WISeR Medicare Pilot Faces Growing CMS and Congressional Scrutiny
WSMA advocacy is driving increased congressional and Centers for Medicare and Medicaid Services scrutiny of the Wasteful and Inappropriate Service Reduction pilot program, highlighting its impact on Medicare patients and physician practices while advancing efforts to repeal the program and reduce prior authorization barriers to medically necessary care.
On June 22, WSMA Vice President Bindu Nayak, MD (pictured, second from left), joined U.S. Rep. Suzan DelBene, University of Washington physicians, and Medicare patients at a press conference highlighting the growing impact of WISeR on patient access to care. Dr. Nayak emphasized that WISeR applies prior authorization-a burdensome process that places barriers between patients and medically necessary care while increasing administrative burden on physician practices-into traditional Medicare. The event generated significant media coverage, including a Seattle Times story featuring the experiences of patients and physicians affected by the program. The following day, KFF Health News further elevated the WSMA’s concerns about the pilot.
Physician advocacy is beginning to produce results. Following months of concerns raised by the WSMA to congressional leaders, the Centers for Medicare and Medicaid Services directed WISeR contractor Virtix Health to submit a Corrective Action Plan after determining the company failed to meet required turnaround times for prior authorization and prepayment reviews. CMS will now provide increased oversight of Virtix’s performance as it works to improve response times. While this is an important acknowledgement of the program’s flaws, the WSMA continues to believe the WISeR model should be discontinued before this inherently burdensome prior authorization framework is expanded to additional traditional Medicare services.
Physician advocacy is beginning to produce results.
Momentum continues to build in Congress as lawmakers increase scrutiny of the WISeR model. Rep. DelBene has championed the Seniors Deserve SMARTER Care Act to repeal the program, while a key legislative panel recently approved language in the fiscal year 2027 appropriations bill that would prohibit CMS from using federal funds to implement WISeR or any similar model that imposes prior authorization in traditional Medicare.
Meanwhile, Washington Sens. Maria Cantwell and Patty Murray have joined Senate efforts to overturn WISeR through a Congressional Review Act resolution, arguing that the program is delaying medically necessary care and should never have been implemented without congressional oversight.
Taken together, these actions reflect growing concern about WISeR’s impact on Medicare beneficiaries and physician practices. The WSMA will continue working closely with Washington’s congressional delegation to ensure Medicare patients have timely access to medically necessary care without unnecessary administrative barriers.
Has WISeR affected your practice?
The WSMA wants to hear from you. Your experiences with delays, denials, appeals, administrative burden, or other implementation challenges strengthen our advocacy with Congress and CMS. Please share your feedback with the WSMA Policy Department at policy@wsma.org.