AI reviews rolling out for Medicare in WA for some procedures

A new pilot program will require Medicare enrollees in Washington to seek additional approval for certain medical procedures starting January 1. This initiative, which will also be implemented in Arizona, New Jersey, Ohio, Oklahoma, and Texas, plans to use artificial intelligence to evaluate the eligibility of outpatient procedures for coverage. Critics, including Dr. Matt Hollon of the Washington State Medical Association, argue that the reliance on AI undermines the doctor-patient relationship and could lead to inappropriate denials of care. The program, known as Wasteful and Inappropriate Services Reduction (WISeR), aims to tackle Medicare fraud and waste but has sparked fears of a shift toward privatization.

Senator Patty Murray has condemned the initiative, stating it allows AI to dictate healthcare access. With about 1. 6 million Medicare beneficiaries in Washington, stakeholders express concern over the lack of clear information regarding the program's rollout. The Centers for Medicare and Medicaid Services asserts that penalties will be enforced for wrongful denials. As physicians weigh participation, the decision to volunteer for prior authorization could significantly impact patient care and healthcare costs.