June 2022 / Vol. 27 No. 6
By Peter Weems, Director of Policy & Strategy, MITA
Artificial intelligence (AI) in medical imaging promises to provide substantial patient benefit by meeting the quadruple aim of improving population health, enhancing patient experiences, avoiding unnecessary costs, and improving the experiences of healthcare providers.
As with any new, emerging medical technology, determining how AI is valued and paid for is largely unexplored territory. Traditional Medicare reimbursement systems were not designed to adequately capture the costs of AI medical technologies, which disincentivizes innovation in AI, especially as the transition to value-based payments continues.
MITA supports the development of reimbursement policies by the Centers for Medicare & Medicaid Services (CMS) that appropriately capture the costs of AI-enabled medical devices to calculate annual Medicare reimbursement amounts. MITA stands ready to work with policymakers to create Medicare reimbursement policies that are transparent, predictable, and accountable, with consistent, clearly stated criteria for coverage of AI-based technologies and services.
Challenges to Adoption of AI
Current reimbursement policies that do not appropriately recognize the cost and value of AI innovations hinder innovation and adoption of medical imaging AI, as do fragmented and incomplete healthcare data sets combined with the need to access data across the Medicare population. The opportunities for using AI outweigh the obstacles, however.
Potential of AI-enabled Devices in Healthcare
Medical imaging AI can lead to improved diagnostic and treatment decisions based on algorithms that augment diagnostic data detection, characterization, and interpretation. AI also can lead to enhanced access to high-level care in traditionally underserved areas, like rural settings, and augmentation of physicians’ decision-making by reducing variability in diagnostic accuracy, performing mundane tasks, automatically annotating images, and automating operations such as patient positioning. Finally, using AI lowered the need for re-scans, optimized radiation dose, and reduced the time to diagnosis.
The Future of AI in Healthcare
AI will modernize U.S. healthcare at an exponential rate. Patients stand to benefit from these new and ongoing innovations. For providers and payers, both private and public, to reap the benefits of AI, a clear and consistent reimbursement structure is needed. The recent development of an AI CPT Taxonomy is the first step in appropriate valuation for these technologies.
Appropriate reimbursement pathways and access to good healthcare data will incentivize AI developers to develop safe, effective products that improve patient care and public health. ei