American College of Radiology urges HHS to address ‘unsustainable’ AI payment policy
The American College of Radiology and other healthcare advocacy groups are urging the Trump administration to address “unsustainable” payment policy relating to artificial intelligence.
ACR recently voiced its frustrations to Health and Human Services, sharing suggestions for how the agency could spur greater use of this technology. Its comments came in response to a December HHS request for comment on how the feds can accelerate adoption of AI in clinical care.
The college believes “unsustainable” payment is one of the biggest barriers to private sector AI innovation.
“Without a payment structure that recognizes this work, clinicians have limited incentives to use AI tools, and health systems face a financial disincentive to adopt innovations that could otherwise improve care delivery,” ACR CEO Dana Smetherman, MD, MBA, wrote to the agency on Feb. 19. “A payment policy that ties reimbursement for AI-enabled services to demonstrated improvements in quality, efficiency or clinical outcomes would more effectively incentivize best practices.”
Smetherman highlighted other key barriers to AI adoption. These include the lack of AI model transparency, interoperability problems and security-compliance uncertainty. On the reimbursement front, one of the central issues is determining how these technologies should be incorporated into the Medicare Physician Fee Schedule, she noted. AI applications span a wide range of clinical workflows, modalities and anatomical regions.
As a result, creating distinct CPT codes for each AI solution risks “substantial fragmentation of the existing imaging code set.”
“This fragmentation could undermine coding consistency, complicate billing and create administrative burden for providers and payers,” Smetherman wrote.
One alternative approach could potentially involve aligning AI payment with the measurable value this technology contributes to clinical care. While many have assumed AI would reduce radiologists’ workloads, “the current reality is quite different.” Instead rads must spend added time reviewing, validating and interpreting AI outputs.
“Radiologists continue to adopt AI because of its strong long-term value proposition, but the short-term effect is often an increase, not a decrease, in cognitive and workflow demands,” Smetherman added.
You can read the full letter from ACR here. The Medical Group Management Association also weighed in on the request for information in its own letter, shared online Feb. 23. MGMA—which represents 15,000 group practices employing 350,000 physicians in radiology and other specialties—also cited payment policy as a potential lever for AI adoption.
HHS plans to use the feedback to support future department actions, ACR noted in a news update posted Thursday.
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.