Has AI Turned On Health Care?

Hospitals hoped artificial intelligence would lighten their staff's workload, but the same tech could be to blame as insurance firms increasingly deny Medicare Advantage claims

- ALEXIS KAYSER

THE NEW YEAR HAD BARELY DAWNED AND KURT Barwis, president of Bristol Hospital and Health Care Group in Connecticut, was on the phone in the emergency room. It was January 2022 and omicron, a new variant of COVID-19, was evading vaccines and antibodies from prior infections.

The virus spread rapidly throughout the United States, overwhelming hospitals-including the small, 154-bed Bristol Hospital.

More than 100 people were awaiting treatment, Barwis told Newsweek. He was calling local hospital CEOs to see if they could take any more patients while other CEOs rang him with the same request.

Meanwhile, more than a dozen patients were needlessly sitting in acute care beds. Doctors had cleared them to discharge to skilled nursing facilities, but their insurance companies hadn't yet granted the prior authorizations required to transfer.

At Bristol Hospital, omicron exposed how this process can delay and disrupt emergency health care operations. And the consequences are a concern for hospitals nationwide. In a 90-day period, patients with Medicare Advantage plans, or MA, spent 14,000 unnecessary days in New York hospitals due to discharge delays, the Healthcare Association of New York State reported in 2023.

According to Barwis, working with MA insurance plans is like dealing in the Wild West, and it's gotten worse since the cowboys started using AI.

Why Does AI Allegedly Target MA?

Multiple health care and tech leaders who spoke to Newsweek began noticing an acceleration in claims denials between 2019 and 2020.