The boys in DC have selected NJ as one of six states to trial an AI based pre-approval for Medicare payments. They plan to use AI companies. The NYT states:
The A.I. companies selected to oversee the program would have a strong financial incentive to deny claims. Medicare plans to pay them a share of the savings generated from rejections. The government said the A.I. screening tool would focus narrowly on about a dozen procedures, which it has determined to be costly and of little to no benefit to patients. Those procedures include devices for incontinence control, cervical fusion, certain steroid injections for pain management, select nerve stimulators and the diagnosis and treatment of impotence. Abe Sutton, the director of the Center for Medicare and Medicaid Innovation, said that the government would not review emergency services or hospital stays.
Specifically they intend to review:
Facet joint procedures for back pain
Nerve and muscle tests (electrodiagnostic testing)
TENS units and similar electrical stimulation devices
Hyperbaric oxygen therapy
Spinal cord stimulators
Deep brain stimulation (commonly for Parkinson’s)
Sacral neuromodulation (for urinary conditions)
Transcatheter aortic valve replacement (TAVR)
Arthroscopic knee cleaning or debridement
Vertebroplasty/kyphoplasty for spine fractures
Epidural steroid injections
Non-emergency ambulance transport
Botox injections for medical issues
Negative pressure wound therapy pumps
Hernia repairs
Lumbar spinal fusion
Skin graft substitutes for chronic wounds
As my readers know I am a doubter in AI at this stage. Thus the application to millions of Medicare recipients is in my opinion grossly negligent. One should try at a lower level, not 15% of the US as a first bite. This is similar to the massive COVID vaccine program, just failing to test and just dumping on hundreds of millions.
One must ask who these "AI" companies are. What are their bona fides? Since we have no definition of what AI is it is likely that they will just be some friendly folks with the current Administration. We should know these companies in detail. What is their technology, what is the basis for their decisions, what have they accomplished before? One suspects this will all be hidden behind some curtain of proprietary nonsense.
The test should be small, transparent and Congress should have a say as well as the Medicare recipients.
But alas, no one in DC gives a phenning!
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