Another AI solution received favorable reimbursement decision recently. Viz.ai received FDA clearance in early 2018 for a deep learning system that can detect blockages in the large blood vessels that supply the brain, on CT scans. This system was an interesting break from the dozens of pure diagnostic systems that startups were producing at the time, in that it was intended not just for diagnosis, but also for triage and fast response. If it saw a blockage, it directly contacted the radiologist and the specialist who could fix the problem
CMS (the Centers for Medicare & Medicaid Services) in the USA approved reimbursement for viz.ai system in September 2020, the first reimbursement for AI augmented medical care. Viz’s system was granted a New Technology Add-on Payment of up to $1,040 per use in patients with suspected strokes.
To secure this reimbursement, viz.ai produced clinical evidence for the benefits of their system. This included faster time to notification of the clot-busting specialist; faster time to transfer from peripheral hospital to a central hospital where the relevant procedure can be performed; faster time to clot-busting procedure. They also showed Improved modified Rankin score (mRS) at discharge; Improved NIH Stroke Score (NIHSS) at day 5; Improved mRS at day 90. These outcomes show that these patients did better than patients without ContaCT. These scores are widely used in stroke trials and summarize degree of damage/disability following a stroke.
It is clear that physician organizations such as the American College of Radiology are taking serious notice of these technologies and are leading the charge in creating the economic case for the technologies and how it will impact their members. Reimbursement experts indicated to me that the creation of the new CPT codes will be engineered by physician organization in such fashion that reimbursement of their members will be protected.
In conversations with thought leaders in health system economics, they indicated that these technologies will be used in niche indications for the near-future but the economics of the health systems will continue to push the money-making procedures. Health systems will be careful to assess the impact of such technologies but if it makes their physician more productive and satisfied, they would invest without reimbursement. They suggested that Health systems are heavily dependent on procedures and thus will incentivize physicians to continue using them as first-line.
As for physicians and their offices, the experts suggested that if AI technologies can help physicians increase their income by helping them take care of more patients, the adoption rates will be brisk. However, if the technologies are neutral in this regard and there is no approved reimbursement, physicians won’t buy them for their offices but will push hospital to buy them.