Health systems are under increasing pressure to embrace new artificial intelligence tools without a formal system for evaluating how well they work.

Why it matters: Even AI developers can struggle to explain why a model makes a particular prediction or recommendation. That has huge implications in clinical settings, where algorithm errors or bias can result in patient harm.

Driving the news: The Coalition for Health AI — made up of more than 3,000 health systems, tech companies and patient advocates — is creating a network of "assurance labs" with the talent and bandwidth to validate systems and evaluate ongoing performance.

• The idea is to create an ecosystem of labs that are trustworthy and "don't have commercial entanglements with the vendor that they're validating the model for," CEO and co-founder Brian Anderson told Axios.
• One goal is to ensure the technology is tested on data representative of a range of patients in a particular region.

Between the lines: While health systems generally rely on the FDA to vet the tools they use, AI algorithms present different challenges because they change over time, and because the data they ingest can be highly variable.

• That presents a unique challenge for regulators, hospitals and clinics.
• An algorithm trained with data from patients in Boston may not work when applied to patients at a hospital in Santa Fe, New Mexico.
• "If you want to know your AI is actually doing what you thought it was doing, you actually need to validate it in the situation in which it's being used," FDA commissioner Robert Califf said recently speaking at the HLTH conference in Las Vegas.
• In an article last month in JAMA Network, Califf and co-authors wrote about the need for ongoing post-market monitoring of AI to prevent algorithm failure and bias.

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Doctors will face another year of pay cuts from Medicare in 2025 under a rule finalized by the Biden administration on Friday, unless Congress steps in again to avert the decrease.

The big picture: The 2.9% decrease in average payment rates brought swift condemnation from provider groups, who said it could jeopardize patient care, especially in underserved and rural areas.

• Medicare law prevents the program from making annual inflation adjustments to doctor payments like it does for hospitals, nursing homes and other providers.

State of play: Physician operating costs will increase an estimated 3.5% in 2025, the rule stated.

• Lawmakers in Congress have already introduced a bill that would avert the cut and give doctors a partial inflationary boost of 1.8%.
• Congress is expected to address the issue in a post-election session, with a temporary "doc fix" to keep at least some portion of the cuts from taking effect.

Meanwhile, hospital outpatient departments will see a 2.9% increase in Medicare reimbursement next year, the administration announced on Friday, amounting to an extra $2.2 billion for the industry.

• Home health providers' Medicare payment will increase by 0.5%, or $85 million, compared with this year.
• Home health lobbyists said the final policy makes it difficult for agencies to keep up with rising costs, and urged Congress to fix their Medicare payment system as well.

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Fewer than 1 in 6 health care workers in hospitals and nursing homes reported getting COVID-19 boosters during the 2023-2024 respiratory virus season, a CDC study found.

The big picture: The drop-off followed the expiration of a Biden administration vaccine mandate for health workers in June 2023 and the end of free access to government-funded COVID shots.

• But health workers in a recent survey also expressed low confidence in the effectiveness, safety and benefit of COVID-19 vaccines, though many still believe the virus is a serious health threat.

By the numbers: The CDC study found 15.3% of workers in 4,112 acute care hospitals got boosted in 2023-2024, with rates lowest among licensed independent practitioners.

• Vaccination coverage was 10.5% overall among workers in more than 14,000 nursing homes.
• Flu vaccination rates for the same period were 80.7% at acute care hospitals and 45.4% at nursing homes.

Go deeper: With immunity from prior vaccinations or infections waning, public health officials say it's important for health workers to stay current on the shots, to avoid getting sick and to reduce the risk of exposing patients to preventable diseases.

• But skepticism about the shots is widespread, with vaccine coverage typically higher in urban areas than in rural areas and lower in the South.

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Almost 200 countries at a UN biodiversity conference in Colombia agreed on a system for distributing proceeds from products derived from genetic information into a global conservation fund.

Why it matters: Countries are seeking fair compensation for their resources, which they could restrict access to without a system for sharing the billions of dollars and other benefits from using genetic sequences to make drugs, cosmetics and agricultural products.

Driving the news: The benefit-sharing plan hammered out at the Convention on Biological Diversity and finalized last weekend is voluntary and states that "large companies and other major entities benefiting commercially" from genetic sequencing information stored in databases "should contribute" to the fund.

• Companies should pay 1% of their profits or 0.1% of their revenue, according to the agreement.
• Academic, public research institutions and other entities that use genetic sequence information but don't directly benefit from it financially are exempt.
• Half of the funds are expected to support Indigenous people and local communities.
• 196 nations were represented at the talks in Cali.

What they're saying: The International Federation of Pharmaceutical Manufacturers and Associations on Saturday said the decision "does not get the balance right between the intended benefits of such a mechanism and the significant costs to society and science that it has the potential to create."

• But there's still concern among some that the plan doesn't do enough to discourage companies from shortchanging lower-income countries.

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Global supply chain issues are 40% less likely to result in a meaningful drug shortage in Canada compared with the U.S., according to findings in JAMA Network.

Why it matters: Shortages are occurring more often and can be incredibly disruptive to U.S. health care, as most recently demonstrated by the IV fluid shortage.

• The study indicates there's more that the U.S. could be doing now to alleviate some of the pain.

What they found: University of Toronto and University of Pittsburgh researchers looked at drug-related reports of supply chain issues from 2017 to 2021 that occurred in both Canada and the U.S. around the same time.

• Among the 104 reports seen in both countries, 49% were associated with drug shortages in the U.S. versus 34% in Canada.
• Canada has created more of a structure that brings health systems, payers, manufacturers and regulators together to better coordinate a proactive response, lead author Mina Tadrous told Axios.
• That could include more quickly reducing the amount of a drug they're using in certain populations, curtailing off-label use, or importing drugs from abroad, he said.

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🤖 From AI programs to Elon Musk's brain implants, the FDA's medical device unit is facing rapid change at a critical time. (NYT)

🥼 Young doctors want work-life balance. Older doctors say long hours and punishing schedules are part of the job. (WSJ)

📂 One of the biggest providers of health care services to prisons is preparing to file for bankruptcy. (Bloomberg News)

🐶 Private equity firm Shore Capital Partners is in talks to combine two veterinary groups through an $8.6 billion deal. (Reuters)