Private practices should treat this month's developments as a call to get more proactive and data-driven — tightening revenue cycle workflows, prior authorization tracking, and compliance processes while getting ahead of how AI and online information sources are reshaping patient behavior and trust.

“Vital Signs" is a monthly RCM column for private practices and medical billers. Each edition covers the headlines that matter and what to do about them. Browse previous editions.

Independent medical practices are heading into the second half of 2026 amid rapid changes in technology, reimbursement, regulation, and patient expectations. AI is reshaping how patients find and interpret health information, while practices continue to contend with prior authorization, Medicaid changes, financial pressures, and physician burnout. At the same time, new developments around physician independence suggest practices that can balance autonomy with operational efficiency may be well positioned for what comes next.

Here are 11 developments private practices should have on their radar — and the steps they can take now to prepare.

Details: OpenAI has launched Health in ChatGPT, which lets U.S. adults connect supported medical records and Apple Health data to help interpret test results, prepare for appointments, and better understand their health information. OpenAI says health conversations and connected health data aren't used to train its foundation models or target ads. At the same time, an AOL article highlights expert warnings about sharing sensitive information — including medical information — with general-purpose AI tools.

Why it matters: Patients are increasingly likely to use AI to interpret their health information before or after a medical visit. That could help patients become more informed, but it could also raise questions about privacy, accuracy, and what to do when AI-generated guidance conflicts with a clinician’s advice.

What’s next: private practices should prepare for more AI-assisted patients by providing guidance on appropriate AI use and clear ways to ask questions about test results and records. Practices should also establish policies governing staff use of AI and ensure clinicians only enter PHI into tools with appropriate privacy, security, and HIPAA safeguards.

Details: No Surprises Act payment disputes are becoming increasingly consequential for providers. According to Becker’s Hospital Review, citing a Wall Street Journal analysis, insurers were ordered to pay providers about $15 billion through the federal independent dispute resolution (IDR) process in 2025 alone. Meanwhile, updated CMS guidance requires health plans and issuers to use specific Remittance Advice Remark Codes (RARC) to communicate how certain No Surprises Act claims were processed and whether amounts may be eligible for dispute.

Why it matters: The $15 billion figure underscores how much reimbursement can hinge on the IDR process. At the same time, accurate RARCs are critical because they help practices identify claims subject to surprise-billing protections and determine whether payment disputes may need additional action.

What’s next: Private practices should ensure billing teams understand NSA-related RARCs and have workflows to identify potentially underpaid out-of-network claims. Practices should also track eligible claims, applicable deadlines, and IDR outcomes to determine whether pursuing disputes is financially worthwhile.

Details: A new report highlights the persistent connection between administrative work, EHR use, and physician burnout. More specifically, the study found PCPs tend to spend significant time in the EHR after-hours and may be more likely to report EHR-related burnout following a transition to a new EHR. 

Why it matters: Burnout isn't simply a physician wellness issue — it can affect practice productivity, retention, and the amount of time physicians have available for patients. The findings also suggest practices can use their own EHR data to pinpoint workflows that are consuming unnecessary clinician time.

What’s next: Private practices should look beyond broad burnout initiatives and identify the specific tasks driving after-hours work. Analyze EHR usage data, gather physician feedback, optimize workflows and templates, redistribute appropriate administrative tasks to staff, and consider technologies such as ambient documentation that can reduce the time physicians spend completing work after the patient visit.

Tebra take: Physician burnout often reflects a workflow problem, not simply an individual resilience problem. Private practices can use EHR data to identify where physicians are spending time after hours and target the specific workflows creating unnecessary work. Reducing documentation burden through streamlined templates, better task delegation, and tools such as ambient documentation can help physicians reclaim time for patients — and themselves. Learn how Tebra can help.

Details: New research suggests digital sources are increasingly shaping how patients find and evaluate health information. A News-Medical report highlights research finding that YouTube’s engagement-driven environment can favor attention-grabbing health videos over more reliable medical information. Meanwhile, an Aflac survey found 76% of Gen Z and 63% of millennials use AI for health support before seeking professional care. A separate Hoverboard AI survey found 77% of U.S. adults surveyed use at least one AI answer engine, with 56.8% expressing confidence in AI's accuracy for health-related decisions.

Why it matters: Patients' first interaction with health information may increasingly occur outside the physician's office — and the information they encounter isn't necessarily the most reliable. For private practices, that can mean spending more time correcting misinformation while also competing with AI and social media for patients' trust and attention.

What’s next: Practices should strengthen their presence wherever patients look for answers. Publish clear, authoritative health content, keep websites and online profiles accurate and up to date, and consider how practice information appears in AI-generated answers. During visits, physicians can also ask patients what they have already learned online and help them distinguish credible information from potentially misleading content.

Details: Several new reports point to growing dissatisfaction with corporate medicine — and potential opportunities for physician independence. An Annals of Family Medicine study found independent primary care physicians reported greater autonomy and control over practice decisions, although health system employment offered advantages such as greater infrastructure and resources. Meanwhile, Becker’s reports that nearly 90% of employed physicians surveyed experienced burnout, while another Becker’s report points to ASCs as one avenue helping physicians regain autonomy. 

Why it matters: Independent practice remains challenging, but physician frustration with burnout, administrative burdens, and loss of autonomy could make independence — or models that preserve physician ownership — more attractive. 

What’s next: Private practices should capitalize on autonomy as a competitive advantage while addressing the operational pressures that have historically made independence difficult. Investing in technology, efficient workflows, strong revenue cycle performance, and strategic partnerships can help practices gain some of the infrastructure advantages of larger organizations without necessarily giving up physician control.

Tebra take: The appeal of independent practice may be growing as more physicians question whether employment is worth the loss of autonomy. But independence is most sustainable when physicians can pair greater control over care with the operational capabilities traditionally offered by larger organizations. The opportunity for practices is to use technology, automation, and strategic partnerships to reduce administrative burden and strengthen financial performance — without sacrificing ownership or clinical decision-making. Learn how Tebra can help your practice remain independent in the long run.

Details: As demand for GLP-1 weight-loss drugs grows, patients have more ways to obtain them — but concerns about quality and oversight remain. A secret shopper study highlighted by HCPLive found that 91.8% of 49 online sellers issued a GLP-1 prescription to a simulated patient and about two-thirds required no clinician interaction. At the same time, an Annals of Internal Medicine article examines Medicare's new GLP-1 Bridge Demonstration, which provides eligible Medicare Part D beneficiaries temporary access to weight-management GLP-1s from July 2026 through December 2027. U.S. News has also begun evaluating GLP-1 telehealth companies, reflecting the growing number of consumers seeking these medications online.

Why it matters: As payer coverage of GLP-1 medications continues to evolve, more patients are turning to direct-to-consumer options for access. Private practices may find themselves competing with these services while also caring for patients who receive GLP-1 prescriptions elsewhere. Meanwhile, expanding Medicare coverage could increase the number of patients seeking weight-management treatment, monitoring, and follow-up care from their physicians.

What’s next: Practices should consider how GLP-1 treatment fits into their service offerings and make access as convenient as possible without sacrificing clinical oversight. Physicians should also routinely ask patients about GLP-1s obtained online, including compounded products, and establish workflows for screening, medication reconciliation, monitoring, and follow-up.

Details: PatientRightsAdvocate.org (PRA) has sued the American Medical Association, arguing that CPT codes should be freely available to the public. PRA contends that CPT should not be protected by copyright because the code set has been incorporated into federal and state law. The lawsuit seeks permission to publish the CPT codebook online in a free, searchable format.

Why it matters: CPT codes underpin physician billing and reimbursement, yet practices and other healthcare organizations pay licensing fees to access and use them. The lawsuit could eventually affect those costs and make it easier for patients to understand the codes behind their medical bills. The challenge also comes as CMS separately seeks input on federal reliance on CPT and potential alternatives.

What’s next: Private practices shouldn't expect immediate changes to CPT requirements or licensing. Instead, monitor the lawsuit and CMS activity while continuing to use current CPT coding standards. A successful challenge — or broader federal action — could ultimately change how practices access, license, and use the codes that drive reimbursement.

Details: Patients increasingly receive test results before speaking with their physicians. A Medical Economics report on a recent study found that most patients viewed results through a portal before discussing them with a clinician. But access doesn't guarantee understanding. A Baker Institute policy brief notes that only 12% of U.S. adults have proficient health literacy and explores how AI could translate complex clinical information into more patient-friendly language.

Why it matters: Practices increasingly need to think about what happens between the moment a result appears in the portal and when the physician discusses it with the patient. Confusing terminology or abnormal results without context can generate anxiety, questions, and additional messages to the practice. AI could eventually help bridge that comprehension gap, but research cited by the Baker Institute also raises concerns about inaccuracies and omissions in AI-generated summaries.

What’s next: Private practices should pair timely access to test results with patient-friendly explanations and clear expectations about when and how clinicians will follow up. As AI tools become integrated into patient communication, practices should evaluate them for accuracy, safety, and appropriate clinical oversight rather than relying on AI-generated explanations alone.

Details: Private practices are facing growing financial pressure, making major expenses such as real estate increasingly important. A new Medical Real Estate Calculator is designed to help independent physicians evaluate procedure demand and other market factors at a specific U.S. address before signing or renewing a lease. Meanwhile, Medical Economics reports that clinics and physician practices accounted for almost 30% of healthcare Chapter 11 filings in the first half of 2026.

Why it matters: Rising labor costs, reimbursement pressure, denials, and other expenses are squeezing practice margins. For independent physicians, decisions about where to locate, expand, or renew a lease can therefore have significant long-term consequences — and relying on demographics or intuition alone may leave practices vulnerable to costly mistakes.

What’s next: Private practices should take a more data-driven approach to both real estate and overall financial planning. Before committing to a location or lease renewal, evaluate local demand, competition, referral patterns, payer mix, and expected procedure volume. Practices should also closely monitor cash flow and revenue cycle KPIs and model how reimbursement, expenses, and other changes could affect their financial sustainability.

Details: Major Medicaid changes could create new challenges for patients and practices. A NAMI/Ipsos poll found 80% of Americans are unfamiliar with new Medicaid community engagement requirements, while 65% are concerned they could cause people to lose coverage. Medscape also reports that physicians may face requests to document whether patients qualify for exemptions, with requirements potentially varying across states. Meanwhile, CMS says its Medicaid Fraud War Room stopped more than $203 million in potentially improper payments and identified 50 high-risk providers during its first 88 days.

Why it matters: Private practices could feel pressure from both sides: patients may need help maintaining Medicaid eligibility, while providers face greater scrutiny over Medicaid payments and compliance. Coverage losses could also translate into more uninsured patients, disrupted care, and higher uncompensated balances.

What’s next: Practices should prepare for more Medicaid-related administrative requests by establishing workflows for exemption documentation and educating staff about state-specific requirements. At the same time, strengthen documentation, coding, billing, and compliance processes to ensure Medicaid claims can withstand increased program-integrity scrutiny.

Details: New federal reporting requirements provide a clearer picture of insurer prior authorization practices. A KFF analysis of 2025 data found Medicare Advantage insurers denied 12% of standard prior authorization requests. Medicaid managed care denied 14%, and ACA Marketplace plans denied 18%. Denial rates also varied substantially among individual insurers. Median response times were about one day, although KFF notes the available data still don't show important details such as denial reasons or how rates vary by service.

Why it matters: The data give private practices new insight into how prior authorization performance differs by payer. High or widely varying denial rates can translate into more administrative work, delayed care, and additional staff time spent appealing decisions.

What’s next: Practices should compare their own prior authorization approval, denial, and turnaround-time data by payer and service against emerging industry benchmarks. Use that information to identify high-friction payers, strengthen documentation for frequently denied services, and prioritize appeals and workflow improvements where they can have the greatest impact.

This month's developments point to a common theme: Private practices need to become more proactive, data-driven, and digitally prepared. Patients are increasingly turning to AI and online sources for health information, creating new opportunities and risks around patient education, test results, privacy, and trust.

Meanwhile, reimbursement and regulatory pressures remain significant. New prior authorization data reveal substantial differences in payer denial rates, Medicaid changes could increase both eligibility-related administrative work and compliance scrutiny, and No Surprises Act disputes continue to put significant reimbursement at stake.

The takeaway for private practices is to focus on what they can control: efficient workflows, strong revenue cycle and compliance processes, thoughtful technology adoption, and a patient experience built around accessibility and trust. These capabilities can help practices navigate growing complexity while preserving one of independence's biggest advantages — greater control over how care is delivered.

That's August's Vital Signs. The thread running through this month: patient trust and payer accountability are converging on the same pressure point — practices are being asked to meet patients where they're gathering health information while pushing back on inconsistent, opaque payer decisions. Prior authorization transparency, AI-literate patient communication, and revenue cycle discipline aren't separate initiatives anymore; they're the same effort to keep practices paid, compliant, and trusted.