Artificial Intelligence (AI) to be used to review Medicare outpatient procedures

From Washington State Standard

The new Medicare prior authorization model, known as Wasteful and Inappropriate Services Reduction, or WISeR, will work with third-party companies deploying artificial intelligence to decide if traditional Medicare enrollees qualify for certain outpatient procedures.

Health care professionals will review denials that the AI technology makes. Procedures covered are those the federal government sees as too costly for the resulting medical benefit, such as impotence treatment, deep brain stimulation and knee arthroscopy for osteoarthritis.

Dr. Matt Hollon, with the Washington State Medical Association, is among those unconvinced that the program is a move in the right direction. "Patients expect their care to be guided by doctors, not insurance companies or automated systems." 

The third-party companies involved will be compensated with a share of the savings they generate, stoking fears the decision-makers will be incentivized to deny approval.

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