HEALTH TECH
Insurers and providers keep pace using the same financial strategy: more AI
Insurers say AI tools driving overzealous coding and billing from providers are hurting their bottom line. What's their plan? More AI tools.
Large insurers and their subsidiaries have long used AI to scrutinize medical claims — some have even been sued over allegedly wrongful denial of care using AI — but this recent strategy has emerged in recent months as health systems have also aggressively taken up AI. Top insurance executives such as UnitedHealthcare's CEO have noted that increasing their use of AI tools has boosted profits, especially when applied to coding and billing practices.
The mistrust runs deep and on both sides. Some payers are skeptical about whether the hospitals' new AI tools accurately capture medical reality, while providers point to insurers' upcoding patients within Medicare Advantage plans.
To hear what doctors think about this infighting and what this will mean for patients, read more from STAT's Katie Palmer.
FIRST OPINION
Proposed Medicare changes could end key procedure for chronic pain disorders
Recent changes to Medicare coverage could imperil access to interventions that are critical for millions of Americans with chronic pain, writes Tricia Pendergrast, an anesthesiology resident physician at the University of Michigan.
Medicare administrative contractors across the country have recently proposed eliminating coverage for peripheral nerve block procedures, which are minimally invasive, non-opioid treatment options for chronic pain disorders. If approved, Pendergrast writes, these changes could drive patients back to opioids, exacerbating the overdose epidemic in the United States, or force patients to pursue invasive and expensive surgical interventions.
A leading cause of disability in the United States, chronic pain is associated with depression, substance use disorders, and roughly $722.8 billion in medical costs annually. It is also more prevalent in veterans, women, adults living in poverty, and rural residents. Read more from Pendergrast.
WHAT'S THE WORD
Cryptids? Dragons? Scottish actors?
Julia Bujalski/STAT
No, this isn't a Game of Thrones rip-off, it's our weekly mini crossword puzzle! It includes a clue about one of my favorite actors — shoutout Beginners, such an underrated movie — and an answer that Republicans' routinely use to describe federal health agencies. You should do it.
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