Congress should relax budget neutrality to pay for imaging AI, industry lobbying group urges

Congress should consider relaxing Medicare’s budget-neutrality requirements to help pay for imaging artificial intelligence, a key industry lobbying group urged Tuesday. 

AdvaMed made the suggestion in its new “AI Policy Roadmap,” offering a blueprint for lawmakers and federal agencies to propel greater use of these technologies. The U.S. Food and Drug Administration already has authorized over 1,000 AI-enabled devices in the last 25 years, ranging from imaging analysis tools to cardiac monitors. 

However, most lack a clear payment pathway in Medicare, excluding America’s seniors from breakthroughs in radiology and other specialties. 

“Appropriate reimbursement for the adoption and use of AI-enabled devices is critical to ensuring patients have timely access to and benefit from these innovations,” AdvaMed—which represents over 50 imaging manufacturers including Bayer, Canon, GE HealthCare, Philips and Siemens Healthineers—said in the 19-page report. “As the nation’s largest payer of healthcare, Medicare’s policies on coverage and payment for AI technologies are especially critical, applying to the millions-strong Medicare population, and because private payers and state Medicaid plans often look to Medicare as they establish their own coverage policies.”

AdvaMed emphasized there is no one-size-fits-all solution to solve the AI pay conundrum and spur greater use of this technology. However, it offered a list of five policy recommendations to address AI reimbursement and coverage issues. These include considering “legislative solutions to address the impact of budget neutrality constraints on the coverage and adoption of AI technologies.” Currently, spending increases in the Medicare Physician Fee Schedule necessitate cuts elsewhere.  

This has resulted in radiologists and other physicians facing annual reimbursement cuts.

“These requirements and others like it have a significant impact on Medicare’s ability to expand coverage for and support the adoption of new technologies including AI … because the funding for these expansions comes at the cost of other services under the same payment system,” AdvaMed noted. “We urge Congress to consider legislative solutions to address the impact of budget neutrality constraints on the coverage and adoption of AI technologies.”

Other pay-related recommendations include testing the ability of AI technologies to improve patient care and lower costs, along with developing a formalized pathway for algorithm-based healthcare services. You can find report here and a summary for the news media here.

“The continued support of Congress and the administration will be important in creating policies necessary to help further ensure as many patients as possible have access to AI-enabled innovations to speed diagnosis, promote the right treatment, and increase access to high-quality and affordable care,” Taha Kass-Hout, MD, MS, global chief science and technology officer, GE HealthCare, and chair of AdvaMed’s digital health tech division board, said in a statement.