Tenet executives said the Dallas-based system is prepared for a new traditional Medicare prior authorization pilot that is set to begin in January.
CMS unveiled the Wasteful and Inappropriate Service Reduction (WISeR) initiative in June. Under the model, CMS will partner with companies specializing in AI and machine learning to test ways to provide an improved and expedited prior authorization process for certain Medicare services. Companies hired to manage the initiative will be paid based on how much money they save the federal government by stopping payment for unnecessary or noncovered services.
The program is set to run from Jan. 1, 2026, through Dec. 31, 2031, in Arizona, Washington, New Jersey, Texas, Ohio and Oklahoma.
During Tenet’s Oct. 28 earnings call, an investor asked executives how the system is preparing for the program, particularly in its ambulatory business segment, United Surgical Partners International.
“The WISeR program still has some uncertainty about what scope of services it will be implemented for,” Tenet Chairman and CEO Saum Sutaria, MD, said. “We have taken into consideration what will be required there. There are really three threads there. One is understanding of documentation requirements for appropriate care. Two is actually consistently complying with those. And three is the operational element of managing our scheduling to be complemented by preauthorization having been achieved.”
Dr. Sutaria said the system is prepared to do all of that.
“We don’t talk about it much, but we have a very capable revenue cycle function within USPI that deals with all of the end-to-end type of services that are required there, and so we feel pretty good about that. The other thing is in any marketplace, when these types of things are introduced, there’s an adjustment period, but also physicians have the opportunity to adjust different mixes into the centers, especially the ones that have block time. I think the move here will also be to work with the physicians to increase their commercial mix in that process.”
Some lawmakers — House Democrats in particular — have scrutinized the program, particularly its use of AI to test methods for expediting prior authorization, and introduced a resolution opposing WISeR.
The American Hospital Association has asked CMS to delay the program by at least six months, calling the timeframe impractical for providers and saying it “jeopardizes the administration’s goal of easing provider administrative burden associated with prior authorization.” The AHA also advocated for several changes, such as using a flat-fee model instead of a vendor payment structure that “incentivizes denials at the expense of physician medical judgment.”
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