Medicare spending on wound care products is expected to exceed $15 billion in 2025, up 55% from last year, with some skin substitutes costing up to $6,000 per square centimeter, according to an analysis by the National Association of ACOs and the Institute for Accountable Care. The organizations say the increase is driven by fraud and abuse, as legally questionable reimbursement schemes inflate costs and expensive new products flood the market. The CMS has proposed significant changes in how the products are reimbursed.

Compliant billing for Medicare and other federal health care programs can be achieved by understanding what government auditors focus on, developing clear policies and procedures and tailoring training, writes certified documentation integrity practitioner Cheryl Ericson. Compliance training should be tailored to cover the organization's specific needs and risks as well as general compliance risks identified by CMS contractors.

~ Cheryl Ericson, senior director of clinical policy and education, Brundage Group

Peregrine Health, a virtual behavioral health firm serving federally qualified health centers, is deploying an AI agent called Emma that automates scheduling, referrals and patient communication. The AI agent, developed by Unity AI, improved patient engagement and reduced no-shows at HealthPoint.

A 12-week web-based self-help program was as effective as a 20-week cognitive behavioral therapy program for treating binge-eating disorder, according to a study in JAMA Network Open. The usual care group reported a stronger therapeutic alliance, but BMI increased among participants in that program while remaining stable for those in the web-based program. "Based on the positive findings from this study, future work should examine the source of guidance in the guided self-help program," researchers wrote.

Hospital leaders are navigating the rapid rise of artificial intelligence and digitalization with both excitement and caution, as they recognize the need to balance innovation with oversight and empathy. Sutter Health Chief Digital Officer Laura Wilt says it's important to maintain a human touch in health care while leveraging AI to automate administrative tasks and improve efficiency. Tampa General Hospital Chief Digital and Innovation Officer Scott Arnold anticipates that AI agents will significantly differentiate health systems that adopt them, as they relieve staff from repetitive tasks and enhance productivity.

Fitbit has launched a public preview of its Gemini AI-based health coach for premium subscribers using Android devices, with an iOS release planned for later this year. The AI "coach" offers fitness training, sleep coaching and health insights, and it can adjust plans based on user feedback.

Medicare could have saved $301.5 million on opioid use disorder treatment if bundled payments better matched services provided, according to an Office of Inspector General audit. The audit found that bundled payments often exceeded the actual cost of services because of flaws in the Centers for Medicare and Medicaid Services' methodology.

Public health experts are concerned that federal funding cuts for programs aimed at improving care for minority communities will widen racial health disparities. Grants have been terminated and federal and state offices focused on minority health have closed, causing states and nonprofits to struggle in maintaining health equity initiatives. "COVID revealed the impact of health disparities to individual health -- as well as how not addressing these disparities undermines the health system for everyone," said Georges Benjamin, executive director of the American Public Health Association.

AHIMA is proud to introduce Health Information: Making Every Patient's Story Matter, a dynamic new digital series created in partnership with Content With Purpose. Through inspiring films, expert interviews, and real-world case studies, the series shines a light on the people, ideas, and technologies advancing the health information profession and improving patient outcomes. Read about the series in a new Journal of AHIMA article, and watch it now to see how HI professionals are making every patient's story matter.