CMS wants to pay for AI-enabled primary care

What a week for news! We had a blue wave and the final 2027 Physician Fee Schedule dropped. Chrissy and I sat down with several experts to discuss what the blue wave will mean for health tech in a sweep conversation. Check that out here.

Now, let’s talk about the PFS.

Some people will be upset about the changes to remote patient monitoring. Starting in 2029, the Center for Medicare and Medicaid Services will only pay for remote patient monitoring services when a patient’s doctor renders it. Third party monitoring services are out. There was major push back on this change, because lots of providers use vendors to handle this aspect of care. You can read about that here. TLDR: President Trump’s health administration wants to cut down on fraud and RPM is in the hot seat, because of past reports that show some entities are abusing the codes. However, it’s interesting that CMS is putting off implementation. Mario Aguilar at Stat dug into the opportunity those gap years present.

But I’m interested in a different aspect of the PFS. In the final rule there’s a request for information that I think should be particularly interesting to you, dear reader. It’s about reforming how primary care is paid for and the influence technology should have on new payment structures.

Since 2025, the Department of Health and Human Services has put forward several programs that incentivize making health care better and cheaper with technology. Now, it’s considering how the physician fee schedule can do that.

CMS says that it’s concerned that primary care is undervalued and it’s interested in a hybrid model of payment that would be both fee-for-service and capitated (or paid for prospectively). Of note for technologists the agency is interested in understanding how it should approach paying for tech enabled care differently than it has in the past, particularly in terms of time and intensity of service.

The agency sees an opportunity to change payment for tech-enabled care for Medicare’s Initial Preventive Physical Exam and Medicare Annual Wellness Visits. Specifically can AI make sure more Medicare patients complete more of these visits than they currently do. The agency sees a role for AI in collecting pre-visit data, assessing potential health risk, and putting questionnaire data in language that patients can actually understand. They also see opportunities within the clinical workflow, through documentation to identify opportunities for treatment and follow up.

CMS wants to know: how can tech increase access to care and potentially improve outcomes in a documented way? Remember also that the agency wants AI to be a deflationary force in health care. So in this new payment paradigm, how is AI saving the agency money?

The takeaway: For tech operators, this is an opportunity to weigh in on how CMS decides to explore how tech-enabled care gets paid for. You can read the whole thing under Technology and AI-Augmentation in Primary Care via the Medicare AWV.

Now onto the news.

—Ruth