Trump’s Healthcare Plan

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WISeR (https://www.cms.gov/priorities/innovation/innovation-models/wiser), which stands for Wasteful and Inappropriate Service Reduction, aims to use AI and machine learning to ensure “appropriate Medicare payment” for select services while benefiting taxpayers “by decreasing fraud, waste and abuse.” It was rolled out in January in six states—New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington—and intends to run until the end of 2031.

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Another vendor, Virtix, was found to be denying more prior authorization requests than it was approving. According to a weekly report on March 30, Virtix had reviewed 6,096 pre-authorization requests. It approved 2,863 of them, denying 3,233 (53 percent).


In addition to a questionable number of denials, decisions from the various contracted companies often took too long. WISeR is intended to provide authorization decisions within 72 hours, but many have taken weeks, some even months. The documents from EFF reveal at least one request was still pending after 83 days. In a survey, one healthcare provider said it “had a surgery pushed back almost two months due to zero communication.”

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The reality of WISeR’s implementation may best be captured by feedback from one healthcare provider in Ohio, which was working with Innovaccer, the vendor that initially auto-approved requests. In a survey response, the provider wrote (in all capital letters) about patients trying to get a minimally invasive surgery to treat compression fractures in their spines, saying:



I HAVE HAD TO WATCH 3 PATIENTS CRY AT BEDSIDE FOR NOT HEARING BACK ON THEIR PRIOR AUTH FOR KYPHOPLASTY/VERTABRAL AUGMENTIATION PROCEDURE. THESE PATIENTS ARE IN DEEP PAIN. SO MANY OFFICES OF MY PHYSICIANS ARE NOT HEARING BACK FROM INNOVACCER… THERE IS NO WAY TO GET A HOLD OF A HUMAN TO TALK TO… WHAT A DISGRACE TO THE HUMAN RACE IN AMERICA. THIS IS THIRD WORLD.

Another Ohio provider expressed similar frustration with Innovaccer about delayed care and lack of communication, writing in a survey response that the experience has been “extremely disappointing”:



A 3–4 day delay for necessary pain procedures is already difficult for vulnerable patients, but when providers cannot obtain answers for weeks, the situation becomes unacceptable… The lack of accessible support, accountability, and timely communication is deeply concerning. Programs affecting patient access to medically necessary procedures must have reliable provider support systems. Currently, that standard is not being met. Patients deserve better. Providers deserve answers. And systems designed to improve care should never result in preventable suffering.

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financial incentive to deny care


CMS documents, included in the packet obtained by the EFF, clearly explain that the companies implementing WISeR are financially rewarded for denying requests for care. CMS’s planning documents describes it as a “novel payment approach where the model participants are compensated based on a share of averted expenditures.”

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Trump is either a pitiful dunce who doesn't know how doctors and hospitals get paid in the US, or he's bullshitting us again or he's trying to wreck US healthcare entirely

https://th.bing.com/th?id=OIF.xpgyZfDPsAKOqVSVHB9%2fJQ&w=301&h=180&c=7&r=0&o=7&dpr=1.5&pid=1.7&rm=3



We will pass a truly great healthcare plan that will stop all payment to big insurance companies