Federal health officials are exploring how Medicare could pay for artificial intelligence tools that provide medical care or diagnoses as the Trump administration pushes to expand the technology’s role in patient care, The New York Times reported Sept. 14.
Officials are working to develop a new Medicare payment category that could reimburse companies for AI software supporting medical care or diagnosis, according to the Times. Medicare officials have also encouraged private insurers to reimburse for certain forms of technology-supported care if they improve care and lower costs.
The efforts come as federal officials move forward with several initiatives involving AI in patient care, including technologies capable of performing tasks traditionally handled by physicians.
Within the administration, officials have discussed whether AI physicians operated by technology companies and startups should be paid as much as 60% to 80% of what human physicians earn for the same service, according to a person involved in the discussions cited by the Times.
The payment discussions are unfolding as regulators determine how to oversee increasingly autonomous AI tools. The FDA has approved more than 1,500 medical devices that include AI and perform discrete tasks, such as identifying tumors or blood clots. But the agency does not have rules designed to address newer models, including chatbots and agentic AI systems capable of performing tasks such as prescribing medications.
Medicare has allowed more than 200 companies to participate in pilots that can include AI. Through a program aligned with the Medicare effort, the FDA has also allowed four otherwise unapproved AI models that met safety criteria and appeared likely to benefit patients to participate. One involves an AI chatbot providing therapy to Medicare beneficiaries with depression or anxiety.
Another federal initiative is exploring autonomous AI for heart failure management. An Advanced Research Projects Agency for Health project with about $60 million in funding is intended to ultimately deploy autonomous AI to manage care for heart failure patients, including through a chatbot that could prescribe and manage medications. Teams at Stanford (Calif.) University and Durham, N.C.- based Duke are among those involved. Under current laws and rules, a physician would oversee the AI.
The efforts have also raised questions about safety and the evidence supporting autonomous AI. John Whyte, MD, CEO of the American Medical Association, told the Times that models designed to independently provide patient care are not ready for widespread use. He also questioned evidence cited by AI proponents, including Vinod Khosla, that suggests AI can outperform physicians, saying much of it was based on simulations.
Grace Davis Jamison, a health department spokesperson, told the Times that the department was taking a responsible, evidence-based approach to AI and expanding its use as evidence demonstrates value.
“H.H.S. is embracing cutting-edge American innovation, including A.I. as a practical tool, to better serve patients, families, and clinicians as we work to Make America Healthy Again,” she said in a statement to the publication.
