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Practical Considerations of AI: Part 7 – Economics
I got an e-mail from one of the AI vendors asking me Isnt it unprecedented to reimburse for a specific vendors algorithm? Unprecedented? The amount of phone calls and emails I have gotten on Part 7 certainly has been unprecedented for sure. And since no vendor has ever gotten reimbursement before, to that end reimbursement for a specific vendors algorithm can be considered unprecedented. I think the bigger question being asked is why only one vendors algorithm and not all the 510-k approved stroke protocol algorithms that available out there? Im not asking why just happy even one got approved. .
When my kids were young they would ask me why my oldest son got something the youngest didnt (or vice versa). I would play with their heads a bit and tell them its because “I like your brother better, thats why”but then I realized if one of them grew up a serial killer because of own stupdiity that would not be cool so I stopped doing that after just a few times. I cant answer why one vendor is approved and not another but Im sure the answer is much better than I like them better….
Keep in mind this is an add on payment that only deals with inpatients on Medicare so it the end add on payment is limited in who gets it. It’s also not a CPT code (that remains a ways out yet) but at least it’s s start .and the beleaguered and developing Ai industry will take whatever it can get.
Want to learn more? Hear what AI vendors are doing right, doing wrong, market dynamics and more in The Challenge of Integrating Enterprise Imaging with AI webinar this Weds 9/23 at 10 a.m. The event is FREE. To register:
[link=https://www.auntminnie.com/index.aspx?sec=vendor&sub=webinars&pag=dis&itemId=129943]https://www.auntminnie.com/index.aspx?sec=vendor&sub=webinars&pag=dis&itemId=129943[/link]
Mike Cannavo
PACSMan
(407) 359-0191 (Office)
(407) 247-7345 (cell)
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3 Replies
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Mike, you said:
[blockquote] In the AI market, nobody will show up to buy the software unless they know about the technology and why they should buy it. So market education is a must to overcome the plethora of mistakes that have already been made in the radiology AI sector.
[/blockquote] Are we sure about that? Look at the hundreds of millions of bucks thrown at Nanox, which appears to be less than kosher so far…
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Ah yes Nanox….Thernos 2.0….
There have been hundreds of millions of dollars thrown at AI as well- but dispersed among numerous companies…but at least we are seeing SOME products developed even though no one may know about it yet….Maybe that should have read ” NO REASONABLE (OR EDUCATED) PERSON” INSTEAD.
Don’t even get me started on VC’s. The editors at AM kept me from getting shot by editing out some choice observations I made about the VC’s. Let it suffice to say they really do need some fresh eyes looking at the investments they make both before and after with someone constantly providing input as to how the VC money is being spent… not blind trust or listening just to the advisory board.
I love the comment made by one VC “about how exciting it is supporting a company that improves patient care and saves lives on a daily basis. Pulease…..Ever seen Shark Tank? Jerry McGuire? Yes, it’s great that we can help patients but most VC’s I know resonate Rod Tidwell having his “chat” with Jerry McGuire.
[b][i] “I wanna make sure you’re ready, brother. Here it is: Show me the money. Oh-ho-ho! SHOW! ME! THE! MONEY! A-ha-ha! Jerry, doesn’t it make you feel good just to say that! Say it with me one time, Jerry.”[/i][/b]
Show me the money….
In light on the Nanox’s of the world, AI needs to be like Hebrew National- they, too, need to answer to a higher authority…
PACSMan-
An astute radiologist who heavily involved in the AI industry and is up to date on the CMS action relating to payments for using the viz-ais stroke algorithm, protocol provided me with some excellent information that bears sharing with AM readers.:
1) The Viz.AI payment announcement technically is not a ‘real reimbursement but an add on payment. I clarified this point already but it bears repeating. Whatever you call it the NTAP program is still a positive step in the right direction,
2) CMS has said they will provide reimbursement ONLY for the following narrow group of patients:
1. Medicare patients (approx 50-70% of stroke work ups)
2. Code stroke patients that had a CTA (angiogram) and
the Viz.ai software was used to determine if a stroke
occurred or not. No clarification was made if a CTA
was done and a stroke not found. I assume you would
get the add on payment either way.)
3. Patients that showed a financial loss compared to the
DRG that was billed (approx 50%).will get this
payment. Specifically, 65% of any loss will get
reimbursed up to $1040 per patient. What this basically
says is CMS will only provide a payment for patients
where there was a financial loss and only up to a max
amount. In fact, the program is more about CMS re-
adjusting their DRG payments year-to-year. They will
then look at this payment each year for 3 years (and
each year it can be changed from $1040). After that it
is anyone’ guess as to what will happen to this
payment. The idea is that , based on the data, CMS
would just adjust the stroke DRG payments and not
really ‘reimburse’ the AI since it would be incorporated
in the DRG.
No one knows what the outcome of the program will be. This is not a reimbursement like many are used to (i.e..for CAD or other imaging studies). Also ,it depends on how much Viz charges for their subscription model, which may eat up any real savings here. That said, any payment is better than no payment, but we have a ways to go…
I am truly indebted to this physician for sharing this information. I just reinforces one of the key points I made in the article- its all about market education. Finally showing money coming in for using AI was promoted as a ground breaking ruling and the word reimbursement used more than once in print, including by myself. In fact, were it not for a viz.ai webinar that the individual who shared this data with me attended we would know nothing rldr. I like to think I keep up to speed on what is going on in the industry but knew nothing of a webinar or would have sat in on it..Im sure many others in the industry and those who care to look more closely at using this echnology are all in the same boat,.
It all comes back to two words- market education. That is and always will be what its all about
The newly educated PACSMan
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