AHA shares concerns, recommendations with CMS on WISeR model
The AHA Oct. 23 recommended changes to the Centers for Medicare & Medicaid Services’ Wasteful and Inappropriate Services Reduction model to address multiple concerns. The model is designed to use technology-enabled prior authorization to decrease services that CMS considers having little to no clinical benefit for some patients. The AHA expressed concerns about the WISeR model’s payment structure for participating vendors, appeal rights, oversight on the use of AI, oversight of vendors used by Medicare Advantage plans, expansion of the model’s scope and its implementation timeline, among other details. The model, scheduled to begin Jan. 1, will be conducted in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. The AHA urged CMS to delay its implementation by at least six months.
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