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.
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?