JustCare

Tag: Diagnoses

  • AI can second-guess physicians and improve care

    AI can second-guess physicians and improve care

    Regardless of what we think about the benefits of using artificial intelligence (AI) for medical treatment, physicians are now using AI in a variety of ways. One way that AI can benefit patients is by second-guessing patients. Alvin Powell reports for the Harvard Gazette on how AI is beginning to reduce human suffering.

    Sometimes, patients have such rare conditions that physicians are hard-pressed to diagnose them properly. But, if the physician puts their symptoms into a well-working Large Language Model (LLM), AI, it can answer a wide range of questions. And, the patient can get treated appropriately.

    Powell gives the example of seeing a rare condition in a child. The physician asked AI a range of questions, the “genetic causes, biochemical pathways, next steps in the workup, even what to tell the child’s parents.” AI made the physician’s job efficient and effective.

    To be clear, AI cannot work alone. We still need physicians. But, lay people can get helpful answers on medical conditions. And, AI can successfully second-guess physicians. For example, AI diagnosed a child’s pain correctly after 17 physicians had failed to do so over three years.

    The child’s mom gave ChatGPT all of her child’s medical notes. And, ChatGPT correctly determined the child’s spinal cord was attaching to his backbone. With that accurate diagnosis, a surgeon could treat the problem.

    AI also should be able to allow physicians to see more patients, helping physicians with patients’ histories, possible diagnoses etc. One experiment using AI found that doctors who entered all information into an LLM and left it to the AI to determine the diagnosis had a 90 percent accuracy rate, as compared to the doctors not relying on AI at all, who had a 74 percent accuracy rate.

    One physician with AI expertise explains: “The best way a doctor could use it now is for a second opinion, to second-guess themselves when they have a tricky case,” he said. “How could I be wrong? What am I missing? What other questions should I ask?

    But, physicians can also use AI to understand and prevent harmful drug interactions in hospital. Today, as many as one in four hospitalized patients in Massachusetts suffer from bad side effects. Using AI, they can be avoided.

    And, physicians can use AI for good note-taking while speaking with a patient. Rather than looking into a computer as they discuss the patient’s condition, AI can do the work, writing up and summarizing the clinical notes. The physician need only review the notes for accuracy, easing the physician’s workload.

    Still, AI can spit out bad information. So, physicians who rely on it need to be mindful.

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  • UnitedHealth physicans help boost insurers’ Medicare payments

    UnitedHealth physicans help boost insurers’ Medicare payments

    UnitedHealth now employs or contracts with about 10 percent of the physicians in the US. It’s one way UnitedHealth maximizes Medicare Advantage profits, report Anna Wilde Mathews, Christopher Weaver and Tom McGinty for the Wall Street Journal. UnitedHealth incentivizes its physicians to include additional diagnoses codes on Medicare Advantage patient records, which enables UnitedHealth to receive higher Medicare payments.

    UnitedHealth advises its physicians to check their Medicare Advantage patients for certain diagnoses. So, in Eugene, Oregon, one physician explained that before he could move from one patient to another, he must enter into a software system whether his patient had any of a list of diagnoses. In many cases, the diagnoses had nothing to do with the patient, such as hyperaldosteronism, which is a hormone condition related to high blood pressure.

    Rather than ensuring their doctors focus on treating Medicare Advantage patients for the conditions these patients are reporting, UnitedHealth is focused on having its doctors document as many conditions as possible that will increase the company’s Medicare payments.

    UnitedHealth does nothing to ensure its doctors document additional conditions for their patients in traditional Medicare. That’s not surprising.  Because of the way Medicare pays insurers in Medicare Advantage, adding diagnoses codes to traditional Medicare patient records would hurt UnitedHealth financially.

    The Wall Street Journal found that patients leaving traditional Medicare for Medicare Advantage in the three years ending 2022 had many more diagnoses in their medical records once they were in Medicare Advantage. Their “sickness scores” typically increased 55 percent. To put it succinctly, once in Medicare Advantage, from a sickness perspective, patients effectively had HIV and breast cancer.

    While UnitedHealth does more than other insurers to raise sickness scores for its Medicare Advantage patients, other insurers raised scores by 30 percent for new patients in Medicare Advantage. There is no evidence whatsoever that entering more diagnoses into Medicare Advantage enrollees’ medical records benefits patients in any way. In fact, UnitedHealth doctors do not use the company’s diagnoses software for patients outside of Medicare Advantage.

    By the Wall Street Journal’s calculations, United’s Medicare Advantage enrollees who saw UnitedHealth physicians had such high sickness scores that UnitedHealth benefited financially to the tune of $4.6 billion over three years.

    This insurer gaming of the Medicare payment system must end. Among other things, it is gouging taxpayers, depleting the Medicare Trust Fund, and driving up Medicare Part B premiums.

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