TAMPA, Fla. — There is no denying that artificial intelligence has crept into nearly every aspect of our lives at a breakneck pace. It was only a matter of time before AI made it to healthcare. Many doctors, politicians, and experts are asking how AI will be used.
ARTIFICIAL INTELLIGENCE IN THE EXAM ROOM
"The difference with ambient AI is it's actually more close to an intelligent human scribe," Dr. Nishit Patel, Vice President and Chief Medical Informatics Officer at Tampa General Hospital, said.
Last year, TGH launched new AI-powered software called Ambient Listening. More than 500 doctors are participating in the program. The doctor simply sets the phone down to record the conversation (with patient approval), and the software transcribes it in seconds.
Doctors can spend on average 4.5 hours per day working on paperwork or electronic documentation. Dr. Patel said this saves time while capturing precise medical information gathered during the appointment.
"These tools help us get through the massive amounts of unstructured paperwork and data we have that insurance companies are trying to go through to figure out if this is an appropriate authorization. And, so I think hopefully if we use these tools in the optimal ethical way to do the right thing for the patient, we all win," Dr. Patel said. "What I fear, though, is that if a payer or a health system is trying to use these tools to sort of win a battle, what we end up in is much more of an AI arms race, where, frankly, nobody really wins. And so I think these tools have the opportunity for us to get authorizations more timely."
Pre-authorizations and peer-to-peer reviews have come under scrutiny as doctors and medical professionals are speaking out about dealing with health insurance companies.
ABC Action News reporter Michael Paluska recently reported on those doctors for the ongoing series, "Patient No More.”
INSURANCE DENIALS USING AI
"Are insurance companies using AI to really kick out and deny batch claims by the hundreds or maybe thousands at one moment?" Paluska asked Dr. John Licato, Associate Professor in the Computer Science and Engineering Department.
"What I can say is that the technology to do it is definitely there, and the technology to auto-reject a claim is not necessarily even that sophisticated," Licato said. "There are lawsuits going on that accuse insurance companies of doing things like that, but, you know, it's impossible to know for sure what they're actually doing. That's going to come out in the trials, hopefully."
"If AI is rejecting claims, then the patient will probably have to use AI to fight the claims because the AI is so good, a human won't be able to beat it?" Paluska asked.
"Yeah, and that is exactly an example of the kind of arms race that we're anticipating," Licato said.
"AI will have a really big part in whether or not your care goes through?" Paluska asked.
"Yeah," Licato said.
"So something gets denied, like a claim. I guess it's going to be on the doctors now to figure it out and get their patients covered until AI is being used in a way where it's balanced?" Paluska asked.
"I'm skeptical that that balance will ever be found, though. I think it's just going to be a continuing arms race. You know, maybe you'll reach a temporary equilibrium, but some breakthrough is going to happen," Licato said.
States are trying to get ahead of the technology. Several across the country are passing laws to make sure a human reviews any claims rejected by AI.
Florida State Senator Jennifer Bradley filed SB794 this legislative session.
According to the bill:
An act relating to mandatory human reviews of insurance claim denials; creating s. 627.4263, F.S.; defining the term "qualified human professional"; requiring insurers' decisions to deny claims to be reviewed, approved, and signed off on by qualified human professionals; prohibiting artificial intelligence, machine learning algorithms, and automated systems from serving as the basis for denying claims; requiring insurers to maintain certain records of the human review process for denied claims; requiring insurers to include certain information in denial communications to claimants; providing reporting requirements; authorizing the Office of Insurance Regulation to audit claim denials; providing an effective date.
"My initial reaction to that is, I'm not sure how you'd enforce that, right? You know, you say, okay, a human has to review this. What is to stop them from just saying, 'Yeah, I looked it over.' Then you see this text that was generated here. 'I read that. It looks okay to me.' I don't know how you'd enforce that."
