The Trump Administration's latest healthcare move could endanger countless lives while wasting billions of taxpayer dollars. With the unveiling of the Wasteful and Inappropriate Service Reduction (WISeR) model by the Centers for Medicare and Medicaid Services (CMS), a troubling trend emerges: the expansion of prior authorizations in Traditional Medicare, which have proven detrimental in privatized Medicare Advantage plans.
Expansion of Prior Authorizations Poses Risks
Prior authorizations (PAs) are already notorious for delaying access to necessary care, a reality highlighted by a 2024 American Medical Association survey. A staggering 93 percent of physicians reported that prior authorizations delayed access to critical services. The introduction of PAs to Traditional Medicare threatens to exacerbate this issue, leading to potential delays and denials of essential care.
Profits Over Patients with AI Contracts
CMS's new model aligns itself with profit-driven motives, as it contracts with companies utilizing artificial intelligence to determine the necessity of care. This approach not only risks denials based on flawed algorithms but also incentivizes companies to maximize profits by reducing care. According to a report on machine learning in health financing, reliance on AI creates a dangerous precedence, prioritizing corporate profits over patient well-being.
Medicare Pares Payment Model Portfolio, Saving $750 Million (1)
Administrative Burdens Will Skyrocket
The administrative expenses associated with prior authorizations are staggering. Physicians reportedly spend an average of 13 extra hours per week dealing with PAs, diverting valuable time and resources away from patient care. As reported by the Medicare Payment Advisory Commission, the move to increase administrative burdens in Traditional Medicare will lead to higher costs for taxpayers, compounding the already exorbitant healthcare expenses in the U.S.
Failure to Address Real Waste in Healthcare
The WISeR model is pitched as a solution to the $5.8 billion spent on what CMS identifies as low-value care. However, this approach fails to confront the massive overpayments occurring within the Medicare Advantage system, which amount to an estimated $84 billion in 2025 alone. The Committee for a Responsible Federal Budget projects that over the next decade, these overpayments could reach a staggering $1.2 trillion.
AMA series helps doctors share what they wish their patients knew - The ...
Corporate Interests Undermine Healthcare Access
The WISeR model's structure reflects a disturbing trend: prioritizing corporate interests over healthcare access. By contracting with for-profit companies that are incentivized to deny care, the administration creates a system where the bottom line trumps patient needs. The Senate Permanent Subcommittee on Investigations has already uncovered how major insurers like United Healthcare and Humana have been denying essential services under similar models. These practices lead to millions of denied claims that should rightfully be covered, as indicated by the Consequences and Future of Prior-Authorization Reform.
The Dangers of AI in Healthcare
Moreover, the reliance on AI in healthcare decisions raises ethical and practical concerns. Studies have shown that AI systems can be manipulated, leading to biased outcomes that favor denial over patient care. Reports reveal that the FDA's AI models have difficulty accurately assessing data, raising alarms about their deployment in life-or-death healthcare decisions. As reported by the Ethical and Legal Challenges of Artificial Intelligence-driven Healthcare, the introduction of AI into this process is a gamble that could endanger the health of countless Americans.
Thank You - HAP Medicare | Michigan Health Insurance | HAP
