Oppose the WISeR Model Medicare Prior Authorization Program

I am writing to urge you to oppose the Wasteful and Inappropriate Service Reduction (WISeR) Model, a Medicare pilot program scheduled to begin in January in Ohio and five other states. This program represents a dangerous shift that will deny necessary care to over 2.5 million Ohioans enrolled in Medicare, including our most vulnerable elderly and disabled residents. For the first time, traditional Medicare will require prior authorization for medical procedures, using AI algorithms to approve or decline care. The targeted procedures include steroid injections for pain management, electrical nerve stimulator implants, knee arthroscopy, incontinence control devices, and cervical fusion. These services represented approximately $5.8 billion in spending in 2022. The AI companies overseeing this initiative will receive a share of savings from denied claims, creating a direct financial incentive to deny care to patients who need it. The evidence shows this system fails patients. In 2023, about 12% of prior authorization denials for Medicare Advantage were appealed, and more than 80% of those denials were overturned. This means patients are being wrongfully denied care, and the vast majority never appeal due to system complexity. Nearly one in five insured adults experienced claim denials in a 12-month period according to KFF's 2023 survey. Charlotte Rudolph of Universal Health Care Action Network of Ohio stated this program "will save money at the cost of the patients." Judith Stein from the Center for Medicare Advocacy warned it "creates a barrier between what physicians and other healthcare providers order and want as medically necessary for their patients and what can be provided based on algorithms." Carrie Graham of Georgetown University's Medicare Policy Initiative called it "a backdoor way of putting everybody in a Medicare Advantage plan." I urge you to defund this program and protect traditional Medicare's guarantee of physician-directed care without algorithmic interference. Our seniors deserve better than becoming test subjects for profit-driven AI systems.