Today on HITshow:



Hospitals are walking a narrow financial line with thin margins, outpatient volumes doing most of the heavy lifting, and expense pressure from workforce and supplies showing no signs of letting up. Rural maternity care is in crisis—116 rural hospitals have closed or scheduled closure of L&D units since 2020. Indiana just approved a closely watched COPA merger between Union Hospital and HCA's Terre Haute Regional with price caps and conditions. We're tracking a privacy push for wearables data that currently falls outside HIPAA, and Congress is pushing back hard on AI-driven prior authorization in Medicare before the pilot even launches.



HOST: RHONDA BROOKS



???? Hospital Financial Snapshot — Logan Stokes



Kaufman Hall's National Hospital Flash Report shows September 2025 data pointing to continued thin margins, with outpatient volumes doing most of the heavy lifting. Expense pressure from workforce and supplies hasn't let up, so CFOs are threading the needle on Q4 and early 2026 capital plans. The playbook: protect outpatient growth, watch contract labor, and get more disciplined about service line contribution.



???? Rural Maternity Crisis — Jade Romero



A CHQPR analysis reveals 116 rural hospitals have closed or scheduled closure of labor & delivery units since the end of 2020. Today, only 41% of rural hospitals still deliver babies—and in a dozen states, it's less than one-third. The financing gap: 24/7 staffing costs for low-volume L&D aren't reliably covered by payers, forcing patients to travel 30-50+ minutes to reach maternity units. The report recommends standby capacity payments plus smaller delivery fees so hospitals aren't penalized for safer, lower C-section rates.



???? Indiana Hospital Merger — Teresa Vaughn



The Indiana Department of Health approved a Certificate of Public Advantage for Union Hospital in Terre Haute and HCA's Terre Haute Regional, creating a single system with price caps and conditions. Supporters say it preserves access and constrains prices; critics warn it reduces competition. Expect more states to dust off COPA frameworks as a path through consolidation fights.



???? Wearables Privacy Legislation — Anika Shah



Senator Bill Cassidy is advancing a bill to tighten protections for wearable and app-generated health data that currently falls outside HIPAA. The proposal requires clearer disclosures and stronger user controls as consumer-grade devices increasingly blend into clinical workflows. Hospitals need to map non-HIPAA data streams, prep standardized consent language, and prepare for stricter state-federal alignment.



???? Prior Authorization Pilot Under Fire — Jalen Johnson



House Democrats introduced the Seniors Deserve SMARTER Care Act to repeal the CMS Innovation Center's WISeR model before it launches. WISeR would add AI-backed prior authorization for some Medicare services in six states starting in January. Hospital revenue cycle and access teams should prepare for scenario A or B—repeal or rollout—because operational changes for ordering and documentation are non-trivial.



Leadership Moves:



Joint Commission names Arjun Srinivasan, MD (ex-CDC) Deputy CMO—signal: infection-prevention and quality emphasis. Clearway Health taps Brandon Newman, PharmD as CEO—specialty pharmacy plus health-system focus. AdventHealth Altamonte Springs (Florida) names David Goldman, DO CMO. Oracle Health now reports to co-CEO Mike Sicilia after September's leadership shift.



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