Make no doubt that there have been two top targets for Republicans of all stripes since the New Deal became ensconced in our country. The first, of course, is Social Security. Target numero uno since it was signed into law in August of 1935, Social Security is to Republicans the very essence of socialism. Imagine being able to quit working with dignity after a certain age without starving? What a concept.
In a very close second is the Medicare program which provides health care for the elderly. Made into law in July of 1965, Medicare saved seniors from dying way before their time due to lack of funds to pay hospital and other care needs. While it had some drawbacks such as the co-pay that Republicans insisted on, it was still a godsend to Americas elderly. Democrats hoped that a Medicare system for all would follow closely behind.
However, Republicans for 60 years have been able to stop any furtherance of Medicare, at the behest of their funders, Americans inurance companies. While Republicans haven’t been able to kill Medicare they have been able to do the next best thing and wound it in such a way that its full effectiveness has been blunted.
Now it looks like they have a weapon that could wound it to the point where it will be wounded to the point where it can be drastically altered to the point where it will look very much like the gawd awful mess we call privatized health insurance in this country. Like so many Republican initiatives, it has a name that sounds like something that favors people while actually hurting them badly.
It is called the WISeR program (Wasteful and Inappropriate Service Reduction model). This program will very much resemble both the current Medicare Advantage scam and privatized health insurance. The biggest single feature will be the introduction of pre-authorization for procedures. With current gold-standard Medicare today, there is no preauthorization. Now with real Medicare, the doctor and the patient decidewhat care is needed and Medicare is billed for the service.
Here is a brief overview of the WISeR model and why it will be very bad for seniors. (8:20)
Couple things to note here:
- This is supposedly a pilot evaluation that is supposed to last 6 years.
- Since Republicans make things up as they go, I think we can expect them to push to expand the program quickly claiming great (but unsubstantiated) results.
- As noted the rollout will be in 6 states (New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington). As I noted expect a push to expand the program quickly, so you may be drawn in much sooner than you would like.
- A major note that this change was not done by legislation, but by the CMS without congressional input. However, congressional input could certainly stop and reverse this move. It must be an election issue.
- As also noted in the video, there will be incentives for pre-authorizers to deny claims. This is most certainly the wrong place to put incentives.
- Much of the planning and implementation for this major scam has been done while the media has been covering diversions the Trump administration has been involved in.
- Once again, THIS MUST BE AN ELECTION ISSUE! Republicans now have cover to wreck the essence of Medicare without a peep.
tip of the hat to all-hat-no-cattle.com
Services Targeted for Prior Authorization
The services eligible for prior authorization under WISeR include:
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Electrical Nerve Stimulators
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Sacral Nerve Stimulation for Urinary Incontinence
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Phrenic Nerve Stimulator
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Deep Brain Stimulation for Essential Tremor and Parkinson’s Disease
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Vagus Nerve Stimulation
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Induced Lesions of Nerve Tracts
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Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea
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Epidural Steroid Injections for Pain Management, Excluding Facet Joint Injections
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Percutaneous Vertebral Augmentation for Vertebral Compression Fracture
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Cervical Fusion
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Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee
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Incontinence Control Devices
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Diagnosis and Treatment of Impotence
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Percutaneous Image-Guided Lumbar Decompression for Spinal Stenosis
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Skin and Tissue Substitutes
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Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds
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Wound Application of Cellular and/or Tissue-Based Products, Lower Extremities
Providers and suppliers of the above-listed services for Original Medicare beneficiaries will have the choice of submitting a pre-service, prior authorization request through the WISeR model or going through post-service, prepayment review.
Services Have Existing Clinical Validation
Although CMS considers the above services suspect, it should be noted that they all fall under national coverage determinations (NCDs) or local coverage determinations (LCDs), including some that are subject to coverage with evidence development requirements. Rigorous evidence reviews and established standards of care are required before CMS grants an NCD or the Medicare Administrative Contractors (MACs) grant an LCD. These services have also passed the U.S. Food and Drug Administration’s “safety and effectiveness” thresholds.
tip of the hat to all-hat-no-cattle.com
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