June 26, 2026
Hospital Resources—not Patient Factors—Linked to Adoption of AI for Stroke Detection Under Medicare New Technology Add-On Payment
A new study published this week in the American Journal of Neuroradiology finds that adoption of artificial intelligence (AI) software for detecting large vessel occlusion (LVO) in acute ischemic stroke (AIS) — when billed through Medicare’s New Technology Add-On Payment (NTAP) program — has grown but remains uneven, with use concentrated in larger, specialized hospitals and varying geographically.
These findings from research conducted by the Harvey L. Neiman Health Policy Institute and collaborators at Northwell Health demonstrate that AI adoption was driven predominantly by facility characteristics rather than patient demographics or stroke severity.
Using nationally representative Medicare data, the research team analyzed 2,116 inpatient AIS episodes across 1,076 unique facilities from October 2020 through December 2023, the period during which the NTAP code was available to hospitals for reimbursement. NTAP provides temporary supplemental reimbursement to support adoption of innovative technologies not yet reflected in standard payment systems. NTAP-billed AI use increased annually, peaking at 21% of eligible AIS episodes in 2022, before declining in 2023 as the temporary NTAP code began to sunset. Overall, AI was used in just 14.8% of analyzed stroke cases.
“AI tools have the potential to improve speed and accuracy in stroke detection, but our findings show that access to these technologies depends more on where a patient is treated than on their clinical needs,” said lead author Casey Pelzl, MPH, principal research scientist at the Neiman Institute and study lead author. “That has important implications for variation and disparities in stroke care.”
The study found no disparities in NTAP-billed AI use across patient demographics — including sex, age, or race/ethnicity — or across measures of stroke severity. Instead, facility-level factors emerged as the primary factors associated with adoption. Use of NTAP-billed AI was significantly more likely at comprehensive stroke centers and at facilities located in the Stroke Belt. Hospitals serving more socioeconomically deprived areas were significantly less likely to use NTAP-billed AI, raising concerns that patients in underserved communities may have reduced access to AI-enhanced stroke evaluation.
“This research affirms that AI for LVO detection has found its footing at major stroke centers, where CT-based workflows and the infrastructure to support these tools already exist,” said Maria X. Sanmartin, PhD, co-author and Assistant Professor at the Department of Radiology at Zucker School of Medicine at Hofstra/Northwell. “AI tools may support faster stroke evaluation, but operational readiness, infrastructure, and clinical workflows play a major role in determining whether these tools are actually used in practice. When adoption is concentrated in facilities that already excel in stroke care, it misses the opportunity to improve care in less-resourced settings where potential gains are the greatest.”
“Reimbursement pathways are critical to accelerating adoption of clinical AI, but they are only one piece of the puzzle,” said Elizabeth Rula, PhD, Executive Director of the Neiman Institute, co-author of the study. “The economics for adoption at smaller sites differ from those of larger and more-resourced facilities and may require different models for deployment. For example, centralized or shared service models could enable these hospitals to access AI without investing in fully independent AI solutions.”
The published work was supported by the American Heart Association Grant #24SCEFIA1249718/Dr. Maria X. Sanmartin/2024.
To arrange an interview with a spokesperson, contact Nichole Gonzalez at ngonzalez@neimanhpi.org.
About the Harvey L. Neiman Health Policy Institute
The Harvey L. Neiman Health Policy Institute is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care. Visit us at www.neimanhpi.org and follow us on X, BlueSky or LinkedIn.