A new report from Sen. Maria Cantwell (D-WA) on Medicare’s Wasteful and Inappropriate Service Reduction (WISeR) prior authorization pilot should raise red flags for practices. Washington State hospitals and clinicians describe the new WISeR model—built around an AI-enabled prior auth vendor—as significantly delaying care for seniors and increasing administrative friction.
According to the report, turnaround times for services newly subject to WISeR prior authorization have stretched from a few days to two–three weeks, even for patients with urgent needs. Hospitals cite dozens of cases in which medically necessary procedures were postponed purely due to pending authorizations, with staff often unable to obtain timely information or speak to a clinician decision-maker. While the pilot is currently limited to six states including Washington, it reflects a broader trend: deploying aggressive utilization controls before adequate guardrails, transparency, and clinical input are in place.
For gastroenterologists, the initial WISeR experience is a cautionary tale about the risks of “black box” prior authorization—especially when models rely heavily on algorithms and non-GI clinical criteria. The report underscores several principles ASGE has consistently advanced in the context of prior authorization reform: the necessity of clear, evidence-based criteria developed with specialty societies; enforceable timeliness standards; straightforward peer-to-peer and appeals processes; and meaningful physician oversight when automation is used.
As CMS evaluates WISeR’s performance, ASGE and others will be watching closely and advocating to ensure any future Medicare prior authorization models do not replicate these access problems for endoscopy and GI care.