Artificial Intelligence Implemented for Pre-Authorization of Medical Procedures under Medicare Experiment
The Centers for Medicare and Medicaid Services (CMS) has announced the expansion of a new pilot program aimed at reducing unnecessary costs in Medicare. The program, which currently applies only to traditional Medicare, will start in Ohio, Oklahoma, Arizona, New Jersey, Texas, and Washington next year, and will also be extended to California and Florida.
The goal of the program is to require prior authorization for certain medical procedures, including steroid injections, spine surgeries, and skin substitutes. In addition, treatments that will be reviewed by private AI firms for coverage decisions will also face the extra prior authorization step.
The expansion of the program to include private AI firms for case reviews is part of CMS's efforts to streamline the process and make more informed decisions about coverage. The government estimates that these treatments could cost billions in unnecessary taxpayer dollars each year.
However, concerns about potential inappropriate denials due to the use of AI firms have been raised by experts. The private AI companies involved in the CMS pilot program for decision-making on canceling or not canceling medical services have not been explicitly named in the available search results. Companies engaged in AI medical projects mentioned include MediTECH Electronic GmbH, cibX GmbH, and institutions like the Czech Technical University within the AIMECA network, which is involved in AI-supported medical services, but their direct involvement in CMS's pilot is not specified.
The program will now cover treatments in California and Florida, potentially affecting a larger number of Medicare beneficiaries. It's important to note that the program will continue to apply only to traditional Medicare.
As the program expands, it will be interesting to see how the use of AI firms for coverage decisions impacts the cost and quality of care for Medicare beneficiaries. The goal is to reduce unnecessary costs while ensuring that patients receive the care they need. Only time will tell if the program is successful in achieving this balance.
