AI and Physicians

CMA is sponsoring the Physicians Make Decisions Act (SB 1120), which requires that physicians be the ones to make final decisions on what kind of treatments patients should receive, rather than artificial intelligence (AI).

In recent years, health plans have increasingly relied on AI to streamline the processing of claims and prior authorization requests. SB 1120—authored by Senator Josh Becker (D-Menlo Park)—requires licensed physicians to supervise treatment and coverage decisions made by algorithms.

While AI is becoming an important tool in diagnosing and treating patients, it should not be the only factor in determining if or what kind of health care a patient receives.

“SB 1120 underscores the essential role of physicians in guiding patient care. Artificial intelligence can enhance health care delivery, but it must be overseen by trained medical professionals who understand the complexities of each patient's unique situation,” said CMA President Tanya W. Spirtos, M.D. “This legislation will help ensure that patients receive the care they need.”

While AI has the potential to improve access to care and save insurers money, there are legitimate concerns about inaccuracies and biases, prompting calls for oversight. Wrongful denial of insurance claims based on AI algorithms can lead to serious health consequences and even death.

The Physicians Make Decisions Act acknowledges that algorithms cannot replicate the nuanced decision-making process of a physician, ensuring that patients receive fair and appropriate coverage decisions. By reintroducing human oversight, SB 1120 seeks to uphold the integrity of the healthcare system and prioritize patients' well-being above all else.