“Simplicity is a great virtue but it requires hard work to achieve it and education to appreciate it. And to make matters worse: complexity sells better.”
– Edsger W. Dijkstra

From Washington, DC

• The mid-term elections campaign trail ends on Tuesday, which is Election Day. Both the House and the Senate return to Capitol Hill next for a lame duck session.

• Roll Call reports,
  • “Republicans in both the Senate and House will hold their leadership contests on Nov. 10, just a week after a high-stakes Election Day that will determine whether they keep their majorities.” 
    
• Beckers Health IT relates,
  • “U.S. Sen. Bill Cassidy, MD, R-La., has released a discussion draft of the PATIENT AI Act, proposing to clarify whether the FDA or ONC oversees healthcare AI tools and to create a federal payment pathway for AI-based services.
  • “The Protecting Americans Through Intelligent, Ethical, and Transparent Artificial Intelligence in Health Care Act comes from Dr. Cassidy, who chairs the Senate Health, Education, Labor and Pensions Committee. AI applications that don’t qualify as FDA-regulated devices would be added to the definition of ONC’s certified health IT.
  • “The FDA would get a risk-based review process for software-based devices, including authority to accept premarket software changes and review updates on a rolling basis. HHS would certify third-party bodies to review low- to moderate-risk software. The Oct. 29 draft also applies existing federal preemption of state product liability laws to integrated and software-based devices.
  • “On reimbursement, HHS would build a coverage evaluation framework for AI-based services, propose payment methodologies and establish a process to use Healthcare Common Procedure Coding System Level II codes for them. The Center for Medicare and Medicaid Innovation would test a payment model for AI applications that deliver care autonomously.”

• The Street tells us,
  • “A rare pricing shift is coming for Medicare beneficiaries in 2027, but taking advantage of potential savings will depend on the coverage decisions they make before the December 7, 2026, enrollment deadline.
  • “Medicare Advantage premiums are expected to fall next year, while Medicare Part B premiums are projected to rise more modestly than some retirees may have feared, according to the Centers for Medicare and Medicaid Services (CMS). 
  • “Prescription drug coverage, however, comes with a higher annual out-of-pocket limit and deductible in 2027.”
  • “Meanwhile, major insurers are reducing their coverage in some areas, leaving certain counties and limiting provider choices while cutting extra benefits like dental care in some regions.”‘
• FEHBlog Observation — The FEHBlog’s guess is that CMS will announce 2027 Part B and D premiums shortly after Election Day.

• The New York Times lets us know “What to Know About the 6 Experimental Peptides Kennedy Has Cleared for Use.
  • “Patients will now have widespread access to the peptides, despite experts’ safety concerns.”

From the public health and medical / Rx research front.

• MedPage Today reports,
  • “As Measles Outbreak Hits Pennsylvania Amish Country, More Show Openness to Vaccines.
    • “— After a decline in trust, some minds are changing.

• Health Day relates,
  • “No single exercise is best for weight loss, and varying workouts helps prevent progress from stalling
  • “Cutting calories drives most weight loss, but regular activity is key to keeping the weight off
  • “A sports doctor recommends pairing 30-minute cardio sessions with strength training that targets the legs and large muscles.”
• and
  • “Low-risk prostate cancer (PC) has become less common at diagnosis since 2010, and low-risk patients are increasingly avoiding treatment, according to a study published online Oct. 26 in Cancer.”
• and
  • “A vaginal swab test in development could help some women with abnormal bleeding avoid a painful uterine biopsy
  • “Early company-reported results suggest the swab catches at least 90% of endometrial cancers
  • “Developer PinkDx hopes to offer the test by mid-2027, pending results from a larger 3,000-woman study.”

• The New York Times tells us,
  • “Knee Surgery Isn’t Always the Answer. Here’s How to Avoid It.
    • “If you want to avoid the knife, you have to be patient.”
• and
  • “Why Your Mental Health Needs an Annual Checkup, Too
    • “Here are a few questions to ask yourself — and your primary care doctor — to keep your psychological well-being on track.”

• Medscape informs us,
  • “For many problem drinkers, the after-work drink is automatic. Now, some patients of Sylvie Stacy, MD, tell her they pour a glass, take a sip or two, and walk away.
    “That sense of anticipation isn’t there anymore, and the situations that used to trigger an immediate craving for alcohol suddenly feel very neutralized to them,” said Stacy, an addiction medicine specialist and chief medical officer for Rehab.com.
  • “Why? These patients are using GLP-1 medications.”
• and`
  • “In a small pilot trial, adults who had lost weight while they were on a GLP-1 receptor agonist (GLP-1 RA) and then stopped it regained less weight over 4 months with either a digital wellness app or dietitian-developed meal deliveries compared with usual care.

From the U.S. healthcare business and artificial intelligence front,

• Modern Healthcare reports,
  • “Hospital units dedicated to treating the nation’s sickest kids are disappearing nationwide. In the past year alone, hospitals have closed pediatric intensive care units for critically ill kids in Montana, Oregon, and Missouri. Overnight hospital wings for kids have also shuttered in Illinois and California.
  • “Depending on the hospital, pediatric units — which are separate from neonatal intensive care units — can serve patients ranging from a few weeks old to well into their teens or early adulthood. As hospitals look to cut costs, many are converting those beds into more services for newborns or adults. As a result, pediatric intensive care has become centralized in medical hubs, requiring critically ill children to travel farther for lifesaving care.
  • “You can’t expect that people will be fine if the next-closest children’s hospital is a flight away or an eight-hour drive,” said Elizabeth Mack, a pediatric critical care doctor and spokesperson for the American Academy of Pediatrics.
  • “Hospitals cutting pediatric care tend to cite low patient volumes; it’s relatively rare for a child to need intensive care. It’s also hard to find doctors to treat those rare cases because the nation is short on pediatric subspecialists, who earn less than those focused on adults. Meanwhile, hospitals are often paid less to treat children than adults, and buying gear tailored to kids adds extra costs.
  • “The gap in care is acute in rural places. Cutbacks are happening across community hospitals, whether owned by small nonprofits or massive private equity companies.

• Beckers Physicians Leadership relates,
  • “San Ramon, Calif.-based Hill Physicians Medical Group has agreed to have the Santa Clara County Independent Practice Association join its enterprise, according to an Oct. 29 news release.
  • “As part of the deal, Hill Physicians would also acquire the IPA’s management services organization, Pacific Partners Management Services, from an affiliate of HCA Healthcare. The addition would bring about 1,000 physicians and other providers into Hill Physicians’ network and give it a presence in all nine Bay Area counties.
  • “Hill Physicians is Northern California’s largest independent physician association, with more than 6,000 physicians serving more than 400,000 patients across 14 counties. The deal is subject to regulatory approvals, and financial terms weren’t disclosed.”
    
• Beckers Health IT informs us,
  • “When Dallas-based Baylor Scott & White Health and Thrive Global, the behavior change technology company founded and led by Arianna Huffington, announced their collaboration in October, they set out to help people make healthier decisions about sleep, food, movement, stress and connection through what Ms. Huffington called “microsteps.”.
  • “For Ms. Huffington, supporting people through microsteps between doctor visits is an important part of moving healthcare beyond treating illness.
  • “One of our mottos is that health is also what happens between doctor visits. If we don’t nail how we can help people sleep better, eat better, move more, stress less and connect more, it’s going to be very hard to transform what is really a sick care system into a healthcare system,” she told Becker’s in an interview alongside Pete McCanna, CEO of Baylor Scott & White.
  • “Mr. McCanna said the idea resonated with him when he heard Ms. Huffington describe Thrive Global’s approach at a dinner, because it fit with the system’s effort to redefine what a modern health system should be, one he described as customer-centric and demand-driven.”

• Fierce Healthcare informs us,
  • “Building on its recent guidance for organizations’ use and governance of clinical AI, the American Medical Association on Thursday gave a deeper breakdown of how it believes different parties should be responsible for decisions, actions and failures involving the technology. 
  • “The latest framework from AMA’s Center for Digital Health and AI addresses liability issues the group said are currently unanswered by existing liability frameworks. Those structures, it said, could leave physicians facing “liability for risks they cannot reasonably prevent, while patients may struggle to seek remedies when AI causes harm.”
  • “Other key issues with the status quo liability frameworks, AMA said, are ambiguity around when product liability applies to AI; how contract terms and disclaimers from developers can distance responsibility from risk control; and whether deploying healthcare organizations hold various responsibilities specific to AI, such as local testing or outcomes monitoring. 
  • “AMA said the clinical AI liability framework it’s advancing “recognizes that multiple parties may bear liability for the use of AI when something goes wrong,” and then aligns that accountability based on a party’s ability to prevent harm. Responsibility is spread out in areas where control is shared, but it does not become interchangeable, and no party’s obligations disappear because another party also bears some,” AMA wrote in a brief outlining its thinking.”