Autumn 2025 Issue

Editor’s Note: Managing Headwinds
By Dave Yeager
For The Record
Vol. 37 No. 3 P. 4

I’ve never been sure whether the saying “May you live in interesting times” is a blessing or a curse. Whatever your opinion on current events may be, I think most people would agree that “interesting” is an apt description. The present uncertainty extends to health care, and many evolving scenarios will have implications for health care providers. Managing through these headwinds will require foresight, a steady hand, and a little bit of luck. In this issue, we offer some information that we hope will help expand your field of vision, at least a little.

Tighter reimbursement policies and rising denial rates are cause for concern among health care providers. In our cover feature, Susan Chapman details the ways in which AI is helping to ease the burden. AI can help automate and standardize denial appeals, and new generative AI models offer a range of features that promise new capabilities for processing unstructured data, which would be a significant time saver. AI does require oversight, however. How organizations implement and manage it will go a long way toward determining how much benefit they derive from it.

Another cause for concern is cybersecurity. The HIPAA Security Rule—which is being revised—mandates a level of compliance, but it’s not all-encompassing. This is both good and bad news for health care organizations. On one hand, it avoids saddling organizations with overly prescriptive regulations that may be unaffordable or unworkable or both, but it also doesn’t offer much protection in the event of a data breach. Aside from the regulatory aspect of cybersecurity, what is a data breach likely to cost? Elizabeth S. Goar investigates the business case for cybersecurity and why health care providers need to go beyond HIPAA to protect their organizations.

Yet another concern for providers is communicating follow-up recommendations to patients. Motivating patients to act on them produces better outcomes for the patients and reduces liability risk for providers, but tracking and monitoring follow-ups have been notoriously challenging. Jessica Zimmer reports on some new efforts that make use of—among other methods—AI and generative AI. The goal is to get patients more involved in their care so they can receive necessary treatment sooner rather than later.

Finally, Jennifer Lutz has an in-depth look at how looming Medicaid cuts could affect hospitals. Although less money seems straightforward enough, the loss of Medicaid funds will filter through the health care system in a variety of ways. As is often the case, saving money on the front end could very well lead to higher costs on the back end, and rural hospitals will likely be affected more than others.

Enjoy the issue.

— Dave Yeager
david.yeager@gvpub.com