Patients Wary of Governments, Companies Pushing AI as a Rural Healthcare Solution

By Arielle Zionts and Darius Tahir

Aug 11, 2026

(Oona Zenda/KFF Health News)

HOT SPRINGS, S.D. — Two of the nation’s most powerful health officials predict artificial intelligence will play a key role in solving rural America’s health challenges.

Health Secretary Robert F. Kennedy Jr. told a panel of U.S. senators that AI nurses can provide “concierge care” to rural patients. Mehmet Oz, who leads the Centers for Medicare & Medicaid Services, has said “the best way to help some of these communities is going to be AI-based avatars” that connect rural patients to mental health services.

And many state health leaders agree. They are using some of their funding from the $50 billion federal Rural Health Transformation Program to expand AI among rural health organizations.

AI is computer technology that performs tasks that typically rely on human intelligence by finding patterns or generating words. It has the potential to improve the healthcare system by automating back-office work or identifying patients at risk, but several reports contend there’s little evidence AI can improve access to care and patient health in rural areas. It’s unclear how well states will track and share outcomes of the tech they invest in.

Meanwhile, some rural Americans are skeptical, according to interviews with people in Hot Springs, South Dakota, a city of about 3,400 residents at the southern end of the Black Hills.

“I get artificial intelligence for certain things, but for personal healthcare — no,” Tara Haffner said while standing outside the American Legion.

Haffner said she’s worried about AI making mistakes and wants healthcare to stay between her and her doctor.

But Phillip Mues, who oversees technology at Cherry County Hospital and Clinic in rural Valentine, Nebraska, said AI is already helping clinicians save time, reduce burnout, and focus more on patient care.

“I think it will help reduce burden on actual staffing,” he said. “It won’t replace people, but I think it will help in rural communities.”

Still, Mues said, AI can’t fix every challenge. Rural hospitals at risk of closing or ending certain services probably can’t use AI to save enough money to prevent those consequences, he said.

Congressional Republicans created the five-year Rural Health Transformation Program last summer as a last-minute sweetener to President Donald Trump’s signature One Big Beautiful Bill Act. The funding was intended to offset concerns about the outsize fallout anticipated in rural communities from the law, which is expected to reduce overall Medicaid spending by more than $900 billion over a decade.

The Word on the Street

Hot Springs, which has a 25-bed independent hospital and a Department of Veterans Affairs hospital, is known for its sandstone buildings, veterans’ services, and, yes, hot springs. Residents must drive at least an hour for more advanced care.

Six people interviewed there by KFF Health News said the biggest problem in rural healthcare is the cost or long wait times caused by staffing shortages.

Doug Nikkila, a heavy equipment operator, said AI and other technology come with benefits and risks.

“If it’s not utilized correctly, it becomes a burden,” he said.

Nikkila, who’s concerned about nursing home residents being neglected amid staffing shortages, said he thinks AI should send reminders to staff when their residents are due for diaper changes or other care. He also wondered whether AI-powered video monitors could send alerts when they detect falls or illness symptoms.

The healthcare industry is rapidly adopting AI despite the tools being “poorly evaluated,” according to a recent report from ARISE, a Stanford- and Harvard-led group that evaluates health-related AI. The report says that while some AI has been successful in controlled settings, there’s less evidence it can perform in the real world. It also said few studies track patient outcomes.

Evidence is especially lacking in rural areas. A recent academic paper found that only 26 peer-reviewed studies about AI in rural healthcare were published from 2010 through April 29, 2025. Few analyzed implementation or outcomes.

Despite the dearth of results, some states appear interested in bold experiments — such as using AI to suggest diagnoses or recommend treatments. Utah officials said in their application to the rural health program that they are interested in funding a controversial experiment in AI-powered prescription refill requests.

Even tools proven to work in urban settings may not work in rural ones, said Qian Huang, an assistant professor at the Center for Rural Health and Research at East Tennessee State University.

She said the technology is usually tested at large, academic hospitals and trained on data from urban patients, who may not have the same health issues and obstacles — such as a lack of transportation — as rural patients.

A KFF Health News review of states’ plans for the Rural Health Transformation Program shows they’re interested in using AI to automate time-consuming, behind-the-scenes tasks, such as medical charting, coding, referrals, and prior authorization requests. Some states also mentioned ways AI can save money, such as Washington, which discussed tools that “identify and recover” money it’s owed.

Mues said the Valentine clinic has been using AI scribes that record appointments and generate notes describing the visit. He said surveys of clinicians before and after they started using the technology show the scribes have helped reduce burnout by letting providers focus on patient care with “eye contact on the patient, not the computer.”

States also mentioned funding AI that directly affects patient care, such as tools that recommend possible diagnoses and treatment options to clinicians. Mississippi wants to use predictive AI algorithms to “guide” emergency medics with “triage, routing, and treatment decisions.”

Several states want to use AI to analyze patients’ medical charts and remote monitoring devices to identify immediate or future health risks. North Dakota’s plans mention AI to “detect early signs of chronic disease and behavioral health conditions,” while New Hampshire’s discusses AI that identifies patients “at high risk of adverse drug events.”

Some states plan to give patients access to chatbots or wearable devices that transmit data to their clinicians. Utah is interested in funding AI-powered fetal-monitoring devices, while Kentucky will explore using AI chatbots to “deliver personalized nudges and education” through “health coaching, gamified incentives, and rewards.”

Whether the technology appeals to consumers is another matter. Hot Springs resident Stephanie Keller wears a smartwatch to track her fitness but has no interest in an AI chatbot using her data to encourage her to reach her health goals.

“I don’t have the time to chat with AI every day. I mean, are you kidding me? I don’t want to spend my time on a cellphone,” she said.

Rural health facilities also face challenges in implementing AI.

Huang, who has written about AI in rural healthcare, said rural hospitals and clinics may not have the hardware or IT staff needed to support the technology. She said clinicians and staff may already be doing three jobs at once and not have time to go through AI training.

Rural health facilities may not have fast-enough internet to use AI, while patients may have slow connections at home — if they have internet at all — or may not feel comfortable using AI, Huang said.

“In rural communities, trust and a personal relationship is essential,” she said.

Roy Ehlers, a Hot Springs resident, said he doesn’t trust AI in healthcare, or anywhere else.

“I’m old-fashioned. I don’t believe in it. Technology is not my forte,” Ehlers said.

Mues said that while some rural patients are “scared of AI,” most have let their clinicians at the Valentine facility use the scribing technology to record patients’ visits.

Will States Share AI Results?

Despite questions about implementation, the boom is on. Jordan Everson, an assistant professor at the Georgetown University Department of Family Medicine, said both urban and rural health facilities are rushing to use AI.

“The risk of signing contracts that rural healthcare organizations come to regret is pretty high,” said Everson, who previously worked in the information technology office at the U.S. Department of Health and Human Services.

Several states are addressing that risk by using their rural health funding to create groups that will help rural health facilities vet, select, or monitor AI tools while offering training, ongoing assistance, or funding for upfront costs.

CMS spokesperson Timothy Foster said the agency doesn’t have any AI-specific reporting requirements but is working on a form for states to report their overall progress and outcomes.

Abraham Pritzker, who works at Julota, a company that helps health organizations track data, said states should measure more than how often AI programs are used.

For example, states can measure whether the tech reduces falls, 911 calls, or hospital admissions, said Pritzker, a former paramedic. Huang said it’s also important to ask clinicians and patients about their experiences using AI.

Yet many states’ applications to the rural health program mention tracking only AI adoption metrics, not what happens after facilities deploy the tech. Some of these states may add further reporting requirements down the road.

Vermont spokespeople did not respond when asked why their state’s funding opportunity for AI scribes requires organizations to report only how many clinicians and patients are served by the tech, not how much time they save.

States requiring recipients to report outcomes include Connecticut, which will track how often AI-powered patient monitoring devices trigger accurate alerts. Texas will require organizations to track cost savings, while Wisconsin lists “patient outcomes” and “productivity and efficiencies” as possible metrics.

Huang said that after collecting results, states need to share them so other states and healthcare organizations can learn from their experiences.

“We do not have a lot of resources to waste on tools that don’t work in rural areas,” she said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Diarrhea, Lettuce and Cyclosporium

A nationwide outbreak of diarrhea thought to be caused by contaminated lettuce is occurring.

https://fb.watch/IQB_vJ7jHp/

The People Eating Salads and Fruit Are Getting Sick. The People Eating Meat Are Fine. The Irony Is Not Lost.

Lettuce absorbs contaminated water. You can't wash it off. You can't peel every leaf. When there's a widespread outbreak, produce and meat get shipped in the same trucks and containers — cross-contamination is a real risk. Wash your vegetables. Grill your meats and vegetables well. And if the diarrhea hits — explosive, watery, cramping — don't fool around with it. Get on trimethoprim-sulfamethoxazole immediately. This one doesn't resolve on its own.

https://lnkd.in/p/gDNb7upT

What are Peptides?

Television is overflowing with advertisements for GLP-1, Ozempic, and others. GLP-1 is a glucagon-like peptide,

HRT & Peptide Evidence Compendium

This link will take you to a complete list of peptide products. Only some of them are FDA approved.

Peptides are a sequence of amino acids, which are a short chain of amino acids, smaller than a complete protein.

Many of these peptides signal the production of other hormones, such as testosterone or estrogen. 

Some of them are prescribed as anti-aging compounds.

Users must use due diligence for a specific product.  The peptides are frequently promoted by anti-aging clinics, naturopaths, and/or functional medicine clinics.

TruthTides — HRT & Peptide Evidence, Source-Locked

Are you ready for Private Equity ?

 

Private equity firms now account for a large percentage of all physician practice transactions in the United States (NICHM Foundation). 

Cardiology, dermatology, gastroenterology, and pediatrics are seeing the heaviest activity, and the pace is accelerating heading into 2027. Most physicians I talk to have one of two reactions when they hear this. Either they see PE as a threat: outside investors squeezing more work for less pay, eroding physician autonomy, turning medicine into a transaction. Or they see it as a windfall: a potential exit that could set them up for life if the timing is right. 

 Regardless of your stance on PE in medicine, one of the biggest learning lessons is turning your clinic from a "glorified job" into a true asset that can be sold, even if you never want to exit it. The first diagnostic question every clinic owner needs to answer is whether their practice is supply-constrained or demand-constrained. A demand-constrained clinic does not have enough patients. The schedule has gaps, new patient volume is inconsistent, and revenue is limited by how many people know about the practice and choose to come in. The fix is marketing and conversion: getting the right patients to find you, trust you, and book an appointment. A supply-constrained clinic has the opposite problem. Demand exists, but the physician is the bottleneck. The schedule is full because every slot requires the owner, which means growth is capped by how many hours that one person can work. The fix is capacity: adding providers, systems, or both. Most clinic owners assume they have a demand problem when they actually have a supply problem, and vice versa. Diagnosing this correctly determines everything about where you focus your energy and investment next. Regardless of which constraint you are facing, the first practical move is the same: audit where your time actually goes. Take one full month and track every clinical and administrative activity you personally perform. Then ask three questions about each one. Can this be automated using software or AI? Can this be delegated to someone else on the team? D oes this actually need to happen at all? That last question is the most valuable one. A significant portion of what most clinic owners do every week falls into the category of tasks that do not need to happen, have never been questioned, and are consuming hours that could go toward the three or four activities that actually drive the practice forward. When you identify your highest-value activities — the ones that are Easy, Lucrative, and Fun, and that generate the most income per hour — those are the activities worth protecting aggressively. Everything else is a candidate for automation, delegation, or elimination. This is the most direct path to recovering time that can be reinvested into building the practice rather than just running it. 

 A clinic that functions as a real asset, rather than a well-paying job, is built on developing consistency within three functions: marketing, conversion, and operations. 

 Marketing means getting the right potential patients to find out about you consistently. Not episodically, not when you remember to post on Instagram, but through a repeatable system that generates new patient inquiries week after week. For most clinic owners, this means a combination of a clearly differentiated brand, a search presence for the specific procedures they do best, and a referral system built around their existing patient base and physician network. 

 Conversion means getting the patients who find you to choose you. This is where most clinics leave significant money on the table. A patient who finds your clinic and has a poor experience with the front desk, a confusing booking process, or a long wait for a consultation is a lost patient. 

 The difference between a clinic converting 10% of inquiries and one converting 50% is not clinical quality. It is communication, follow-up, and the experience a patient has before they ever meet the physician. 

Operations means delivering care at a level that makes patients come back, refer others, and leave reviews that bring more patients in. This is the flywheel. Strong operations turn each patient into a marketing asset, which means your marketing budget buys less of the growth over time because your patient base does more of the work for you. A practice built on these three foundations does not just command a better valuation when PE comes knocking. It generates more income, demands less of the owner personally, and provides more optionality across the board. The physician who built it can choose to sell at a meaningful multiple of EBITDA. They can choose to stay independent and continue collecting the income. They can choose to reduce their clinical hours without the practice collapsing. Every one of those options exists because the asset was built deliberately rather than left to develop on its own. 

 The physicians who feel most trapped by their clinics almost always built them around their own personal production. The ones who feel most free built something that can run and grow without requiring everything from them personally. 

 The PE firms know which kind of practice they are looking at within about thirty minutes of due diligence. So does the physician who owns it. Be Phenomenal, Dr. Vikram Raya

Michigan hospitals sue CVS for $95M over alleged drug savings scheme

Michigan hospitals say CVS improperly kept $95M in drug savings scheme

Michigan hospitals sue CVS for $95M over alleged drug savings scheme

The System is Undeniably Broken

 

‘The system is undeniably broken’:    

More insurers sue CMS over Medicare Advantage stars.   SCAN Health Plan and Alignment Healthcare both filed lawsuits against the CMS last week after regulators refused to recalculate industry-wide MA scores using the same methodology as for Clover Health.

Doctor pay to drop in 2027 under proposed Medicare pay rule Physician groups said the sweeping rule is a double-edged sword, given that it includes an unwelcome fee cut but positive changes to Medicare’s value-based and quality payment programs. Behind the Outcomes Advances in medicine have shifted oncology care beyond the traditional one-size-fits-all model of chemotherapy and radiation managed in the clinic. Patients are increasingly navigating more complex treatment regimens, often at home, while making care decisions outside of doctor visits. HHS watchdog says it’s targeting Medicaid, Medicare Advantage fraud

The HHS watchdog unit said it had kicked over 1,200 people and entities off federal programs as the Trump administration ratchets up oversight into what it says is rampant healthcare fraud.

Health systems charged for MyChart messages. The inbox kept growing anyway

When hospitals and health systems started charging patients for MyChart messages amid the pandemic, the reasoning was straightforward: Give clinicians a way to be compensated for the growing volume of medical advice flowing through patient portals, and perhaps slow that traffic down in the process.

Years later, health systems that adopted the practice say the second half of that bet hasn’t panned out — though nearly all say they’d do it again anyway.

Cleveland Clinic launched its MyChart Medical Management initiative in November 2022. Like most systems that bill for portal messages, it charges only for messages that require new medical evaluation or treatment decision-making, not for routine communications such as prescription refills or follow-up questions.

Message volume dipped the following month briefly, then resumed climbing: up 5% in 2023, 15.94% in 2024 and 18.56% in 2025, according to Sarah Hatchett, senior vice president and CIO.

“We are not changing patients’ behavior around messaging,” Ms. Hatchett said. “I think [the program] is valuable because it supports an alternative care pathway for patients while enabling providers to be reimbursed for care delivered through messaging.”

Houston Methodist has processed more than 53,000 billed messages since it began charging for certain portal communications in 2022. But the program was never designed as a standalone fix for inbox volume, said Aroub Khleif, PhD, senior director of innovation, access, billing and ambulatory clinical systems.

“We have not observed a significant change in overall message volume,” Dr. Khleif said. The benefit, she said, has been helping patients “better understand when portal messaging is appropriate and when a virtual or in-person visit may be the best option.”

At Winston-Salem, N.C.-based Novant Health, MyChart enrollment has grown 37% since the policy took effect, with overall messaging volume rising 5% year over year, according to a system spokesperson.

Seattle-based UW Medicine has seen a similar pattern. Crystal Wong, MD, a family medicine physician and associate medical director at UW Medicine Primary Care, said billing has not meaningfully changed inbox volumes, and the system hasn’t seen evidence that patients are rewording messages to avoid a charge.

The pattern lines up with limited published research on the subject. A study of San Francisco-based UCSF Health’s e-visit billing found only a 2% decline in average weekly messages after the system began charging in 2021. A separate study, also published in 2024, concluded that billing for portal messages has become more of an ongoing revenue stream for health systems than a tool for easing inbox burden.

Not every system that considered billing adopted it. Christopher Sharp, MD, chief medical information officer at Stanford Health Care in Palo Alto, Calif., said the system decided against charging for messages after watching how the policy played out elsewhere.

“We have been happy with this approach based on what we are seeing from others’ published experience to date,” Dr. Sharp said.

At Ann & Robert H. Lurie Children’s Hospital of Chicago, the goal was to create a clear pathway for clinical interactions that are better categorized as e-visits, alongside phone, video and in-person care. “As MyChart adoption has grown, messaging volume has continued to increase, so billing alone has not eliminated In Basket burden,” a Lurie Children’s spokesperson said.

None of the health systems that bill for messages reported an increase in patient complaints or help desk calls tied to the policy, and none said patients appeared to be rewording messages to avoid charges. Dr. Wong said UW Medicine would implement the policy again, though she said she would want more workflow readiness from ambulatory leadership before rolling it out a second time.

For Cleveland Clinic, the response to rising volume hasn’t been more billing. It’s been a separate set of inbox management projects, including improved message triage, prioritization tools and AI-drafted responses for clinicians to review. Ms. Hatchett said those efforts, not the billing policy itself, are where the health system expects its next real reduction in clinician burden.

The reason given for messaging is to increase patient access.  The actual fact is it is designed to decrease physician workload.  Messages actually increase physician loads because there is no decrease in their face-to-face patient encounters

Health systems charged for MyChart messages. The inbox kept growing anyway