According to the Blue Cross Blue Shield Association, the AI tools used by hospitals are documenting more "complex" patients without changing the care provided.
The Blue Cross Blue Shield Association has estimated the additional cost of using artificial intelligence by hospitals in preparing their claims at $942 million over two years. His analysis found a net increase in the number of patients documented as having complex pathologies, without any corresponding change in the actual care provided.
The mechanism in question is not the diagnosis but the documentation: the transcription and synthesis tools deployed in the services bring back to the file elements that justify a heavier coding, thus a higher billing. The publishers concerned, including Abridge by the voice of its founder Shiv Rao, on the contrary defend a more faithful description of the real state of patients, hitherto under-documented for lack of time.
The debate goes beyond the technical framework. Hospitals and insurers have long opposed what needs to be paid, and AI is now setting up on both sides of the table — on the side of institutions to justify the actions, on the side of the payers to challenge them. The New York Times had established this link a few days earlier, on 24 September.
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