AI has begun to play an important role in aiding physicians in diagnoses — and the Centers for Medicare & Medicaid Services has recognized this progress in recent years by granting dedicated reimbursement codes and payments to a handful of diagnostic AI tools that demonstrate clear clinical utility, such as those for detecting diabetic retinopathy, analyzing coronary artery disease and triaging stroke patients.
This week, CMS established a payment rate for another AI-powered diagnostic tool. The agency established a $128.90 payment rate per use for Eko Health’s Sensora platform, which aims to aid clinicians in the diagnosis of heart conditions.
Emeryville, California-based Eko Health, founded in 2013, seeks to help clinicians move away from traditional, reactive modes of disease detection with its digital stethoscopes and accompanying AI platform. The platform combines the stethoscopes’ data with real-time electrocardiogram data to flag serious cardiac conditions like atrial fibrillation, low ejection fraction and valvular heart disease.
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By giving the Eko’s AI system a payment rate, CMS is creating a financial pathway for providers to implement AI into their heart screenings at the point of care, said CEO Connor Landgraf.
“Cardiovascular disease remains the leading cause of death in the United States, yet many serious conditions, including low ejection fraction, valvular heart disease and atrial fibrillation, go undetected during routine exams. Primary care clinicians often lack the time, tools or specialized training to catch these early warning signs, particularly in fast-paced outpatient settings,” he explained.
As a result, delayed diagnoses are all too common. Patients often go without a diagnosis until their symptoms become severe, which means higher costs, worse outcomes and preventable hospitalizations, Landgraf stated.
This diagnostic gap doesn’t just put strain on the healthcare system — it also disproportionately hurts patients who face barriers to accessing specialty care, he added.
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Eko’s AI platform is designed to address this challenge by providing frontline clinicians with real-time clinical decision support during routine physical exams. To Landgraf, the system “turns a standard doctor’s exam into an advanced heart checkup without adding extra time or complexity.”
Eko’s digital stethoscope allows clinicians to listen to a patient’s heart just like they normally would. As they do this, the stethoscope records the sounds and rhythm of the patient’s heart and instantly sends that data to the Eko’s AI platform for analysis. In under a minute, the system checks for signs of cardiac problems and displays an alert if something may be wrong, Landraf said.
The platform is trained on data from millions of heart sounds and rhythms, which is why it can pick up on patterns that are too subtle or complex for human clinicians to recognize.
“By transforming the standard stethoscope into an intelligent diagnostic tool, Sensora enables scalable early detection at the point of care,” Landgraf declared.
The goal is to help catch heart disease earlier, when it’s easier to treat, and to make high quality diagnostic care more accessible, he noted.
In Landgraf’s eyes, CMS’ reimbursement framework for Eko’s system creates a pathway for health systems and hospitals to invest in innovative technologies with greater confidence.
“It supports a more equitable model of care by bringing advanced cardiac insights to settings that may not have immediate access to specialists or diagnostic equipment. This approach reinforces broader goals in healthcare, including the expansion of preventive care, the reduction of disparities and the advancement of sustainable innovation across the system,” he remarked.
Eko has sold over 650,000 digital stethoscopes, all of which are able to connect with its AI software.
Photo: ismagilov, Getty Images