Disclaimer: This article is based on actual news from the real world – honestly! However, it has been sprinkled with a healthy dose of satire.
Fill everything in for AI to reject every procedure. (zimmytws/depositphotos)
Starting next year, Medicare will join private insurers in testing artificial intelligence to make prior authorization decisions. The program, called WISeR (Wasteful and Inappropriate Service Reduction), will run through 2031 in six states. Federal officials say the goal is to save taxpayer money by cutting back on “low-value services,” which is bureaucrat-speak for cutting back on “healthcare that would keep you alive.”
The pilot comes on the heels of the Trump administration’s announcement that insurers should reduce prior authorization delays, which confused observers since this new program is basically Prior Authorization 2: Deny Harder.
CMS promises no claim will be denied without a human clinician reviewing it first. Unfortunately, those clinicians will be chosen using the same algorithm that once recommended you buy seventeen inflatable hot tubs on Amazon and the best way to eat rocks.
Lawmakers aren’t thrilled either. Rep. Suzan DelBene accused the administration of “talking out of both sides of their mouth”, but if one of those sides was their own butthole.
Insurers claim prior authorization prevents fraud. Patients point out that it prevents treatment. Seems like now is a good time to bring up the shooting of UnitedHealthcare’s CEO again. Because apparently, insurers didn’t get the message.
The WISeR AI will initially target procedures like skin grafts, nerve stimulators, and knee scopes. Emergency care won’t be affected, which is comforting if you think Medicare’s AI won’t eventually declare your stroke “low-value.” But it definitely will.
CMS insists vendors won’t be rewarded for denial rates. Instead, they’ll earn “shared savings” for reducing costs. Which is like saying a casino doesn’t encourage gambling.
Red, you get your pacemaker. Black, it's all down to the ol' heart. (jukai5/depositphotos)
Administration spokesman Alexx Pons added that oversight will be “strict.” Translation: it will not be strict.
So here’s the deal: the same government that thought Tide Pods needed warning labels is now letting AI decide whether your pacemaker is necessary. But don’t worry, Medicare assures us it’s only a pilot. Which is fitting, because much like a Boeing Dreamliner, this one’s probably going to crash.
This story is based on fully factual news, but if we got it wrong, blame these guys, we’re just here to make it funny.
