There’s a lot happening in healthcare right now: Payers are facing new pressure to justify payment reductions, patients are struggling with rising healthcare costs, and AI is raising new questions about privacy, security, and physician reimbursement. For private practices, these developments bring both challenges and opportunities. In this month’s Vital Signs, we break down the latest news, explain what it means for your practice, and share practical tips to help you prepare for what’s next.

Details: The Medical Group Management Association (MGMA) is pushing for federal legislation to protect physician practices from automatic downcoding, excessive payer audits, and burdensome prior authorization requirements. Proposed reforms would restrict Medicare Advantage plans from automatically reducing reimbursement without adequate justification. MGMA also wants insurers to compensate practices for the administrative costs of responding to downcoding audits that uncover no errors.

Why it matters: Automatic downcoding can reduce reimbursement for appropriately documented services, while audits and appeals consume valuable staff time and resources. For private practices, these challenges can increase administrative costs, delay payments, and disrupt cash flow. 

What’s next: Although federal reforms could eventually provide greater protection against unjustified downcoding, practices shouldn’t wait for legislative action. Strengthening coding accuracy, monitoring payer payments, and improving denial management workflows can help private practices protect revenue now.

Tebra Take: Now is the time to strengthen coding accuracy, identify underpayments, and streamline denial management to protect your bottom line. Tebra's integrated billing and practice management solutions can help you catch claim errors before submission, track denials, and reduce administrative work. Don't let payer challenges put your revenue at risk. Discover how Tebra can help you get paid faster, reduce denials, and keep your practice financially strong.

Details: The Trump administration has finalized new requirements designed to make health insurers’ publicly reported pricing information more accurate, standardized, and easier to use. The rule eliminates unnecessary pricing data, requires insurers to report most negotiated rates as dollar amounts, expands reporting of out-of-network payments, and holds insurers more accountable for data accuracy. 

Why it matters: For private practices, greater access to reliable insurer pricing data could make it easier to compare reimbursement rates, identify payment disparities, and negotiate more favorable payer contracts. Patients may also gain better tools to compare healthcare costs before receiving services, increasing expectations for clear pricing information. However, greater transparency could also intensify price competition among providers.

What’s next: Changes to existing insurer pricing files will take effect five months after the rule’s publication in the Federal Register, with additional reporting requirements taking effect after 11 months. Private practices should monitor implementation, explore opportunities to use publicly available pricing data in payer negotiations, and strengthen patient financial communications. Practices should also consider how greater pricing transparency could affect their competitive position and reimbursement strategies.

Details: A new U.S. News & World Report survey of more than 1,200 GLP-1 telehealth users found that patients prioritize thorough initial screenings (29%) and quality medical follow-ups (26%) when choosing a platform. However, ongoing behavioral and psychological support was associated with greater weight loss. Among patients who lost more than 20% of their body weight, 52% had access to this support. Nearly one-third (31%) switched platforms, primarily because of high costs or insufficient support. 

Why it matters: The findings highlight opportunities for private practices to compete with direct-to-consumer GLP-1 platforms by offering personalized, comprehensive weight management services. Practices that combine appropriate prescribing with ongoing monitoring, nutritional counseling, behavioral support, and transparent pricing may be better positioned to attract and retain patients.

What’s next: Practices offering GLP-1 treatment should evaluate their screening protocols, follow-up processes, patient education, and ongoing support services. They should also consider using telehealth, patient portals, and automated communications to improve access, strengthen patient engagement, and support long-term treatment adherence.

Tebra Take: For private practices, growing demand for GLP-1 medications presents an opportunity to compete with direct-to-consumer platforms by offering personalized, comprehensive weight management care. Tebra’s integrated EHR, practice management, and patient engagement tools can help practices streamline scheduling, simplify follow-ups, automate patient communications, and strengthen patient relationships. The result? A more convenient, connected care experience that helps practices attract and retain patients while supporting long-term treatment success.

Details: Two recent reports highlight the growing financial burden of healthcare on American families. According to the Robert Wood Johnson Foundation, 27% of U.S. adults reported that they or a family member had medical debt in December 2025, including 26% of insured adults. More than half (54%) of those with medical debt owed at least $1,000. Meanwhile, KFF Health News reports that U.S. healthcare spending reached $5.3 trillion in 2024, accounting for 18% of GDP, with per-person spending averaging $15,474. Healthcare spending is projected to reach 20% of GDP by 2032. 

Why it matters: Rising healthcare costs and medical debt create challenges for private practices as patients struggle to afford care, delay appointments, or fall behind on medical bills. Even insured patients may face significant out-of-pocket expenses, increasing the risk of delayed collections, bad debt, and uncompensated services. Practices must balance patients’ growing need for financial flexibility with the importance of maintaining predictable cash flow.

What’s next: Private practices should prioritize patient financial transparency and proactive collections strategies. This includes verifying insurance eligibility and benefits, providing accurate cost estimates, communicating patient financial responsibility before visits, offering flexible payment plans, and simplifying digital payment options. Practices should also monitor patient A/R, collection rates, and outstanding balances as healthcare affordability pressures continue into 2027.

Tebra Take: As healthcare costs rise, private practices need to make it easier for patients to understand and manage their financial responsibilities without putting practice revenue at risk. Tebra’s integrated practice management, billing, and patient payment tools can help practices streamline insurance verification, improve billing transparency, simplify collections, and offer convenient digital payment options. By making the financial experience easier for patients, practices can reduce administrative burdens, improve collections, and maintain healthier cash flow.

Details: Two federal initiatives could help accelerate the transition from fee-for-service reimbursement to value-based physician payment. According to the Commonwealth Fund, CMS is advancing the Achieving Healthcare Efficiency through Accountable Design (AHEAD) Model, which supports state-led payment reforms and greater accountability for healthcare costs and outcomes. Meanwhile, the $50 billion Rural Health Transformation Program (RHTP) provides states with funding to strengthen rural healthcare infrastructure, technology, workforce capabilities, and readiness for alternative payment models. 

Why it matters: These initiatives signal a continued federal emphasis on rewarding quality, outcomes, and cost-effective care rather than service volume alone. For private practices, participation in value-based payment arrangements could create opportunities for more predictable reimbursement and greater investment in care coordination. However, practices may also face new financial risks, reporting requirements, and operational challenges associated with tracking performance, managing patient populations, and demonstrating value.

What’s next: As states implement AHEAD and RHTP initiatives, private practices should monitor opportunities to participate in emerging payment models and access available resources. Practices can prepare by strengthening care management workflows, improving data collection and reporting, tracking quality and financial performance, and evaluating their readiness for value-based reimbursement. The initiatives could also provide valuable lessons as Congress considers broader Medicare physician payment reforms.

Details: Two recent developments highlight growing efforts to preserve physician independence amid healthcare consolidation. Federal lawmakers introduced the Stop Corporate Takeovers of Physicians Act, which would restrict private equity firms, insurers, and other for-profit corporations from owning or controlling medical practices, including through management services organizations. Meanwhile, the AMA is highlighting the opportunities for physician entrepreneurship as doctors seek greater autonomy and innovative ways to deliver care. 

Why it matters: For private practices, these developments underscore the importance of maintaining control over clinical decisions, staffing, operations, and financial priorities. Limiting corporate ownership could give physicians more control over their practices, but it could also make it harder for them to get outside funding or business support. At the same time, physician entrepreneurship offers opportunities to develop new care models, adopt technology, and build financially sustainable practices without sacrificing independence.

What’s next: The proposed federal legislation remains under congressional consideration, while states continue developing their own restrictions on corporate ownership and control. Private practices should monitor regulatory developments, review existing ownership and management agreements, and explore opportunities to strengthen financial sustainability. Investing in AI-enabled administrative automation and improving patient experiences. 

Details: As more patients connect their medical records (including their medical bills) to AI chatbots such as ChatGPT Health, healthcare organizations face new privacy and financial challenges. At Advocate Health, the number of patients linking MyChart accounts to ChatGPT jumped more than 7,000% from July to August 2026, increasing the volume and cost of EHR data requests. Epic is developing more efficient ways to exchange data to reduce these costs. Meanwhile, cybersecurity experts warn that sharing sensitive medical information with consumer AI platforms introduces privacy and security risks, particularly because these platforms may not be subject to the same HIPAA requirements as healthcare providers. 

Why it matters: For private practices, growing patient use of AI to interpret medical records could increase questions about diagnoses, test results, and treatment recommendations, adding to administrative workloads. Practices may also face greater expectations for convenient access to medical information while navigating privacy concerns and potential technology costs. Although consumer AI tools can help patients better understand their health, inaccurate or incomplete AI-generated information could create confusion and undermine patient trust.

What’s next: Private practices should prepare for more patients using AI to access and interpret their health information. This includes educating patients about the benefits and risks of sharing medical records with third-party platforms, encouraging them to verify AI-generated information with their physicians, and reviewing patient data-sharing and cybersecurity policies. Practices should also monitor how growing AI-related data requests could affect EHR performance, costs, and workflows as technology vendors develop more efficient solutions.

Details: A new Clearwater report, 2026 Healthcare AI Security and Governance Benchmark, reveals significant gaps between healthcare organizations’ AI policies and their ability to enforce them. Only 8.6% of surveyed organizations verify which AI tools are being used through automated monitoring, while just 14.3% fully validate their vendors’ AI security controls. Nearly half (44.3%) rely on written data protection policies without technical safeguards. Meanwhile, 30.8% identify shadow AI—employees using unapproved AI tools—as their greatest AI-related data risk. 

Why it matters: For private practices, these findings highlight growing cybersecurity, privacy, and compliance risks as AI becomes embedded in clinical and administrative workflows. Employees may use unapproved AI tools to draft patient communications, summarize medical records, or perform billing tasks, potentially exposing sensitive patient information. Practices may also unknowingly inherit AI-related risks through EHR systems and other technology vendors. Without adequate oversight, these risks could lead to data breaches, HIPAA violations, and operational disruptions.

What’s next: Private practices should move beyond simply establishing AI policies to ensuring those policies are followed and enforced. This includes identifying approved and unapproved AI tools, addressing shadow AI, establishing clear rules for acceptable use, evaluating vendor security practices, and training employees to protect patient information. Practices should also implement appropriate technical safeguards and regularly assess AI-related risks as adoption accelerates. 

That's October's Vital Signs. From protecting reimbursement and managing rising patient costs to navigating AI adoption and new regulations, private practices have a lot on their plates. Staying informed, strengthening financial and administrative workflows, and taking a proactive approach to technology and compliance can help your practice reduce risks, improve efficiency, and continue delivering high-quality, patient-centered care.