PBN eyes the future: AI growth, fee-based practice changes, compliance concerns and more

Why This Topic Matters

The article helps readers anticipate operational, regulatory, and reimbursement changes that may affect medical practices in the coming year. It is especially relevant for organizations preparing for new CMS policies, AI-related workflow and privacy issues, and increased scrutiny around compliance and coverage processes.

Article Sections

1. Introduction to the 2026 predictions issue

   Overview of the annual forecast format and the broad health care trends being tracked for the coming year.

2. New CMS rules will shift service settings

   Discussion of expected payment and site-of-service changes affecting practice, facility, and hospital settings.

3. “Agentic” AI will advance with more sophisticated tools that push to the edge of clinical work

   Coverage of emerging AI capabilities in health care, including clinical support, workflow automation, and revenue cycle use cases.

4. Practices will face a big new AI issue in health care: Security

   Focus on security risks associated with AI systems, including cyber threats and data exposure concerns.

5. AI becomes a major fraud detection tool

   Predictions about AI use in fraud detection and enforcement activities across health care organizations.

6. AI HIPAA issues emerge around ambient listening

   Discussion of privacy, consent, and data-handling concerns tied to ambient documentation and related AI tools.

7. 2026 will usher in a bonanza for care-management providers

   Outlook for growth in care-management programs, staffing needs, and model-driven adoption.

8. Majors compliance targets will be IT regulations, drugs, DME

   Overview of anticipated compliance priorities, including health IT, transparency, information-blocking, and enforcement topics.

9. AI-powered wearables will deliver more actionable clinical data

   Predictions about wearable technologies and their expanding role in monitoring and clinical decision support.

10. The number of independent physicians will continue to dwindle

    Commentary on consolidation trends and the ongoing shift toward employed physician models.

11. Reimbursement woes, operating costs will rankle practices

    Discussion of financial pressures on practices, including coverage uncertainty, payment changes, denials, and operational costs.

12. Prior authorization in Medicare Advantage — and Medicare — reaches a crisis

    Coverage of expected prior authorization developments, payer use of AI, and policy scrutiny in both Medicare Advantage and traditional Medicare.