‘How Should We Approach Regulating AI?’: Chuck Grassley Asks Witness About Technology In Healthcare

7 months ago

During a Senate Budget Committee hearing last week, Sen. Chuck Grassley (R-IA) questioned witnesses about administrative burdens.

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00:00 I'm going to ask all my questions of Dr. DiGiorgio.

00:04 Your testimony talks about the weight

00:07 of daily administrative burdens put on doctors

00:11 and frontline healthcare workers.

00:12 What's the source of these administrative burdens?

00:16 Can you give an example of a top-down regulation the federal

00:20 government should remove today

00:21 that wouldn't compromise patient safety or quality?

00:24 I think, broadly speaking, what I'd really like to see is a

00:28 shift from CMS being a plan provider

00:32 to being a plan regulator.

00:33 I think CMS is largely focused on the minutiae

00:36 of the fee schedule, and unburdening CMS

00:38 from that would allow it to focus more on things

00:41 like the adequate risk adjustment model

00:43 and population health quality control.

00:46 And then, specifically, I'd love to see CMS go on a quality diet.

00:49 I'd like it to install a living system of quality metrics

00:53 where metrics are retired as they're shown

00:54 to no longer be useful, and new metrics can come into place

00:57 that would, instead of focusing on the frontline clinician

01:00 and how we practice care, focus more on larger hospital systems

01:03 and hospital practices,

01:04 helping to improve the clinician experience.

01:07 I think we need to make sure

01:08 that any new quality metrics are easily collected using existing

01:12 technology, and that we're not adding additional administrative

01:15 burden for data collection for these metrics.

01:17 You described the importance

01:21 of fostering competitive dynamic healthcare marketplace

01:26 that values efficiency and quality.

01:28 Is Medicare Advantage a marketplace

01:31 where we can foster competition

01:33 to address administrative burden problems

01:35 in our healthcare system?

01:37 And if so, what can we do to make it more competitive?

01:41 Yes, I think absolutely Medicare Advantage is a space

01:44 that could foster competition, but there has

01:45 to be a lot more competition.

01:46 If we're talking about inefficient prior authorizations,

01:49 we shouldn't need to regulate efficiency in the health plans

01:52 if there is adequate competition.

01:54 So I think we need to improve competition

01:56 with more plans entering the space.

01:58 And in addition, I'd like to see equalization

02:01 between Medicare fee for service and Medicare Advantage

02:03 with a unified quality reporting system and star rating system

02:06 between the two types of Medicare.

02:08 Your testimony stated employment growth

02:12 of healthcare administrators, outpacing growth in the number

02:18 of new doctors by over 20 to 1 in recent years.

02:22 What are these administrators doing in the healthcare system?

02:25 Who are they and why haven't they returned value

02:30 to our healthcare system and decreased spending?

02:32 Largely what Dr. Cutler mentioned is they are taking all

02:35 of the unstructured data that physicians are putting

02:38 into our clinical documentation and attempting

02:40 to make it structured data to fit

02:42 into certain billing codes and quality metric formula.

02:44 A lot of that could be automated, I believe,

02:46 using again existing technology.

02:49 But really CMS creates sort of a floor

02:51 of the documentation burden.

02:53 So if CMS says that a certain CPT code

02:55 or billing code requires XYZ, then physicians are going

02:58 to be encouraged to put XYZ in every single one of our notes

03:02 to try to get that billing code.

03:03 And then the, again, all these administrators go

03:06 through our notes, try to maximize

03:07 which code can be assigned to each instance

03:09 of clinical documentation and put that in

03:12 and bill it regardless of the payer.

03:13 My last question, your testimony spoke to the lack

03:18 of labor productivity gains in healthcare over recent decades.

03:23 In other words, doctors haven't become more efficient even

03:27 with new technology like electronic medical records.

03:30 How should we approach regulating artificial

03:33 intelligence given the impact

03:35 of top-down regulations on current technology?

03:38 Yes, I think AI has huge potential to do a lot

03:42 of that administrative work.

03:43 Again, taking unstructured data

03:45 and creating structured data out of it.

03:47 I am worried that we would overregulate it.

03:49 If I went back to 1990 and told all physicians that we're going

03:52 to computerize electronic --

03:53 we're going to computerize paper charts

03:55 and have instant access to data and imaging,

03:57 I think everyone would be thrilled with the amount

04:00 of efficiency gains we would have with that technology.

04:02 That never happened because we overregulated EMR

04:05 with things like meaningful use.

04:06 And so I am worried that we would take the same approach

04:09 to AI and take away any potential efficiency gains

04:13 with overregulation.

04:14 Thank you.

‘How Should We Approach Regulating AI?’: Chuck Grassley Asks Witness About Technology In Healthcare

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