Controversial Medicare cost-cutting initiative may kill seniors, radiology society warns
The Society of Interventional Radiology on Monday formally announced its opposition to a controversial new Medicare model aimed at cutting unnecessary IR service.
SIR is criticizing the Wasteful and Inappropriate Service Reduction (or “WISeR”) Model, which was first announced by the feds in late June. Medicare plans to roll out the pilot across six states, tasking tech companies with using artificial intelligence to root out requests for certain low-value interventional services.
However, SIR—which represents over 8,000 members in the specialty—believes the model is “fundamentally at odds with the administration’s stated priority to reduce administrative burden in healthcare delivery.”
“Prior authorization has consistently been shown to impose excessive and often harmful bureaucratic barriers, particularly in specialty care such as interventional radiology, where timely access to image-guided, minimally invasive procedures is essential,” SIR leaders wrote in a Sept. 22 letter to Centers for Medicare & Medicaid Services Administrator Mehmet C. Oz, MD, MBA. “These delays can have severe clinical consequences, especially for elderly patients with vertebral compression fractures, a vulnerable population that depends heavily on Medicare coverage.”
WISeR is slated to begin on Jan. 1 and last five years, operating in New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington. It will target over a dozen services, including image-guided decompression of the spine, epidural steroid injections for pain management (excluding facet joints), and percutaneous vertebral augmentation. Medicare has noted that such services often are prone to abuse, and it’s offering incentives to tech firms to help curb their use.
SIR noted there is robust clinical evidence underscoring the benefits of vertebral augmentation, an image-guided procedure using bone cement to stabilize and reinforce fractured vertebrae. One landmark study published in 2020 showed the powerful impact of the procedure, not just in palliative care, but also for saving lives. Adding prior authorization to deny or delay this service will likely increase both morbidity and mortality, SIR emphasized.
The society forecasted, based on previous data, that upward of 96 Medicare beneficiaries could die in the first year of WISeR, due to vertebral augmentation care delays.
“Even under conservative assumptions, these numbers represent a significant and preventable loss of life attributable solely to administrative delay,” SIR President Robert A. Lookstein, MD, and CEO Eve Lee, MBA, wrote. “Moreover, this estimate reflects only a fraction of the total Medicare population that undergoes vertebral augmentation each year. Scaling the impact across thousands of patients could result in hundreds to thousands of avoidable deaths nationwide.”
The society is strongly urging CMS to remove prior authorization requirements for vertebral augmentation in the new model and any future such pilot demonstrations. It’s also urging the administration to engage with interventional radiologists and other clinical stakeholders to better understand the real-world ramifications of prior authorization.
“We appreciate the opportunity to provide comments and urge CMS to reconsider this harmful provision,” the letter writers concluded. “Given the seriousness of this issue, we respectfully request a meeting with CMS to discuss our concerns further and explore potential alternatives that protect both patient care and program integrity.”
SIR joins other opponents of the model, including the Medical Group Management Association, American Osteopathic Association and the Congress of Neurological Surgeons. Two Democratic members of the U.S. House also recently condemned WISeR, agreeing with SIR that the pilot “will kill seniors.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.