THE US IS USING TO AI APPROVE AND DENY MEDICAL CARE. HERE'S WHAT THAT MEANS

An AI pilot programme is attempting to cut down on 'wasteful' medical procedures, and patients are paying the price

- TOM KNOWLES

Over the past two years, Keith Magnuson has been in debilitating pain. The 83-year-old has lumbar spinal stenosis, a back condition that causes problems any time he is on his feet. Until recently, Magnuson was a regular rock climber and hiker, but these days it hurts just to unload the dishwasher.

"Any time I'm on my feet, I'm in pain," says Magnuson, who lives in Seattle.

His doctor had found a solution. Magnuson could have a procedure called minimally invasive lumbar decompression (MILD), which would help his back and carries less risk than surgery. As Magnuson was over 65, the procedure would be covered by his Medicare insurance and could be arranged and performed quickly.

There was just one problem. One part of the planned procedure an epidural steroid injection to help address the back pain had been denied by Medicare. Magnuson's doctors asked for approval again after providing more documentation, and then a third time. On each occasion, it was denied.

It was on the third denial that Magnuson discovered it wasn't a person who had made this decision about his treatment. It was AI.

"I was outraged," Magnuson says. "I was like, wait a minute, it's not even another person at the other end? It's AI? It's a bot?"

A PILOT WITH PROBLEMS

Magnuson is not alone. Across the US, in six specially selected states - Washington, Arizona, New Jersey, Ohio, Oklahoma and Texas - people enrolled in Medicare are finding that AI is deciding whether or not they can receive certain treatments.

These states have been involuntarily enrolled in a six-year pilot programme by the US Department of Health and Human Services (HHS), which wants to find out whether AI can protect US taxpayers from "wasteful" spending within Medicare, and prevent patients from receiving "unnecessary" procedures.

Medicare is a government-run health insurance programme for the over-65s and some younger people with disabilities.