Lack of reimbursement hindering AI adoption, American College of Radiology warns Congress

Lack of reimbursement may be hindering the adoption of artificial intelligence, the American College of Radiology warned Congress on Monday.

Physician and Rep. Ami Bera, MD, D-Calif., recently issued a request for information on the current state of AI in medicine. ACR was among those responding this week, noting that radiology has been “the vanguard for AI innovation and regulation within the healthcare sector.”

However, the college is concerned that challenges in paying for imaging AI may be preventing more widespread adoption. Figuring out how to reimburse for AI is likely to be a “complex policy challenge,” CEO William T. Thorwarth Jr., MD, wrote May 6.

“Appropriate and predictable reimbursement for AI is necessary to prevent a two-tier system of care where some patients will have access to AI as part of their care and others will not,” he wrote to Rep. Bera, who is a member of the Bipartisan House Task Force on AI. “To avoid wasteful spending, reimbursement must be based on whether the AI tool adds value to patients and the health system and whether it is safe, effective and trustworthy for widespread clinical use.”

The Centers for Medicare & Medicaid Services already has a physician-led mechanism for determining if a new service or device provides value. ACR emphasized that “physician leadership must continue in any future AI reimbursement paradigm.” Possible parameters to consider such value could include whether the FDA has cleared the AI product, the college noted.

Establishing CPT or other codes for every AI tool or use case is “problematic and likely infeasible,” due to the sheer volume of products. Plus, coding systems do not have pathways for creating procedure codes for services that are already performed by physicians.

“Consequently, AI that perform tasks physicians are often unable to perform during routine workflows, such as advanced quantitative functions, have fared better with the establishment of Category III CPT codes and a few Category I codes,” Thorwarth wrote, adding that CMS has provided reimbursement for some of the latter.

As far as specific legislative measures Congress can take to ensure access to healthcare AI, ACR has two suggestions. The federal government could expand the FDA’s authority beyond medical devices to “comprehensively encompass” all healthcare AI. “Voluntary health IT certification and/or optional standards do not adequately substitute for FDA oversight,” ACR said. And secondly, the feds could create payment policy incentives in CMS to promote more widespread clinical use.

“Quality and value-based reimbursement policy should focus on providing end-users with incentives designed to increase the adoption of clinical AI devices that are safe and effective for use by qualified end-users, in AI accredited healthcare facilities, with appropriate privacy-security safeguards and governance practices,” Thorwarth wrote. “The ACR is currently a CMS-designated accreditation organization of advanced diagnostic imaging suppliers and could similarly perform accreditation of safe and effective use of AI to enable value-based reimbursement.”

You can read the full letter to Rep. Bera here. The American Hospital Association also issued its own response to the request for information on Monday.

Marty Stempniak

Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic. 

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