CMS Releases Proposed Changes to CY ’22 Medicare Physician Fee Schedule

New proposed rule states that “the eye exam must be performed by an ophthalmologist or optometrist, or there must be evidence that fundus photography results were read by a system that provides an artificial intelligence (AI) interpretation”

Integrating autonomous AI into the healthcare system has been a long path as the system was not originally designed with computers making diagnoses in mind. Nevertheless, it is incredibly rewarding when significant progress is made to ultimately improve patient outcomes and reduce health inequities. Specifically, the Centers for Medicare & Medicaid Services (CMS) released their proposed changes to Calendar Year 2022 Medicare Physician Fee Schedule (MPFS) [Page 1612 of 1747 Federal Register Document]. The proposed changes include the most important reimbursement mechanism for healthcare and include the important updates and clarifications regarding the use of autonomous AI for the diabetic eye exam.

As an example, NCQA had previously updated the HEDIS measurement language to support the use of autonomous AI to close the diabetic eye exam care gap. It is therefore exciting that CMS has proposed to change the MIPS measurement language accordingly:

“The eye exam must be performed by an ophthalmologist or optometrist, or there must be evidence that fundus photography results were read by a system that provides an artificial intelligence (AI) interpretation.”

Digital Diagnostics and AI the Right Way™

Less than 50% of people with diabetes receive the recommended annual diabetic eye exam, and this lack of access is a major cause of health inequities. It leaves many with undiagnosed and untreated levels of disease, and a high risk of consequent visual loss and blindness. To mitigate such disparities, Digital Diagnostics’ designs autonomous AI to be transparent, free of bias, and rigorously validated, in order to have the greatest impact on improving patient care through increased access, lower costs, and improved quality.

Supporting autonomous AI diagnosis for diabetic retinopathy and diabetic macular edema allows for better access to the diabetic eye exam for racial and ethnic minorities as well as rural and economically disadvantaged groups, so that they can undergo these exams at the point-of-care where they receive their diabetes management. The proposed changes that CMS has made allow high quality exams for these groups, as well as every American under Medicare, at lower costs, while providing for better patient outcomes.

As our healthcare system continues to embrace autonomous AI, we are encouraged by CMS’ leadership on autonomous AI in their latest proposed update and look forward to a future where autonomous AI the Right Way™ mitigates health disparities and improves outcomes for every patient.