Trump’s Health IT Rollback Opens Door for Smart Tech Investment—If You Know Where to Look

Primary Care Perspective - Texas Edition | Friday, January 2, 2026

Source: Rebecca Pifer | Category: AI & Technology

Trump’s Health IT Rollback Opens Door for Smart Tech Investment—If You Know Where to Look

The Hook

The Trump administration just proposed gutting nearly 70% of federal health IT certification requirements, including Biden-era AI transparency rules that would have forced vendors to disclose how their clinical algorithms actually work. For Texas independent practices navigating the AI adoption curve, this deregulation cuts both ways: lower barriers to entry for innovative tools, but zero federal guardrails protecting you from snake oil salesmen.

Analysis

The two proposed rules from HHS’s Office of the National Coordinator represent a dramatic pivot from “trust but verify” to “buyer beware” in health IT. The elimination of “model card” requirements—documentation showing how AI diagnostic and treatment tools are developed and tested—means vendors can now market clinical AI without proving algorithmic accuracy or revealing potential bias in their training data.

For Texas practices, this matters immediately. You’re already seeing AI pitch decks weekly: ambient documentation tools, prior authorization automation, clinical decision support for chronic disease management. The Medicare population in Texas is projected to grow 42% by 2030, and these tools promise to help you serve more complex patients without adding staff. But without federal transparency standards, you’re flying blind on what’s legitimate innovation versus expensive vaporware.

The simultaneous rollback of interoperability requirements for public health data exchange is equally significant. Texas has invested heavily in regional health information exchanges, particularly in underserved areas. Weaker federal data-sharing standards could fragment these networks right when value-based contracts demand robust population health data. If your ACO or direct primary care model relies on aggregated community health intelligence, you may find data partners pulling back from voluntary sharing without federal mandates.

The deregulation playbook claims to reduce costs for health IT developers, theoretically passing savings to practices. Reality check: enterprise EHR vendors aren’t dropping prices. What this does create is opportunity for nimble, Texas-based health tech startups to enter the market faster—some will be game-changers, others will burn your implementation budget.

The TMA hasn’t issued formal guidance yet, but the smart money says they’ll push for state-level consumer protections if federal guardrails disappear. Texas practices that anchor to TMA’s eventual recommendations while carefully piloting new technologies will thread this needle best.

Key Takeaways

• Demand your own due diligence: Without federal AI transparency requirements, insist vendors provide internal validation data, peer-reviewed studies, and pilot results from similar-sized Texas practices before signing contracts.
• Lock in interoperability commitments contractually: If you participate in HIEs or value-based arrangements, ensure data-sharing obligations are in vendor contracts, not just assumed through federal compliance.
• Budget for parallel validation: Plan to run new AI tools alongside existing workflows for 60-90 days with measurable outcomes before full deployment—the safety net of federal vetting is gone.
• Watch for Texas-specific regulations: The state may step in with AI and data-sharing rules if federal void persists; early compliance will be cheaper than retrofit.
• Opportunity window for early adopters: Faster health IT innovation cycles mean competitive advantages for practices that can evaluate and deploy tools quickly—but only with rigorous internal vetting.

What Smart Practices Are Doing

Forward-thinking Texas independents are forming informal peer networks to share vendor evaluations and pilot results, essentially crowd-sourcing the transparency that federal model cards would have provided. They’re also adding “regulatory risk” clauses to health IT contracts that allow renegotiation if state-level requirements emerge.

Original Source: Trump administration nixes Biden-era health IT policies, including AI ‘model cards’

© 2025 Primary Care’s Perspective | Texas Edition

RPM Reimbursement Expands in 2026: New Revenue Stream or Margin Trap for Texas Independents?

Primary Care Perspective - Texas Edition | Friday, January 2, 2026

Source: Unknown | Category: Insurance & Medicare

RPM Reimbursement Expands in 2026: New Revenue Stream or Margin Trap for Texas Independents?

The Hook

Remote Patient Monitoring (RPM) is getting a major policy overhaul in 2026, with CMS expanding reimbursable conditions far beyond the traditional diabetes and hypertension playbook. For Texas independent practices managing large Medicare populations—especially in rural counties where specialists are hours away—this could represent either a significant new revenue channel or an administrative burden that benefits only larger health systems with infrastructure already in place.

Analysis

The shift toward broader RPM coverage comes at a critical inflection point for Texas primary care. With Medicare Advantage penetration hitting 54% of Texas Medicare beneficiaries in 2025, and value-based care arrangements increasingly tied to quality metrics rather than volume, RPM is transitioning from experimental to essential infrastructure.

The conditions now eligible for RPM reimbursement read like a typical independent practice’s daily schedule: pregnancy complications, heart failure, obesity-related cardiometabolic conditions, and hypertension management. For Texas practices—particularly those serving rural populations that overindex for chronic conditions and face significant food desert challenges—this expansion could unlock meaningful per-patient-per-month revenue while improving outcomes that MA plans are increasingly willing to reward.

But here’s the margin trap: implementation costs are real. Device procurement, patient onboarding, staff training for data interpretation, and the technology infrastructure to actually turn transmitted data into clinical action all require upfront investment. Private equity-backed groups and hospital-employed models are already building these capabilities at scale. Independent practices that wait risk falling behind on quality benchmarks that increasingly determine bonus payments and contract renewals with major payers like Blue Cross Blue Shield of Texas and UnitedHealthcare.

The Texas geography makes this particularly urgent. A practice in the Rio Grande Valley managing diabetic patients three hours from the nearest endocrinologist has fundamentally different RPM economics than a Houston suburban practice. Rural Texas practices that master RPM can differentiate against encroaching telehealth competitors and PE-backed urgent care chains by offering genuine longitudinal relationship-based care enhanced by technology—not replaced by it.

The food-as-medicine integration mentioned in recent RPM pilots represents where this is heading: not just monitoring numbers, but coordinating social determinants interventions that MA plans will pay for because they reduce total cost of care. Texas practices positioned to integrate RPM with community health worker programs or partnerships with regional food banks could capture emerging value-based bundles that reward true population health management.

Key Takeaways

• CMS expanded RPM-eligible conditions in 2026 beyond diabetes/hypertension to pregnancy, heart failure, obesity-related conditions—conditions your existing patient panel already has
• Rural Texas practices gain competitive advantage: RPM becomes specialist-access equalizer in counties where cardiology or endocrinology requires 90+ minute drives
• Revenue unlock requires infrastructure investment NOW: Waiting means falling behind on MA quality scores that determine 2027 contract rates
• Integration opportunities with social determinants programs (food-as-medicine, etc.) position practices for emerging value-based bundles
• Risk for non-adopters: PE-backed competitors and hospital systems are already scaling RPM, creating quality metric gaps that threaten independent practice contract leverage

What Smart Practices Are Doing

Forward-looking Texas independents are piloting RPM with their highest-risk Medicare patients first—identifying which vendor platforms integrate with their existing EHR and which staff members can absorb data review workflows without requiring new FTEs. They’re also proactively contacting their largest MA payers to understand which RPM programs qualify for enhanced capitation rates or shared savings arrangements in 2026 contracts.

Original Source: RPM in 2026: What conditions to treat? Many, many of them

© 2025 Primary Care’s Perspective | Texas Edition

Texas Medicaid ABA Cuts Could Be Next: How Independent Practices Can Protect Autism Care Revenue

Primary Care Perspective - Texas Edition | Friday, January 2, 2026

Source: Bram Sable-Smith and Andrew Jones | Category: Insurance & Medicare

Texas Medicaid ABA Cuts Could Be Next: How Independent Practices Can Protect Autism Care Revenue

The Hook

States are slashing Medicaid reimbursements for autism therapy by up to 50%, with North Carolina, Nebraska, Colorado, and Indiana leading the charge as spending on applied behavior analysis (ABA) explodes nationwide. While Texas hasn’t announced cuts yet, the writing is on the wall: North Carolina saw a 423% increase in ABA spending over four years, and Texas—with its larger Medicaid population and autism prevalence—is almost certainly facing similar budget pressures. Independent practices offering or coordinating pediatric behavioral health services need to prepare now before reimbursement cuts hit your bottom line.

Analysis

Applied behavior analysis has become the gold standard for autism treatment, and the numbers tell a compelling story about market growth. Nebraska experienced a 1,700% jump in ABA spending; Indiana saw 2,800%. This explosive growth stems from increased autism awareness, earlier diagnosis, and state mandates requiring coverage—creating a perfect storm of demand meeting mandatory payment obligations.

For Texas independent practices, this presents both opportunity and risk. The Lone Star State has one of the nation’s largest Medicaid programs, covering approximately 5.5 million children. With autism prevalence now at 1 in 36 children according to CDC data, that’s a substantial patient population requiring intensive services—often 10 to 40 hours per week at premium reimbursement rates.

But here’s the reality check: When state Medicaid spending on a single service category increases 400-2,800% in just a few years, budget cuts are inevitable. The Texas Legislature meets biennially, and with the next session’s budget discussions already underway, independent practices need to anticipate how potential ABA reimbursement cuts could cascade through your pediatric service lines.

Smart independent practices understand that pediatric behavioral health isn’t just about direct ABA provision—it’s about care coordination, referral relationships, and comprehensive child development services. If you’re currently referring to ABA providers or offering complementary services, those referral partners may soon face financial pressure that disrupts continuity of care for your patients.

The broader lesson extends beyond autism care: When Medicaid spending on specialized services surges, state officials respond with blunt budget instruments. Whether it’s ABA today or diabetes management programs tomorrow, Texas independent practices must build financial resilience against sudden reimbursement changes. This means diversifying revenue streams, strengthening commercial payer relationships, and potentially exploring value-based arrangements that reward outcomes rather than volume.

Consider also the competitive landscape. Private equity-backed pediatric groups and hospital systems can absorb short-term reimbursement cuts through economies of scale. Independent practices don’t have that luxury—but you do have agility to pivot service lines and deepen patient relationships that larger organizations can’t match.

Key Takeaways

• Monitor TMA and state Medicaid communications closely: Texas hasn’t announced ABA cuts yet, but with similar spending growth patterns, changes are likely coming in the 2025-2026 legislative cycle
• Audit your pediatric revenue exposure now: If more than 15% of your practice revenue comes from Medicaid-reimbursed behavioral health services or ABA referral coordination, develop contingency plans for 20-30% reimbursement reductions
• Strengthen commercial payer relationships for pediatric services: Families desperate for autism care will seek practices that can navigate multiple insurance options—become the practice that accepts diverse payers beyond Medicaid
• Document medical necessity rigorously: When cuts come, practices with bulletproof documentation showing patient outcomes and medical necessity will have the strongest position to appeal denials or advocate for exceptions
• Consider care coordination as a defensible service line: Even if direct ABA reimbursement drops, independent practices that excel at coordinating complex pediatric care create sticky patient relationships and potential quality bonus revenue

What Smart Practices Are Doing

Forward-thinking Texas pediatric practices are already stress-testing their Medicaid revenue concentration and building relationships with commercial ABA providers who accept multiple insurance types. They’re also documenting patient outcomes more carefully than ever—creating the evidence base they’ll need if they must justify medical necessity under tightened state guidelines.

Original Source: It’s the ‘Gold Standard’ in Autism Care. Why Are States Reining It In?

© 2025 Primary Care’s Perspective | Texas Edition

Rural Primary Care Deserts Are Creating a $2B Opportunity for Texas Independents Who Can Bridge the Gap

Primary Care Perspective - Texas Edition | Friday, January 2, 2026

Source: Unknown | Category: Primary Care

Rural Primary Care Deserts Are Creating a $2B Opportunity for Texas Independents Who Can Bridge the Gap

The Hook

While healthcare officials tout the importance of rural primary care access, the real story is the massive market inefficiency creating unprecedented leverage for independent practices willing to serve underserved communities. With 159 of Texas’s 254 counties designated as primary care Health Professional Shortage Areas, the supply-demand imbalance isn’t just a policy problem—it’s a strategic growth opportunity for practices that can deliver accessible, relationship-based care where specialists won’t venture.

Analysis

Texas sits at the epicenter of a rural healthcare crisis that independent primary care physicians are uniquely positioned to capitalize on. The recent emphasis on primary care’s preventive role in rural areas isn’t new information—it’s a tacit admission that the current healthcare system is failing to deliver where it’s needed most.

Here’s what the rhetoric actually reveals: Payers, hospital systems, and government programs are increasingly desperate for primary care solutions in rural Texas. This desperation translates to negotiating power. Independent practices that can demonstrate outcomes in medically underserved areas are commanding premium reimbursement rates in value-based arrangements and gaining leverage in payer contract negotiations that urban-saturated markets simply cannot access.

The math is compelling. Rural Texans have higher rates of chronic conditions, less specialty care access, and rely almost exclusively on primary care for health management. This creates the perfect environment for capitated arrangements and shared savings models where strong primary care actually drives disproportionate value. While private equity-backed groups chase dense urban markets with razor-thin margins, rural and semi-rural markets offer better payer mix ratios and patient populations genuinely seeking long-term care relationships.

Texas-specific dynamics amplify this opportunity. The state’s Medicaid managed care expansion and Medicare Advantage penetration growth (now exceeding 54% of eligible Texans) mean rural beneficiaries are increasingly covered under plans that reward longitudinal primary care relationships and preventive management. The Texas Medical Association’s ongoing advocacy for scope-of-practice protections also ensures that physicians—not mid-level providers operating independently—remain the gold standard for comprehensive primary care.

The practices winning in this environment aren’t waiting for patients to find them. They’re establishing telehealth-hybrid models that extend their reach into adjacent rural counties, partnering directly with rural employers for direct primary care arrangements, and positioning themselves as the essential access point that keeps rural Texans out of expensive tertiary care systems three hours away.

Key Takeaways

• Rural markets offer 20-30% better contract leverage: Payers need rural access and will pay premiums for practices demonstrating outcomes in shortage areas—use this as ammunition in your next contract negotiation
• Value-based care models work better in rural settings: Less specialist competition, stronger patient relationships, and higher-risk populations create ideal conditions for shared savings and capitation success
• Telehealth regulations now favor expansion: Post-pandemic flexibilities allow Texas practices to extend virtual services across county lines, multiplying your addressable market without physical expansion costs
• Rural employers are direct contracting targets: Companies struggling to offer meaningful benefits in areas with limited provider access will pay directly for guaranteed primary care access for their workforce
• The consolidation wave hasn’t reached rural Texas: While PE-backed groups dominate urban markets, independent practices still control rural access—maintain this advantage before regional systems fill the void

What Smart Practices Are Doing

Forward-thinking independent practices are conducting market analyses of adjacent rural counties within 45-minute drive times, evaluating telehealth extension opportunities, and proactively approaching regional Medicare Advantage plans with rural access solutions before RFPs go out. They’re positioning themselves as the essential infrastructure that payers and health systems cannot replicate quickly—and capturing premium economics as a result.

Original Source: Healthcare Officials Stress the Importance of Primary Care in Rural Areas

© 2025 Primary Care’s Perspective | Texas Edition