Alexis Kayser

By Alexis Kayser

Healthcare Editor

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This is a preview of the May 14 edition of Access Health—Tap here to get this newsletter delivered straight to your inbox on Thursday mornings.

Good morning. Hospitals have spent the past several years trying to move care beyond their walls. Washington, meanwhile, appears increasingly focused on tightening the guardrails around who gets paid for it and under what conditions.

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This week, Vice President JD Vance threatened to withhold Medicaid and Medicare funding from states that fail to comply with the White House’s anti-fraud initiative, while CMS paused new Medicare enrollment for hospice and home health agencies in several states amid fraud investigations. The administration insists the effort is about protecting public dollars and preserving the long-term stability of federal health programs. But for hospital and health system leaders, the announcement landed in an environment where operational pressure is already unusually high.

Many organizations are actively investing in home-based care models, remote monitoring and post-acute partnerships. In my reporting on hospital-at-home programs last fall, executives repeatedly framed home care as both a financial and operational imperative. By mid-2025, 400 hospitals across 39 states were participating in CMS’ Acute Hospital Care at Home initiative, using remote monitoring and in-home services to free up inpatient beds and lower spending. University Health in Texas alone said its program had freed more than 17,500 beds and saved over $17 million.

Yet as care shifts into the home and away from traditional hospital infrastructure, oversight challenges become harder to ignore. The home health and hospice sectors have long faced scrutiny over fraud risk, as care is decentralized and documentation-heavy.

It is also undeniably expensive, without a clear expiration date on the outgoing checks. My investigation in late 2024 found that post-acute care was commonly targeted by insurers’ AI systems as they looked to cut costs throughout the prior authorization process. The administration appears prepared to lean into that same perception—aggressively.

Executives may ultimately agree with the administration’s goal of rooting out fraud. Few leaders would argue otherwise publicly. But many are also wondering where legitimate oversight ends and operational friction begins.

At a moment when hospitals are being asked to redesign care delivery faster than reimbursement and regulation can keep pace, is another funding threat what health care needs?

What do you make of this week’s news? Email me at a.kayser@newsweek.com and let me know.

In Other News

Major health care headlines from the week

Pulse Check

Executive perspectives on key industry issues

Leigh Burchell is vice president of policy and public affairs at Altera Digital Health.

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In late March, I sat down with Leigh Burchell—vice president of policy and public affairs at Altera Digital Health (formerly Allscripts)—to discuss data security and patient safety as more consumers pose health questions to AI chatbots.

Our conversation felt especially timely this week. On Tuesday, a California lawsuit asked the court to halt the rollout of OpenAI’s ChatGPT Health. The plaintiffs claim that their 19-year-old son died of an overdose after consulting an older version of ChatGPT, alleging the LLM gave him instructions on combining Xanax with kratom.

Find a portion of my conversation with Burchell below, which covers the risks of patient engagement with publicly available LLMs—and health care providers’ role in preventing harm.

Editor’s Note: Responses have been lightly edited for length and clarity.

What are the risks for patients who are uploading their health care data into a non-HIPAA-compliant LLM?

There are generational differences. Younger generations generally don't have the same concern about their data privacy. But there are risks that can come to people if their data is accessed by people who might have different motivations.

Health data is very valuable on the black market—but even setting that aside, there are things in your medical record that payers might be interested in to determine whether they want to insure you. What should your rates be? How risky are you as a possible member of their health plan?

Say a patient's mom had Parkinson's. An insurance company might be interested to see that in my medical record, and now it could get out there through an app, because various entities purchase health data. They might use that info to justify pricing me a little higher. I think that that's a factor that people want to be aware of.

And then, certainly there are breaches, and that can have a different exposure [than what we’re used to in health care]. You don't necessarily have the right to be notified in the same way if an app or an LLM is hacked as you do if an EHR is hacked. We've already seen some of that: Doctronic just had some unauthorized access [Editor’s Note: On March 2, Mindgard, a security research blog, alleged that they exploited Doctronic’s system and turned it into a “bad doctor.”] It's happening all over the place. LLMs are becoming really big targets for cybercriminals because all of that data is sitting out there.

There just generally, is that risk of, make sure you're taking seriously the value of your health data and the risk that can come if someone sees it, maybe who has it has a different interest in that data than you do.

What’s your view on the growing number of consumer-facing health care LLMs — for example, Microsoft’s Copilot Health — that claim patient data is segregated from public models, protected with additional safeguards and erasable at any time? Do you think consumers should trust companies’ assurances around privacy and data separation?

I do think the intention is good, for sure. I absolutely was pleased to see that [ChatGPT] understands the difference between health data and someone looking for a recipe in Copilot. I would certainly like to see the other large LLMs consider something similar.

One [dilemma] with AI in particular is that most consumers don't understand the difference between an open LLM and one that is constrained, with no external access (that does all of its work within a “box,” for example). There's so much education that's necessary for people to understand. We just want people to understand the risks. We're really committed to transparency, to make sure that providers who might use our software, and patients who either might use our software or whose data might be in our software, really can make an informed decision.

Another area to watch is the increasing application of AI in “health” apps. People use these apps on a spectrum. There are people who are super focused on their wellness—it's not necessarily that they are high risk from a medical perspective, but they're really focused on trying to be as healthy as possible, tracking their runs or their food. So you have this big upsurge in the “wellness apps.”

And then, you also have people with high medical needs from complex medical challenges. Apps can be tremendously helpful to them, particularly people who are seeing providers in multiple environments. As they're traveling between all these different places, an app can be incredibly helpful to them in making sure that their full picture is available to the clinician who is seeing them. That's an amazing opportunity right now, and that's where part of the CMS [Health Tech Ecosystem interoperability] pledge is focused.

However, some of these patients and their families are informed that their data may not be protected in the same way, and they're willing to take that risk. They know, and they're making a calculated decision, and that is totally their right to do.

But others are not necessarily aware that their information might be sold or used for research. And that's why we're trying to push for more transparency.

What responsibility should providers assume in getting this message out to patients?

Patients trust their providers. They look to them for guidance on apps that are out there: “Where is my data is going? Should it go? Is there a risk if it goes?” That's a new responsibility for health care providers, and it is unavoidable that the patient is going to look for guidance from their provider.

Most patients do not know which EHR their data is in, and they don't really care. But now, they might be asking a provider, “I'm using this symptom-tracking app for multiple sclerosis, could I share the data with you?”, or, “What do you think about these two apps? Which one should I use?” A lot of providers are not necessarily comfortable stepping into that role, but it is something that patients are increasingly looking for from their provider.

In terms of the information blocking requirements, we as a software developer really are not allowed to discern whether an app is appropriate. We really can only assess the authentication of the app developer: Are they who they say they are? Do they have a legitimate reason to connect and access patient data? Are they doing it in a secure manner?

We are not in a position to say, “this app is better than that app,” or anything like that. And so really, it does fall to the provider organization, which is kind of a paradigm shift.

C-Suite Shuffles

Where health care leaders are coming and going

This is a preview of the May 14 edition of Access Health—Tap here to get this newsletter delivered straight to your inbox on Thursday mornings.

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