Samwise Healthcare IT Newsletter
Sunday, May 17, 2026
CMS launches initiative to speed electronic prior authorization adoption
The Centers for Medicare and Medicaid Services has launched a voluntary initiative pressing health systems, payers, and technology vendors to accelerate adoption of electronic prior authorization. Thirty organisations have pledged participation, including Cleveland Clinic, Providence, Epic, Oracle Health, CommonWell Health Alliance, and Kno2. The move targets persistent delays caused by phone- and fax-based authorisation workflows: an AMA survey found telephone remains the most common method, with only about a quarter of physicians having EHR-integrated electronic prior auth for prescriptions. Payers must implement prior auth APIs by January 2027 under a separate federal rule. CMS Administrator Dr. Mehmet Oz cautioned that technology alone will not solve the problem.
Sources: Healthcare Dive
CMS suspends new Medicare enrollment of hospice, home health providers
The Centers for Medicare and Medicaid Services has imposed a six-month moratorium on new Medicare enrollment for hospice and home health providers, citing explosive growth it says has enabled widespread fraud. Nevada hospice providers increased 151 percent between 2019 and 2023; California recorded similarly dramatic expansion. CMS Administrator Dr. Mehmet Oz described the suspension as closing the door on fraudulent billing. The National Alliance for Care at Home expressed concern that legitimate operators could be caught in the freeze, while major hospice and home health industry groups offered broad support for the crackdown. CMS said it will use the pause to strengthen screening and oversight before reopening enrollment.
Sources: Healthcare Dive
Bayesian Health gets FDA nod for AI sepsis detection tool
Bayesian Health has received FDA 510(k) clearance for an artificial intelligence tool that detects sepsis two to 48 hours faster than conventional clinical scoring methods. The company was founded by Johns Hopkins professor Suchi Saria following the sepsis death of her nephew in 2017, and received FDA breakthrough designation in 2023. The tool is already deployed at Cleveland Clinic, MemorialCare, and the University of Rochester. A 2022 study published in Nature Digital Medicine found that patients whose clinicians acted on the AI alerts within three hours experienced 18 percent lower in-hospital mortality. Sepsis kills more than 350,000 Americans annually, making early detection a longstanding clinical priority.
Sources: Healthcare Dive
Oracle adds Cleveland Clinic CEO to board of directors
Oracle has elected Cleveland Clinic chief executive Dr. Tomislav Mihaljevic to its board of directors, effective May 6. Mihaljevic, who has led Cleveland Clinic since 2018 and overseen major expansions of its digital health and international footprint, brings direct health system leadership perspective to a board that now numbers 13 members. Oracle chief executive Clay Magouyrk said Mihaljevic's insights would be invaluable as the company builds out its healthcare technology portfolio. Oracle acquired electronic health records vendor Cerner for approximately 28 billion dollars in 2022 and has since worked to modernise the platform, though Epic continues to lead Oracle in acute care EHR market share.
Sources: Healthcare Dive
Labcorp expands Epic pact to make full test menu available
Labcorp has expanded its partnership with Epic to make its full diagnostic test menu available through Epic's Aura platform, which standardises laboratory ordering and results delivery directly within hospital and clinic workflows. The expanded relationship grew partly from Epic integrations Labcorp inherited when it acquired genomics company Invitae. Aura already connects major laboratory and diagnostics providers including Quest Diagnostics, Abbott Exact Sciences, Roche Foundation Medicine, and Guardant Health, as well as device makers iRhythm, Boston Scientific, and Philips. The platform is designed to eliminate the traditional burden of building and maintaining separate point-to-point integrations between each laboratory and each health system customer.
Sources: Healthcare Dive
Rising inflation strains health system IT budgets
Consumer price inflation reaching 3.8 percent in April 2026, its highest level since May 2023, is forcing health system technology leaders to make hard choices about infrastructure spending. Energy costs driven by Middle East tensions are hitting data centre budgets particularly hard. Stanford Health Care chief technology officer Christian Lindmark says the biggest impact is on infrastructure refresh cycles, with teams extending endpoint lifespans rather than replacing on schedule. UPMC chief technology officer Chris Carmody described the approach as spending wisely rather than reactively. TidalHealth chief information officer Dr. Mark Weisman reported software price increases running 20 to 30 percent annually, straining vendor contract negotiations system-wide.
Sources: Becker's Hospital Review
Providence partners on AI model for mental health crises
Providence Health and Services is participating in a federally funded research initiative developing an artificial intelligence model designed to predict and respond to mental health crises before they escalate. The Renton, Washington-based health system is one of several academic and clinical partners working to build a model that could identify patients at elevated risk based on electronic health record signals, enabling earlier clinical intervention. Mental health crisis presentations continue to overwhelm emergency departments nationally, and health systems have increasingly turned to AI-assisted surveillance tools to extend the reach of under-resourced psychiatric and behavioural health teams. The initiative reflects growing federal investment in AI-enabled behavioural health infrastructure.
Sources: Becker's Hospital Review
MACPAC calls for increased transparency in Medicaid AI prior authorization
The Medicaid and CHIP Payment and Access Commission has voted to advance four recommendations to Congress aimed at increasing oversight of artificial intelligence use in Medicaid prior authorisation decisions. The recommendations call for mandatory human review of all automated care denials, CMS guidance requiring qualified clinicians to sign off on fee-for-service denials, state-level oversight authority over AI vendor practices, and contract updates requiring disclosure when AI is involved in coverage decisions. Commissioner Heaphy noted that appeal rates remain vanishingly low despite widespread algorithmic denials, limiting the data available to assess AI accuracy. Commissioner Nardone warned that AI adoption in prior authorisation is advancing far faster than regulatory frameworks.
Sources: Healthcare Dive
Curated by JD · samwise.agency