Federal health officials are considering a proposal to pay for AI tools that provide diagnostic or clinical care at 60% to 80% of what clinicians receive for the same work, Medscape Medical News reported Sept. 24. The proposal has raised an array of concerns among clinicians, primarily over how it might increase healthcare costs while undermining physicians.
Policy experts are urging caution, warning the move could raise healthcare costs and leave physicians behind. “I’m hearing from much of the policy community that we need to be cautious,” Lee Fleisher, MD, former chief medical officer at CMS and CEO of Rubrum Advising, told Medscape. Dr. Fleisher added that CMS has given no sign it plans to pay extra for AI.
AI doesn’t fit Medicare’s pricing model, which is built on clinician time, said Ateev Mehrotra, a health policy researcher at Brown University School of Public Health in Providence, R.I. The tools cost a lot to build but almost nothing to run. Dr. Mehrotra pointed to Medicare’s roughly $900 payment for fractional flow reserve on cardiac CT, which has driven rapid uptake. He argues that most AI should be treated as a practice expense, like EHRs.
Ravi Parikh, MD, a medical oncologist at Emory University’s Winship Cancer Institute in Atlanta, proposes three payment buckets. Efficiency tools such as ambient scribes would be overhead. Decision-support AI would be folded into payment for the underlying service. Autonomous AI that replaces clinician work would get a separate, lower per-use payment.
Narges Sharif Razavian, MD, of NYU Langone Health in New York City said getting from FDA authorization to routine reimbursement can take seven to 10 years. Dr. Razavian supports paying for AI services directly.
Dr. Fleisher warned that adding AI to the budget-neutral physician fee schedule could lower physician pay. A CMS spokesperson said the agency had nothing more to share on future AI payment approaches.
The FDA has authorized more than 1,000 AI-enabled devices. Medicare pays for only a few AI services, including diabetic retinopathy screening and FFR-CT.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
