Fierce Healthcare writer, Dave Muoio reported that initial hospital data presented to Congress indicates that Medicare patients are experiencing longer wait times for care under a new AI-supported prior authorization pilot launched by Centers for Medicare & Medicaid Services.

The WISeR Model, introduced January 1 across six states, aims to reduce fraud, waste, and abuse by applying artificial intelligence to evaluate prior authorization requests for selected services.

However, findings shared by Senator Maria Cantwell based on data from Washington State hospitals show procedure completion times increasing from approximately two weeks to as long as four to eight weeks due to authorization delays.

Hospitals reported that urgent authorizations, previously processed within a day, are now taking 15 to 20 days, with some patients rescheduled multiple times while waiting for approval.

The report also highlights nearly 100 patients awaiting certain procedures, such as epidural steroid injections, as delays accumulate under the model.

Concerns raised include increased administrative burden, reduced transparency in AI decision-making, and potential conflicts of interest tied to third-party administrators benefiting financially from denied claims.

During a Senate hearing, Robert F. Kennedy Jr. acknowledged the delays as unacceptable while maintaining that the program is intended to address improper Medicare spending.

Provider organizations and industry groups have reiterated prior concerns that expanding prior authorization into traditional Medicare may introduce new operational barriers and patient access challenges.

The pilot reflects a broader shift toward integrating AI into utilization management processes, though early feedback suggests operational and clinical impacts remain under scrutiny.

Source: AI-powered prior authorizations for Medicare have greatly delayed care, Washington state hospitals say