If you want adoption of any technology in a meaningful way in the long-term, you need the public and private entities to pay for it. Most modern technologies are out of the reach of the majority of the population in terms of cost. Paying for healthcare is a major headaches for most governments in advanced economies and those brave enough to become private insurance companies have to make trade-off decisions on which solutions to cover and which ones not to cover. AI technologies are in their nascency in healthcare and so far there is not much track record to indicate how they will be reimbursed in the long-term. However, there has been recent progress in this area. This bodes well for the timeline of the adoption of these technologies.
There is some history in this area: Mammography CAD, an old form of AI intended to assist in detecting breast cancer. This became popular in the 00s, when CMS decided to reimburse CAD-aided mammography tests. A provider would get about $10 more if they used CAD than if they did “standard” reading. With this reimbursement, within a decade almost every screening mammogram in America is read with CAD assistance (Figure 1.)
When CMS released its 2022 physician fee schedule, it established the first national pricing for autonomous AI diagnostics. This marks the first national payment for the IDx-DR service in the physician office setting (CPT code 92229) and creates equitable access across the country. The ruling can be found on page 114 under the section titled “e. Establishment of Value for Remote Retinal Imaging (CPT Code 92229) of Federal Register Document. This also marks the first time that the agency has announced a national price for autonomous AI.
Digital Diagnostics, company out of Iowa, that had the first autonomous AI in healthcare technology approved by the FDA. Digital Diagnostics created IDx-DR, the autonomous AI diagnostic system for the detection of diabetic retinopathy (DR) and diabetic macular edema (DME) at the point-of-care. Only 15% of people with diabetes receive the recommended annual diabetic eye exam, and this lack of access is linked to widespread blindness, especially in Black and Hispanic populations. It leaves many with undiagnosed and untreated levels of disease, and a high risk of consequent visual loss and blindness.