Doctors raise concerns about Medicare's new AI experiment: Report

Medical professionals in several U.S. states are expressing worry about a new Medicare pilot program that utilizes artificial intelligence, a recent report indicates. The Centers for Medicare and Medicaid Services are set to roll out the Wasteful and Inappropriate Services Reduction (WISeR) Model next month, which will permit private firms to evaluate seniors medical care requests with AI and receive incentives when they deny coverage.

In theory, it seems reasonable to avoid paying for unnecessary treatments, said Jeb Shepard, policy director at the Washington State Medical Association. However, in reality, prior authorization has often created obstacles. Many denials and drawn-out appeal procedures divert physicians from patient care, forcing them to contend with insurers to secure what they deem appropriate treatment.

The WISeR program, extending through 2031, will be implemented in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. Medicare beneficiaries are particularly vulnerable, Dr. Bindu Nayak stated. This initiative introduces additional hurdles for accessing care, and patients may face prior authorization processes they never encountered before.

Recently, lawmakers from Ohio, Washington, and other states introduced legislation aimed at repealing the WISeR program. The proposed bill is currently under committee review.

Author: Lucas Grant