CMS is preparing to reset Medicare laboratory payments in 2027 after the agency said new private-payer data showed the program is paying substantially more than commercial insurers for many clinical tests. The agency said preliminary rates under the Clinical Laboratory Fee Schedule are about 16% lower on average than 2026 Medicare rates and estimated the changes could save taxpayers about $1 billion annually. The rates are based on the second full data-reporting cycle and remain subject to public comment before CMS finalizes them in November.
CMS will expand its ACCESS model starting in spring 2027 to cover heart failure, COPD, substance use disorders and tobacco cessation. The outcomes-based payment model, which launched in July with 160 participating providers, will now make roughly three in four Medicare beneficiaries eligible for at least one track. The program allows providers to use digital tools, nontraditional services and care teams that are not typically reimbursed under fee-for-service. Participating providers take on responsibility for quality and the total cost of care, with the opportunity to share in savings if they improve outcomes and decrease spending.
UC San Diego Researchers Study Physician Edits to AI-Drafted Messages
Research conducted at UC San Diego Health on the types of editing that physicians across various specialties made to AI-generated drafts of patient messages provides some early evidence about physicians’ roles as humans-in-the-loop and offers some direction for AI optimization efforts. Their findings were published in NEJM AI.
CMS to cancel ACA coverage for 760K, crack down on brokers in latest anti-fraud push
The Centers for Medicare & Medicaid Services announced on Tuesday that it would cancel 315,000 "unauthorized enrollments" covering 760,000 people, a move the agency said will return $2.2 billion in taxpayer funds from premium subsidies. In addition, CMS said it will terminate more than 200 agents and brokers that have failed to comply with enrollment standards for the ACA's marketplaces.
The AI agent bill health systems can’t see
Health systems are already scrambling to rein in AI-based token costs, and the proliferation of AI agents is poised to further complicate that work. Nearly every core system a health system runs now ships its own agent development tool and the pricing models are moving from subscriptions to token consumption. That means the bill is set by how often agents run and how much they process — variables that aren’t fixed when the contract is signed. It also means there is no easy way to see total AI agent costs because each vendor reports usage in its own administrative console, leaving executives to piece together totals from disparate systems.
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