7th Global Gastroenterology and Artificial Intelligence Summit (Live) | September 2025-07 2025 7Th Global Ai Summit And Workshop Part 8

Video Transcription

Video Summary

Kristen Tullia, Senior VP at AdvaMed, discussed Medicare payment policies for AI in healthcare, highlighting the system's complexity and limitations. Medicare payment categories are outdated, set decades ago, creating challenges for covering modern AI technologies. While some AI tools, like inpatient hospital stroke predictors and certain outpatient technologies, receive incremental payments, many AI applications face payment uncertainty. Physician fee schedules generally do not reimburse efficiency improvements from AI, except a few AI-enabled diagnostics crosswalked to existing codes, often resulting in lower-than-expected rates. Durable medical equipment rules further complicate coverage for digital home-use technologies. Medicare Advantage plans also impact AI adoption but present challenges with variable coverage and utilization restrictions. Tullia emphasized the need for updated payment frameworks to provide certainty and adequately support AI adoption without unfairly lowering payments for other procedures. She noted optimism about alternative payment models by the Center for Medicare and Medicaid Innovation, which could foster new AI-enabled care pathways encouraging access and efficiency beyond traditional cost constraints.

Keywords

Medicare payment policies

AI in healthcare

physician fee schedules

Medicare Advantage plans

alternative payment models

Center for Medicare and Medicaid Innovation