Medicare's AI prior authorization pilot cuts service use, JAMA study finds
Oct 27, 2026
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Use of services covered by Medicare's AI-assisted prior authorization pilot fell about 15% to 20% in its first six months in the six participating states, according to a JAMA research letter published Oct. 26.
The authors, Hannah Neprash of the University of Minnesota and Michael Barnett of Brown University, said the data cannot show whether the care patients did not receive was wasteful or necessary. Services that were scheduled for the Wasteful and Inappropriate Service Reduction (WISeR) model but never put under review showed no decline, and the reduction in epidural steroid injections narrowed from about 21% to about 9% between the first and second quarters, the University of Minnesota said.
The same day, the Department of Health and Human Services finalized its HTI-5 rule, which removes the requirement that certified health record software carry standard information on how predictive AI tools were built and tested.
THE DETAILS
- WatchEvidence Oct 26, 2026
The six-year pilot began in January 2026 in six states; the authors said it is not yet known whether forgone care was needed.
Use of epidural steroid injections for back pain, the highest-volume service in the Wasteful and Inappropriate Service Reduction (WISeR) model, fell 15% relative to trends in non-pilot states, and use of the other targeted services fell about 20%, Hannah Neprash of the University of Minnesota and Michael Barnett of Brown University reported in a JAMA research letter published Oct. 26. The authors compared traditional Medicare patients in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington with those in all other states, using Epic Cosmos records for two years before the January 2026 launch and six months after. Services slated for WISeR but never implemented showed no significant decline. The drop in epidural injections narrowed from about 21% in the first quarter to about 9% in the second, which Barnett said suggests "doctors may be adapting rapidly to the new system." WISeR participants, typically technology companies, are encouraged to use AI in their review of 41 services, according to the journal. - WatchRegulation Oct 26, 2026
The rule is scheduled for Federal Register publication Oct. 28 and takes effect 60 days later; some changes start Jan. 1, 2027.
The Department of Health and Human Services finalized its HTI-5 rule Oct. 26, removing 14 of 60 certification criteria for electronic health record software and revising seven, Fierce Healthcare reported; the December 2025 proposal would have removed 34. The rule strikes the requirements, adopted in the 2024 HTI-1 rule, that certified software support and let users view and modify source attributes, the standard information on how predictive decision support tools were trained and tested, according to the rule text. ONC cited "limited demonstrated benefit" and the cost of the transparency requirements and said it may revisit some in future rulemaking, Healthcare Innovation reported. HHS projected more than $1.5 billion in savings for developers. Information blocking proposals were left out of the final rule and remain under consideration, according to HHS. - WatchIncident Oct 23, 2026
WHO said Oct. 23 it is revising its risk assessment, which rated the global risk low as of Aug. 14.
The Democratic Republic of the Congo had 9,704 confirmed cases of Bundibugyo virus disease, including 4,687 deaths, as of Oct. 20, the World Health Organization said Oct. 23. Kenya has nine cases, eight of them in a cluster that includes four health and care workers, and Nigeria confirmed an imported case in Abuja on Oct. 20, according to WHO. No vaccine or specific treatment is approved for the virus; a phase 2/3 vaccine trial enrolled its first participants Oct. 23. Uganda ordered citizens returning from Congo into 21-day quarantine at their own expense and barred transit by anyone who has been in Congo, and the patient in Nigeria was flown to Switzerland on Oct. 26, Euronews reported. WHO advises against travel or trade restrictions.Sources: World Health Organization, Euronews - FYIDeployment Oct 26, 2026Gov. Henry McMaster and National Cyber Director Sean Cairncross announced Project Lifeline 250 on Oct. 26 at Newberry Health Hospital, an independent 90-bed hospital, Fierce Healthcare reported. Participating rural hospitals receive six months of services at no cost: stronger network defenses, inventories of devices used in critical care, backup technology to keep care running during an attack and replacement of high-risk legacy devices. Microsoft, Cisco, Cyera, Trellix and Zscaler are taking part, and Trellix said it will add agentic AI for automated detection and response. Officials said they want to learn which tools could scale nationally. The announcement did not say how many hospitals will take part or who pays for the services.Source: Fierce Healthcare
- FYIDeployment Oct 26, 2026Mass General Brigham's virtual specialist consultation program, run on Andor Health's ThinkAndor platform, connects emergency departments at more than 20 community and rural hospitals in Massachusetts, New Hampshire, Maine and upstate New York with its neurologists for emergency and subacute telestroke and teleneurology, the vendor said Oct. 26. Referring clinicians request consults inside their own electronic health record, and the software routes them to a licensed, credentialed specialist on shift and escalates unanswered requests. The program is on pace for more than 16,000 consults a year, almost 70% more than before, according to the vendor's release; that figure is a projection, and no data on transfers have been published. Mass General Brigham plans to add service lines, including tele-newborn care.Source: Andor Health (PR Newswire)
- FYIEvidence Oct 27, 2026Enrollment in the Heidi ambient AI scribe was associated with an immediate reduction in note-active time of 1.21 minutes per encounter (95% CI, 0.68 to 1.74), and 2.50 minutes among high users, in an interrupted time-series study of 902 outpatient clinicians and 1,637,227 encounters across the 14-hospital Beth Israel Lahey Health system, published in Annals of Internal Medicine on Oct. 27. High users' notes grew longer than nonusers' by about 171 characters. Enrollment was not associated with changes in same-day or after-hours note closure or in work relative value units. The system rolled out the scribe without restrictions beginning January 2025, and 297 of the enrolled clinicians never used it. One author is affiliated with Heidi Health, and the authors noted that they could not tell AI-drafted notes from clinician-written ones.Sources: Annals of Internal Medicine, PubMed
- FYIEvidence Oct 23, 2026In LATE-MT, 336 patients with anterior-circulation large-vessel occlusion and salvageable tissue on imaging 24 to 72 hours after onset were randomized; endovascular therapy shifted 90-day modified Rankin scores toward better function (common OR, 1.74; 95% CI, 1.19 to 2.55), with symptomatic intracranial hemorrhage in 4.8% vs. none and 90-day mortality of 6.0% vs. 1.8%. In MILD-MT, 300 patients with an NIHSS score under 6, a small core and large perfusion mismatch within 24 hours reached a modified Rankin score of 0 or 1 in 69.4% with thrombectomy vs. 50.0% with medical management (OR, 2.32; 95% CI, 1.41 to 3.81), with three symptomatic hemorrhages in each group and serious procedural complications in 13.2%. Both open-label trials were published in the New England Journal of Medicine on Oct. 23.
- FYIIncident Oct 23, 2026The Centers for Disease Control and Prevention counted 4,588 confirmed measles cases reported by 47 jurisdictions in 2026 as of Oct. 22, including 18 among international visitors. The agency recorded 43 new outbreaks this year, 96% of cases were outbreak-associated and three people have died. The 2025 full-year total was 2,289 cases.Source: CDC
- FYIDeployment Oct 26, 2026Sutter Health is enrolling heart failure patients at high risk of hospitalization in Sutter Sync, its digital chronic disease program, MedCity News reported Oct. 26. Patients step on BodyPort's FDA-cleared Cardiac Scale once a day, the readings flow into Epic, and Sutter pharmacists review trends and coordinate medication changes between visits. More than 13,000 patients have enrolled across hypertension, cholesterol and diabetes since March 2025, and more than 90% of those with previously uncontrolled blood pressure improved control within six months, according to Sutter. No heart failure results have been reported.Source: MedCity News