Recent advancements in medtech innovation should translate to a higher standard of care and improvements in patient healthcare outcomes. As medtech advances, so should public policy—especially Medicare reimbursement. Otherwise, many patients will lack access to scientific and medical breakthroughs, perpetuating inequities in access to care for underserved communities.
Take artificial intelligence (AI) enabled medical imaging devices, for example. These tools can improve clinical care and the operation of medical practices.
AI tools can enhance a radiologist’s ability to spot an abnormality on a scan that may have been overlooked, helping identify and target treatable cancers more easily and effectively.
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AI can also alert radiologists of a scan that requires immediate attention, bumping it to the front of the line. AI-powered medical imaging devices are enabling radiologists to perform their jobs more efficiently. These technologies can also use lower radiation doses, minimizing risk to a patient’s health and well-being.
AI-based medical technology is also helping improve physician efficiency and productivity. It reduces burdensome administrative tasks, allowing providers to focus more on patient care. This is helping to alleviate one of the root causes of physician burnout, which is particularly prevalent in underserved and often understaffed rural and urban communities.
To date, the Food and Drug Administration (FDA) has authorized the use of nearly 700 AI-enabled medical devices, with the majority of those used in radiology. While that should be a positive development for patient care, the Centers for Medicare and Medicaid Services (CMS) has approved fewer than ten AI-enabled medical device applications for reimbursement, with challenging pathways to payment for other new technologies. Complicated policies and limited reimbursement means physicians and hospitals will have challenges adopting and offering many of these revolutionary technologies.
With the use of AI in medical imaging and throughout the health care sector growing, the time to address how Medicare will pay physicians and hospitals who invest in groundbreaking technologies is now.
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The question of how these advanced technologies should be reimbursed has become an increasingly important one. If payers, led by Medicare, develop better mechanisms to reimburse providers for using AI-enabled technologies – which are improving patient outcomes and lowering costs – patients who cannot afford to pay higher out-of-pocket costs will receive the same access to innovative technologies as those who can. AI specific payment pathways and separate reimbursement for use of AI clinical tools by payers is most likely to ensure better access to care for all patients.
Just look at the rise in the use of telehealth after Medicare began reimbursing physicians for these services. Prior to the pandemic, physicians were not reimbursed for telehealth and were reluctant to embrace it. As the pandemic spread, the agency rightly recognized the benefits that these technologies provided and created more formal pathways to reimburse physicians. This has expanded access to care for patients – especially in medically underserved regions and for those facing health concerns that prevent them from visiting their doctor in person.
This same pattern would emerge if Medicare were to follow a similar model and establish a payment system that reimburses providers separately for the use of FDA-authorized AI clinical applications. That is why CMS—through its annual rulemaking process—should publish a formalized payment pathway for AI in FDA-regulated medical imaging devices in its 2025 Hospital Outpatient Prospective Payment Systems rule.
If Medicare acts, the potential of AI-enabled technologies to improve healthcare outcomes for patients, regardless of their geographic location or socioeconomic status, will be closer to being fully realized. Reimbursing physicians and providers for these increasingly vital services is the most straightforward and effective way that CMS can help ensure all patients have equal access to the clinical innovations that could help improve and save lives.
Photo: zimmytws, Getty Images
Dr. Julianne Malveaux is Dean of the College of Ethnic Studies at California State University, Los Angeles. She is an economist, author and commentator whose popular writings have appeared in USA Today, Black Issues in Higher Education, Ms.Magazine, Essence Magazine, The Progressive, among other publications.
Well-known for appearances on national network programs, including CNN, BET, PBS, NBC, ABC, Fox News, MSNBC, CNBC, C-SPAN and others; Malveaux is booked to offer commentary on subjects ranging from economics to women's rights and public policy. She has also hosted television and radio programs.
A committed activist and civic leader, Dr. Malveaux has held positions in women’s, civil rights, and policy organizations. Currently she serves on the boards of the Economic Policy Institute, The Recreation Wish List Committee of Washington, DC, and the Liberian Education Trust. Malveaux is also President of PUSH Excel, the educational branch of the Rainbow PUSH Coalition.
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