The WISER Model: When Denying Medicare Claims Pays. Prior Authorization, AI & the Ethics of "No"
カートのアイテムが多すぎます
カートに追加できませんでした。
ウィッシュリストに追加できませんでした。
ほしい物リストの削除に失敗しました。
ポッドキャストのフォローに失敗しました
ポッドキャストのフォロー解除に失敗しました
The WISER Model: When Denying Medicare Claims Pays. Prior Authorization, AI & the Ethics of "No"
-
ナレーター：
-
著者：
Who gets to decide whether you receive the care your doctorordered — and what happens when the person deciding is rewarded for saying no?
Mike and Rob dig into WISER, a new Medicare model (theWasteful and Inappropriate Service Reduction model) that pairs AI and machine learning with human reviewers to evaluate whether certain services get approved. Prior authorization isn't new, and reducing genuine waste is a good thing — but this episode is about what happens when financial incentives, algorithms, and blurred accountability get built into that decision.
They work through the ethics underneath: the appeal processmost patients never use, the human cost of a wrongful denial, the conflict of interest in paying reviewers based on what they save, and the accountability gap when "the algorithm decided." Along the way — the GAO's review, the congressional fight over the model, and two personal stories (including Mike's father's months-long battle over a Medicare eye referral) that put a face on the whole thing.
No easy villains, no partisan axe to grind — just the fourpillars of medical ethics applied to a system where, as Rob puts it, complicated structures can quietly hide who's responsible.Join the conversation. Let's get ethical.