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Medicare pilot encouraging AI for pre-approvals led to a big drop in services, study finds

Epidural steroid injections fell 15% and other targeted services about 20% in six states, a JAMA study found

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Researchers at the University of Minnesota and Brown University reported in JAMA that use of services targeted by a Medicare prior authorization pilot dropped after the program launched in six states. Epidural steroid injections used to treat back pain dropped by 15%, and the remaining targeted services dropped by roughly 20%, relative to states that were not part of the pilot.

The pilot, called WISeR (Wasteful and Inappropriate Service Reduction), began in January and runs for six years in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. It requires clinicians in traditional Medicare to obtain sign-off before coverage applies to selected services regarded as prone to fraud, waste and abuse. The........

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