Members of Congress condemn Medicare model targeting ‘wasteful’ interventional radiology services
Members of Congress are condemning a proposed Medicare pilot targeting “wasteful” interventional radiology services, while a recent budget proposal is excluding funding for it.
Their concern stems from the recently announced Jan. 1 rollout of the Wasteful and Inappropriate Service Reduction (or “WISeR”) Model across six states. WISeR will target more than a dozen services CMS says are subject to abuse, including image-guided decompression of the spine, epidural steroid injections for pain management (excluding facet joints) and percutaneous vertebral augmentation.
However, U.S. Reps. Mark Pocan, D-Wis., and Jan Schakowsky, D-Ill., are roundly criticizing the model, contending it will harm seniors. This after 17 House Democrats in August also expressed concern about WISeR. The pilot plans to tap technology companies, which would use artificial intelligence to root out improper requests for over a dozen healthcare services.
“It is not an exaggeration to say that the requirement of prior authorization for traditional Medicare services will kill seniors,” Rep. Pocan said in a statement Sept. 11. “Not only that, but the use of AI in determining whether or not treatment is necessary is extremely reckless.”
Pocan and Schakowsky noted that, unlike Advantage plans, traditional Medicare is supposed to cover services with “no questions asked.” Changing this long-established precedent would be a “disastrous idea of epic proportions,” Pocan contended.
“This is unacceptable," Schakowsky said. "That is why I am proud to be joining Congressman Pocan in introducing this resolution calling for the termination of the Wasteful and Inappropriate Service Reduction (WISeR) Model. We must protect traditional Medicare.”
Meanwhile, the House Appropriations Committee approved a fiscal 2026 funding measure for Health and Human Services on Sept. 9. The budget proposal, approved by committee members in a 35-28 vote, prevents CMS from running the prior authorization pilot, according to committee documents. Congress has until Sept. 30 to pass a final bill and avoid a government shutdown. The House Appropriations Committee on Tuesday released bill text for a continuing resolution to fund the government through Nov. 21, the American Hospital Association reported.
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.