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- Physicians want to delay AI prior-authorization model in Medicare
The CAP, along with other physician organizations, is urging Congress to prevent traditional Medicare fee-for-service from implementing a prior authorization pilot program.
Background: In July, the Centers for Medicare & Medicaid Services (CMS) announced the Medicare Wasteful and Inappropriate Service Reduction (WISeR) Model.
- WISeR would use AI and machine learning, along with human clinical review, before paying for select items and services.
- This pilot model would begin January 1 in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington.
In a letter to the House Appropriations Committee, the physician organizations commended the committee for approving an amendment pausing the WISeR Model rollout.
- This delay would allow time to address design flaws and implementation concerns, ensuring patient care isn't compromised by administrative burdens.
The big picture: The WISeR Model raises the same concerns over problematic prior authorization programs in Medicare Advantage.
- Stakeholders, including physician groups, were not initially involved in the model’s development.
- The CAP joined other groups in identifying additional recommendations to ensure any adoption will be least disruptive to physicians and patients.
What's next: The CAP and other physician groups urge continued collaboration with the CMS to refine WISeR and avoid a repeat of past missteps in health care reforms.