I would maybe modify this to say - there is a strong incentive to be efficient - you only make so much money per encounter, DRG visit to the hospital, etc. So the pressure from "management" on a lot of us clinicians is to see more people per day, make each hospital visit as short as possible, etc. Medicaid providers now see something like 50-60 patients a day because the per-patient visit is relatively low. But there isn't as much incentive for outcomes. I think CMS has tried it in the past, but with varying success. Whether this new mousetrap will work, who knows.

Why isn't this vulnerable to the upcoding problem that plagues medicare advantage plans?

Isnt "bad actor" just a set of parameters, with cost at the center of it? And AI a neat tool to deflect responsibility and to bury one in verbose but good sounding bs?

When you throw such a tool into the existing incentive structure, that already produces inhumane atrocities, i wouldnt be that optimistic.

That's the biggest risk. I can also imagine it encouraging a certain kind of fraud.

The program sounds reasonable until you become aware that the patients most in need are often the ones least likely to improve. It also ignores the reality that sometimes even the most rigorous, well reasoned treatment plans fail for unpredictable reasons. Do you punish providers and patients for that?

One might argue that that's the goal. There's the approach we've taken of trying to help people, and then there's the approach some people want, which is to treat every problem as if it is an entirely individual problem and treatment has to be earned by trying to will yourself out of the problem.

You see upcoding in risk-based programs already too (like Medicare Advantage). It's trivial to say a patient is sicker than they are and then let them "miraculously improve".

Real bummer.

This recent article about Outcome Aligned Payments in the Journal of the American Medical Association (JAMA) explains how they mitigate cherry-picking: https://jamanetwork.com/journals/jama/fullarticle/2848799?gu...

I think this is less offensive than the kind of scheme where a hospital billed for doing actual heart surgery on patients who didn’t have heart problems. https://www.sfgate.com/health/article/REDDING-Settlement-in-...

The worst one in history was elected to the Senate.

https://en.wikipedia.org/wiki/Rick_Scott

Medicare is a government-run insurance program, so this is one of the few cases where a private insurance company wouldn't receive data.

(There is such a thing as Medicare advantage, where a patient can choose to put their Medicare dollars toward private insurance, but it's not part of the initial launch of this program.)

> what organization would I trust with the full context of my life. None. Zero

Wouldn't this mean you'd rather interact with an AI, if it meant whatever you said was provably shown that it could never leak (though the medical conclusions would be documented in your HIPAA-protected record)?

These are also the markers of human journalists who write daily. Journalism is the reason AI acquired these habits. Gemini says this article is probably not generated by AI, particularly because it has original quotes.

https://gemini.google.com/share/ba48849a15a9

Isn't the first em dash taken from an interview that the writer did with the subject over Zoom? I think using an em dash to punctuate a broken or partial sentence like that is pretty standard journalistic practice when you don't want to modify the original quotation (e.g, denote a paraphrase with brackets), and definitely not an AI tell.

The other uses are honestly pretty standard rhetorical patterns; they do not seem especially AI-flavored to me.

I got an LLM to analyse all of my messages and e-mails from the launch of gmail to work out my writing style, it says I heavily favour em-dash's. I used to work in the industry of type settings and press and publishing. I even use — in HTML when I have to write it nowadays. em-dash is not a LLM thing. It's just most people don't know how to use it. It also said I'm wry. Go figure.

Language is leaky, it gets just about everywhere. Some LLM goes and spills a bunch of emdashes and subordinate clauses all over a billion folks’ browsers and a bunch of them— especially those that may come into contact with a lot of language for a living— writers, for example— and they soak up a bit of it themselves and smear it all around.

Put another way, search out the great vowel shift. That happened over more time but then again the contact with different speakers wasn’t as constant as every day on the internet. It’s just what happens, how things spread. No different and maybe to a further degree than typical memes.

Very obviously LLM written to anyone who's spent any time using them.

Pangram considers this text human written.

Also "X is the real Y" is another tell. Surprised it didn't double down with "X—that's the real Y."

I feel the same about caretaking. Having an AI talk to people with dementia will be a godsend for families. Before he died, my dad had the same thought every 5 minutes and it slowly drove my mom crazy. A super patient AI would have helped a lot and freed up the rest of the family for other tasks.

One step further would be robots that take people to the bathroom, clean them and other stuff. Having this done by humans is either extremely expensive or it will not be done properly.

Some people are horrified by the loss of human touch but for most old people human touch is a luxury they can't afford.

Every psychologist and therapist I have talked to about using LLMs in place of personal interactions (just discussion about this topic) have all said roughly the same thing:

Any attempt to use LLMs as a substitute for personal interaction is playing an incredibly dangerous game that will probably make them a lot of money, while hurting a lot of people.

A 67 year old woman living out of her car? JFC.