Wednesday, April 1, 2026

Today, hospital CEOs must personally attest to the completeness and accuracy of their pricing data. Hospitals must post median allowed amounts and 10th/90th percentile allowed amounts from ERA data. CMS offers a 35% CMP reduction for hospitals that waive hearing rights — real penalties for the first time. Three years of toothless transparency rules end with a signature line and a fine schedule.

Yesterday, every Medicare Advantage plan, state Medicaid/CHIP managed care program, and QHP issuer published aggregate prior authorization metrics for calendar year 2025. Approval rates, denial rates, appeal outcomes, turnaround times — all public for the first time. KFF 2024 baseline: 53 million PA requests submitted, 4.1 million denied (7.7%). Over 80% of denials overturned on appeal. Average physician practice: 39 PAs per week, 13 hours of staff time. CMS suspended health equity disparity reporting provisions in June 2025 but left core metrics intact.

AWS launched Amazon Connect Health — five AI agents for healthcare admin: identity verification, scheduling, medical history summaries, clinical notes, and medical coding. The coding agent auto-generates ICD-10 and CPT codes from clinical notes with full audit trails. Early result: a health system handling 3.2 million patient interactions per year saved 1 minute per call, shifting 630 hours of labor per week from verification to patient care.

The No Surprises Act's independent dispute resolution process — designed as a last-resort backstop — has generated $5 billion in costs since 2022. Three provider groups initiated 44% of all IDR cases in H1 2024. Providers won 83-88% of arbitrations. Insurers paid over 4x the standard in-network rate for arbitrated claims. 40% of submitted disputes were ineligible (providers were in-network, patients had Medicaid/Medicare), but only 17% were declared ineligible by arbitrators. The system is now a profit engine for a small subset of out-of-network groups.

The "big, beautiful bill" is expected to cut $1 trillion from federal Medicaid spending over the next decade. 400+ hospitals are at high risk of closing or cutting services. This week: Molina Healthcare laying off 156 by April 5. Horizon BCBS New Jersey cutting 242 in April. Alameda Health System: 247 positions eliminated, projecting $100M+ in annual losses by 2030. Hennepin Healthcare: 100 employees, $50M shortfall. Baystate Health: 117 positions in February.