Walker, Elijah Rushbanks, Nora V. Becker, and Ge Bai, US Nonprofit Hospitals Have Widely Varying Criteria To Decide Who Qualifies For Free And Discounted Charity Care, Health Affairs 2024 43:11, 1569-1577): "Hospital charity care is the provision of free or discounted services to low-income patients.5 Historically, a large part of the justification for nonprofit hospitals’ tax-exempt status rests on…
Practice Consolidation and Access to Quality Care
May 14, 2023 The New York Times reports on a growing trend among healthcare organizations in the US, the impact of which may be of concern for patients and taxpayers. The Times reported on May 8, 2023 ("Corporate Giants Buy Up Primary Care Practices at Rapid Pace") that:"CVS Health, with its sprawling pharmacy business and ownership of the major insurer Aetna, paid roughly $11 billion to buy Oak Street Health, a fast-growing chain of primary care centers that employs doctors in 21 states. And Amazon’s bold purchase of One Medical, another large doctors’ group, for nearly $4 billion, is another…