In this edition:

• 💻 Doctors using AI to fight insurers

• 🔃 Sanford and Marshfield move forward on merger

• 💲 Indiana hospital accused of price gouging

• 🏴‍☠️ 389 health care companies hit with Ransomware

• And more!

Doctors using AI to fight insurers

For a growing number of doctors, A.I. chatbots — which can draft letters to insurers in seconds — are opening up a new front in the battle to approve costly claims, accomplishing in minutes what years of advocacy and attempts at health care reform have not.

“We haven’t had legislative tools or policymaking tools or anything to fight back,” Dr. Tariq said. “This is finally a tool I can use to fight back.”

Dr. Tariq said Doximity GPT, a HIPAA-compliant version of the chatbot, had halved the time he spent on prior authorizations. Maybe more important, he said, the tool — which draws from his patient's medical records and the insurer's coverage requirements has made his letters more successful.

Since using A.I. to draft prior-authorization requests, he said about 90 percent of his requests for coverage had been approved by insurers, compared with about 10 percent before.

Generative A.I. has been particularly useful for doctors at small practices, who might not ordinarily have time to appeal an insurer's decision — even if they think their patient's treatment will suffer because of it.

Nearly half of doctors surveyed by the A.M.A. said that when they didn't appeal a claim denial, it was at least in part because they didn't have the time or resources for the insurance company's lengthy appeals process.

Dr. Michael Albert, an obesity medicine specialist in Oklahoma, said A.I. had enabled his small, resource-strapped telehealth practice to go from almost never appealing insurance denials to sending 10 to 20 appeals per week.

Indiana hospital accused of price gouging

A small business owner is one of a chorus of employers, patients and political leaders in Indiana speaking out against Parkview Health in the wake of a Guardian investigation released last week that documented how the chain’s aggressive consolidation had helped it to steer patients into expensive care options, secure high prices from insurance companies in negotiations behind closed doors and become the region’s largest employer.

Parkview’s growth is an example of a larger phenomenon of hospital consolidation in recent decades. Academics have consistently found that when hospitals merge, they drive up prices. And emerging research suggests that these high prices may be choking the potential of other businesses, forcing local employers to cut back on payroll and staffing.

Sanford and Marshfield move forward on merger

Two Midwestern health systems that have been looking for merger partners for several years have announced plans to consolidate.

South Dakota-based Sanford Health, the largest rural health system in the United States, plans to merge with Marshfield Clinic Health System, a physician-led integrated health system serving rural Wisconsin and Michigan’s Upper Peninsula.

Over the past few years, Sanford Health has held talks with Utah-based Intermountain Health and Minnesota-based  Fairview Health Services, but those deals did not proceed.

Marshfield had considered a merger with Minnesota-based Essentia Health before calling off talks in January 2024. 

If the merger between Sanford and Marshfield goes through, the combined system will have nearly 56,000 employees, 56 hospitals, 4,300 providers, two integrated health plans, specialty pharmacies and research institutions.

Using each organization’s respective health plan, Sanford Health Plan and Security Health Plan, will allow the fully integrated system to serve more than 425,000 members, maximizing the benefits it can deliver to patients and members through shared governance, Sanford said.

389 healthcare companies hit with ransomware this year

This year, 389 healthcare institutions in the U.S. were attacked with ransomware, which caused network shutdowns, offline systems, rescheduled appointments and delays in critical procedures, finds a new report from Microsoft.

The report, which aggregated information from other reports and data sets, cited a Comparitech analysis showing that the attacks are costly – healthcare organizations lose up to $900,000 per day on downtime alone, the data showed.

According to a recent U.S. government interagency report cited by Microsoft, ransomware attacks have surged by 300% since 2015, largely because ransomware-as-a-service (RaaS) has lowered the barrier for entry for hackers who lack technical expertise, with other ransomware groups finding safe harbor in Russia.

Out of the 99 healthcare organizations that admitted to paying the ransom and disclosed the ransom paid, the median payment was $1.5 million, and the average payment was $4.4 million, according to the HIPAA Journal.