Hospitals’ use of artificial intelligence tools as they submit insurance claims led to an additional $942 million in healthcare spending over a two-year period, according to an analysis by the Blue Cross Blue Shield Association.
The BCBSA analysis found “a sharp increase in patients being documented as having complex conditions,” but argued there is a “clear disconnect between [medical] coding and treatment,” as there’s “no evidence of corresponding change in care delivered.”
The New York Times pointed the analysis as just the latest sign that AI is contributing to an increase in healthcare costs. While battles between hospitals and insurers over treatments and payments are nothing new, the NYT said the use of AI on both sides seems to be making it worse.
“Patients often fell into a higher-cost billing category after a secondary diagnosis, a condition identified in addition to the patient’s primary reason for receiving care. This secondary diagnosis may be derived from single laboratory values, making it particularly well-suited for detection by AI tools. Approximately 70% of the additional costs, more than $650 million, were tied to secondary diagnoses.”
So if these are true positives they’re jist finding more stuff? How does that work with no treatment changes
Just guessing: people are being diagnosed with additional conditions because of AI, which changes the coding and that’s what the visit is billed to the insurance under, but the patients don’t have the time or money to pursue further treatments for these conditions (take the example they use, hemoglobin transfusion for treatment of anemia, takes hours per session and costs thousands which under a high deductible plan comes entirely out of pocket).
AI is being put to good use by doctors, its pattern recognition and relevant memory are identifying health issues doctors miss, and BCBS is trying to spin it as “look, they’re not getting treatments for the diagnosed conditions, there’s a disconnect and it’s why we raised your insurance cost by 30%, someone has to stop this”, when in reality the diagnoses is not bad (they would say that if they had evidence of that), but people working 2 jobs to survive don’t have time or money to pursue testament before it’s an emergency.
The tone of this Luke Chalker from BCBS is truly disgusting. “If patients are truly sicker, we’d expect to see more treatment,” said Luke Chalker, BCBSA’s senior vice president of product and data science. “For example, we’re seeing significantly more anemia diagnoses at these hospitals without a corresponding increase in transfusions. The disconnect between diagnoses and treatment suggests that AI is identifying more billable conditions, not sicker patients.”
And David Merritt, BCBSA’s senior vice president of external affairs, is even more disgusting: "As families face higher healthcare costs, this research underscores the urgent need to better understand these AI tools and the role they may play in exacerbating the affordability crisis.”
It doesn’t cross their mind that expensive time consuming treatment isn’t being done because it’s excessive and time consuming, must be doctors trying to scam the honorable insurance companies. Won’t you think of the families?
John Oliver did an episode recently on a certain healthcare company.
It is the 3rd largest company in the US by revenue.
Yes. 3rd.
They own the doctors, theg own the clinics, they own the hospitals, and …they own THAT insursnce company.
They have abominable methods of care an upcode absolutely everything. Using names like TAMPER in their training manuals to teach how to commit fraud.
Because they bill the government. Which means they bill you.
Which means Luigi did nothing wrong.
Of course he did nothing wrong. Luigi is completely innocent. On the other hand, whoever did do it clearly did do something wrong. They stopped at one.
maybe AI has a silver lining, bringing down HEALTHCARE so you can start again. yea they already get doctors notes wrong with thier AI scribing after a pcp/specialist visit, you can check your doctors note if they have online portal(ours is required to let us see what they said.)
A use of AI we might all support, is dealing with insurance companies. Just have your chatbot talk to their chatbot to get them to do what they were supposed to do all along. This report does claim AI used to find more problems with patients, but harrassing insurance companies is going to lower their margins/prices and increase their approval rates. That could be already be part of blue shield’s higher costs, even if they don’t acknowledge it.
If the health insurance industry breaks that easily, by just reviewing or addressing a more accurate number of diagnoses and treatments, but not even an entirety of all sought or needed, then it’s an incomplete and broken system that was flawed to begin with, which we all knew anyway.
49 billionaire parasites were created from the American health and scam. That is the entire “increase in cost”
Sure, insurers. We believe you. /s
First I was ready to jump in and go, yup AI’s fucking things up more… but I’m more confused on this. It sounds to me like AI is maybe, doing like bob in the incredibles. IE guiding providers through the obstacle course of meaningless hoops that are normally there so that they can deny as many claims as possible, by learning what loopholes insurance companies usually reject, and specifically coding and phrasing the claims to avoid the traps.
IE it’s most likely similar to the job application problem right now. IE companies basically trained AI to auto reject applications that came in on a bunch of arbitrary worthless metrics, thus cutting the pile of applications down by 90% before humans even start looking at it. Then applicants got AI tools that now specifically look for and phrase things specifically to target the searching AIs arbitrary filters, negating it useless. With the exception of the applicants that don’t use the tool, who just get fucked.
Oh no did the technology you use to deny care get turned against you to make you pay more? Fuck Blue Cross in perpetuity.
A future of bots fighting bots!? What a mess.
They probably said it in a super-excited tone, though…
Interesting. I fed my whole medical record into AI and it actually came up with a few tests i needed to take. It ended up saving me money and improving my medical outcomes. Id recommend it before a trip to the doctor.
You trust it more than I do, then. Also, that a.i. company now has your entire medical record. I know I wouldn’t feel comfortable doing that.
No need for trust when you have nothing left to lose ol friend. AI is currently my last leg up on society and i wish it could have arrived a few years before i got disabled. It’s been a life saver for helping me navigate my disability and the formal declaration of that to the government.
You’re getting downvoted by the never AI faction of Lemmy, but I think this is a solid use for AI in medicine. Human doctors have limited mental capacity and increasingly limited time allowed with each patient. Using AI to assist, not replace, practitioners with handling complex cases and identifying rare diseases is extremely beneficial. Complex cases significantly increase the likelihood of insufficient or improper treatment and rare diseases often take years or even decades to be diagnosed.
Limited time is HUGE for them. I just went to an appointment and the doctor rushed off after getting half of my symptoms noted lol. I cant read medical papers so having to digest 100’s of pages of them wasnt happening even if i did i cant interpret half the data correctly. AI worked well here. They kick ass tasks where everything is published online and the hard part is just reading it all. So far medicine, law, and accounting have all just been fantastic use of the service.
