AI reviews rolling out for Medicare in WA for some procedures

Starting January 1, Medicare enrollees in Washington will face new requirements for prior authorization on certain medical procedures as part of a pilot program. This initiative, which leverages artificial intelligence to assess eligibility for coverage, will also be implemented in Arizona, New Jersey, Ohio, Oklahoma, and Texas. Critics, including Dr. Matt Hollon and Senator Patty Murray, argue that the program represents a step toward Medicare privatization and compromises the integrity of doctor-patient relationships. The Centers for Medicare and Medicaid Services aims to reduce fraud and waste in the Medicare system, which serves 1.

6 million beneficiaries in Washington. However, concerns arise over the speed of implementation and lack of clarity regarding the program's scope. Procedures considered for prior approval include expensive treatments with questionable clinical benefits. Patient advocates warn that this AI-driven approach could result in increased denials of necessary care. The program's structure incentivizes third-party companies to save money, potentially prioritizing cost over patient welfare.