Senate Democrats’ push to end Medicare prior authorization pilot fails
Senate Democrats’ push to end a controversial new prior authorization pilot program in Medicare has failed, with lawmakers vowing to continue the fight.
Sen. Patty Murray, D-Wash., vice chair of the Senate Appropriations Committee, had recently introduced a resolution to overturn the Wasteful and Inappropriate Service Reduction. Launched on Jan. 1 in six states, WISeR is tasking tech companies with using AI to root out services Medicare says are subject to abuse, including some interventional procedures.
However, the Senate voted 50-46 to quash Murray’s Congressional Review Act on July 16.
“Democrats tried to stop AI prior authorization in Medicare. Republicans blocked it,” Murray said in a post shared on X.com after the vote. “Apparently they agree with Trump that AI knows better when it comes to healthcare decisions for our seniors. This isn't the end. We'll keep fighting back.”
Sen. Mike Crapo, R-Idaho, meanwhile, defended the WISeR program ahead of the vote.
"Every member of this body agrees that patients should have access to high-quality care, providers deserve predictable payment for services, and avoidable waste, fraud, and abuse in Medicare should be stopped," he said according to MedPage Today. "Ending this pilot program prematurely will deprive CMS of a useful tool to accomplish each of those goals. And I urge my colleagues to consider the facts and oppose this resolution."
The Society of Interventional Radiology, which strongly opposes WISeR, expressed disappointment about the decision on Monday. It echoed previously made comments that prior authorization in traditional Medicare creates “unnecessary barriers to medically necessary, evidence-based care.”
“While we support efforts to strengthen program integrity and reduce fraud, waste, and abuse, those efforts must not come at the expense of timely patient access to clinically appropriate treatments,” the society said in a statement shared with Radiology Business. “SIR will continue to advocate for policies that protect Medicare beneficiaries and preserve physician-led clinical decision making.”
More on WISeR
First introduced last June, WISeR has targeted services including image-guided decompression of the spine, epidural steroid injections for pain management (excluding facet joints), and percutaneous vertebral augmentation. The latter, also known as PVA, uses X-ray guidance to inject bone cement into the fractured vertebrae.
CMS has partnered with for-profit technology vendors, who utilize AI to pinpoint healthcare services the feds say are often subject to abuse. The agency in November announced six participants in the pilot (one for each state), including radiologist-owned technology company Humata Health.
Both politicians and providers have expressed strong opposition to WISeR since its inception. Amid some of these concerns, CMS in April said it was delaying implementation of WISeR for percutaneous image-guided lumbar decompression for spinal stenosis.
Previously, a key committee of the U.S. House of Representatives in June voted to halt the pilot program, which is taking place in New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington.
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.