Time is Brain: AI for Acute Stroke Management
As I was seeing patients in the retina clinic this morning, we had gotten off to a great start. I had done a few intravitreal injections and one pan-retinal laser photocoagulation procedure. At that point, I got informed that one of my patients whom I was yet to see had developed symptoms of an acute stroke. I rushed into the room. Following a very quick assessment, I asked that the patient be immediately transferred to the Emergency Department for a stroke protocol assessment. The rapidness of my decision was based on the stroke management mantra “time is brain.”
From the onset of a stroke, one has approximately 4 hours ideally to administer a certain “clot bursting” drug called tissue-type plasminogen activator (tPA) and or physically remove the clot via a procedure called mechanical thrombectomy — each of which can improve outcomes. And typically, only interventional neuroradiologists have the proper training to perform either of these interventions.
Only last month, the Center for Medicare and Medicaid Services (CMS) granted its first approval for a Medicare New Technology Add-on Payment for an AI software. The approval was for Viz LVO, a stroke detection software from Viz.ai which reads CT angiograms of the head and neck and detects presence of large vessel occlusion (LVO). If there is an LVO, the patient skips over the general radiologist and moves straight to the interventional neuroradiologist who is activated and ready to administer intravenous tPA and perform a mechanical thrombectomy. This can save time and therefore brain.
Details of the payment scheme and some relevant definitions:
- Diagnosis Related Group (DRG): A diagnosis-code related bundle of services reimbursed in a capitated manner.
- New Technology Add on Payment (NTAP): Payment issued for use of a qualifying New Technology when cost of caring for a particular patient exceeds the DRG for their disease. The CMS-determined NTAP for Viz LVO is $1,040.
- Per Site (e.g. hospital) licensing fee: $25,000
- CMS Reimbursement Update Rule: Each new year, NTAP will be updated to equals licensing fee divided by number of eligible scans done in the previous year.
While the NTAP payment for the AI technology seems large, it turns out that the eventual reimbursement per scan is much lower. This is because of a cascade of NTAP eligibility criteria including:
- Patient must be covered under Medicare
- Patient must be covered under Medicare Part A
- The AI must read the patient’s CTA as positive for large vessel occlusion
- The overall cost of the patient’s care must exceed the DRG rate
On the other side of the cascade, Dr. Luke Oakden-Rayner, an Australian radiologist and medical researcher, estimates that the eventual amortized reimbursement per scan comes out to somewhere between $30 and $80.
The Viz LVO payment schema opens up a new paradigm and signals progress in the ongoing discussion around how #AI services in healthcare will be compensated.
BIO: Dr. Stephen G. Odaibo is CEO & Founder of RETINA-AI Health, Inc, and is on the Faculties of the MD Anderson Cancer Center and the University of Houston. He is a Physician, Retina Specialist, Mathematician, Computer Scientist, and Full Stack AI Engineer. In 2017 he received UAB College of Arts & Sciences’ highest honor, the Distinguished Alumni Achievement Award. And in 2005 he won the Barrie Hurwitz Award for Excellence in Neurology at Duke Univ School of Medicine where he topped the class in Neurology and in Pediatrics. He is author of the books “Quantum Mechanics & The MRI Machine” and “The Form of Finite Groups: A Course on Finite Group Theory.” Dr. Odaibo Chaired the “Artificial Intelligence & Tech in Medicine Symposium” at the 2019 National Medical Association Meeting. Through RETINA-AI, he and his exceptionally talented team are building AI solutions to address the world’s most pressing healthcare problems. He resides in Houston Texas with his family.
REFERENCES:
1. Viz.ai Granted New Technology Add-on Payment2. Medicare Hospital Prospective Payment System How DRG Rates Are Calculated and Updated3. It’s complicated. A deep dive into the Viz/Medicare Ai reimbursement model4. Direct Mechanical Thrombectomy Versus Combined Intravenous and Mechanical Thrombectomy in Large-Artery Anterior Circulation Stroke
