Ohio is set to embark on a controversial pilot program that will use artificial intelligence (AI) to make crucial decisions about Medicare prior authorizations for its elderly population. This initiative, named “WISER” (Wasteful and Inappropriate Service Reduction), is one of only six such programs across the United States and has raised significant concerns among healthcare advocates and residents alike.
Under this pilot program, AI technology will determine whether seniors receive approval for essential medical procedures, including steroid injections for pain management, knee arthroscopy, and treatments for incontinence. Critics of the program are voicing their unease about the potential ramifications of allowing AI to have such a significant impact on healthcare decisions for some of Ohio’s most vulnerable citizens.
Chris Quinn, a member of the Today in Ohio podcast crew, expressed his concerns regarding the reliability of AI in this capacity. “AI is a great tool when used correctly, but if it starts denying benefits, we do know AI hallucinates on occasion,” he said. This raises fears that seniors could be denied necessary treatments due to errors in AI judgment.
Podcast hosts highlighted that while officials have assured that all AI-driven decisions will undergo human review, there are significant doubts about the effectiveness of this oversight. Lisa Garvin referenced a discussion with the founder of the Center for Medicare Advocacy, who indicated that human reviews are often not conducted adequately. Furthermore, critics argue that AI companies might have a financial incentive to deny care, as they stand to benefit from the savings generated by such denials.
The program comes at a time when prior authorization practices are already causing challenges in healthcare delivery. Data from 2023 indicated that 12% of Medicare Advantage prior authorization requests were denied, with an alarming 80% of those appeals being overturned. However, navigating the appeals process is complex, and many seniors do not appeal denials, placing them at an even greater disadvantage as the new AI-driven system is implemented.
For senior Ohioans, this experiment adds another bureaucratic layer that could impede their access to essential healthcare services. Residents have expressed concerns about losing accountability within the Medicare system and facing increased obstacles when seeking approval for necessary treatments.
The six-year trial is slated to commence in January, although details regarding its funding remain uncertain. The targeted services for the program accounted for approximately $5.8 billion in costs in 2022, representing a substantial portion of senior healthcare spending. As Quinn noted, many elderly residents fear that they will be further marginalized in their healthcare journeys, expressing a sense of losing control and accountability in a system that should advocate for their needs.
