Arizona Pain Specialist Says CMS's WISeR Model is Disrupting Patient Care

March 20, 2026

Arizona Physician Describes Challenges Following WISeR Model's Implementation 

In an exclusive article published by The Washington Post this week, physicians and patients weighed in on the immediate shortcomings of the Centers for Medicare & Medicaid Services newly-launched Wasteful and Inappropriate Service Reduction (WISeR) Model, which adds prior authorization requirements for select Medicare services.

The model utilizes artificial intelligence and machine learning alongside human clinical review to “reduce clinically unsupported care.”


Prior Authorization Creates Disruptions


Healthcare is suffering because of prior authorization’s shortcomings. It routinely interferes with the physician-patient relationship and delays the delivery of care, even in life-threatening situations. It creates unrealistic administrative workloads for our clinics. And, it's adding to the dire healthcare workforce shortages our state and country face.

The WISeR Model is only making matters worse. Despite the physician community's concerns about the AI-driven model, its rushed implementation, and its lack of stakeholder input, CMS launched the program on January 1.


ArMA Physician Shares WISeR-driven Challenges


ArMA member Matthew Crooks, MD — director of Pinnacle Pain at OrthoArizona and president of the Arizona Society of Interventional Pain Physicians — spoke with The Washington Post about how the model is already disrupting patient care for pain specialists.


Richard Hynds, one of Dr. Crooks' patients, suffers from severe lower back pain, for which he receives steroid epidural injections. These injections allow him to exercise, developing core strength to mitigate the pain long-term, he told The Washington Post. However, once the WISeR Model began, Hynds was repeatedly denied prior authorization for the injection. He had to wait more than a month before he was approved, suffering through severe pain throughout.


Dr. Crooks described the WISeR Model as significantly different from other prior authorization processes: “we’re seeing far, far more denials with Medicare WISeR than we’ve seen in the past with commercial insurances and Medicare Advantage.”

He also described long wait times, with medical staff sitting on hold for up to 90 minutes at a time just to schedule a peer-to-peer review. "Once scheduled, those conversations often occur about a week or more later, leaving patients waiting," The Washington Post reported.


Medical Organizations in Arizona, Other Pilot States Oppose the Program's Implementation


The Arizona Medical Association and other medical organizations nationwide have taken a prominent role in opposing the program's implementation.


In a letter to CMS Administrator Dr. Mehmet Oz, ArMA President Dr. Jason Jameson, along with medical association leaders from the other affected states, requested a halt to the program and asked the agency to collaborate with "stakeholders to design payment processes that protect the Medicare Trust Fund while achieving value, without jeopardizing patient access."

The associations argued the initiative shifts critical clinical decisions away from physicians and patients without adequate transparency, stakeholder input, or evidence demonstrating improved patient outcomes.


Arizona's Prohibition of AI-driven Medical Claims 


Last year, the Arizona Medical Association successfully advocated for state legislation to prohibit AI-driven medical claim denials. The legislation prohibits health insurance companies from relying solely on AI to deny medical claims, requiring medical directors to individually review denials and exercise independent medical judgment. The law was signed on May 12, and takes effect June 30, 2026.


The law sets a national precedent for regulating AI's use in commercial medical insurance, putting Arizona ahead in the race to ensure regulation keeps up with development and implementation. While the new legislation will put a stopper in an issue physicians have identified as pervasive, it does not apply to Medicare or Medicaid coverage.


Sources: The Washington Post

ADHS Issues Standing Orders for Flu, COVID-19 Vaccine Access

By Admin User • September 18, 2026
Statewide orders keep pharmacists and physicians authorized to vaccinate Arizonans amid uncertainty over the next ACIP meeting. Statewide Orders Cover the 2026-27 Flu & COVID Season The Arizona Department of Health Services has issued statewide standing orders supporting access to the 2026-27 influenza and COVID-19 vaccines approved by the U.S. Food and Drug Administration. Arizonans seeking a flu or COVID-19 vaccine should contact their physician or pharmacy to confirm availability. Why the Orders Were Issued Arizona pharmacists may administer vaccines recommended by the Advisory Committee on Immunization Practices, vaccines recommended by the Centers for Disease Control and Prevention for international travel, or vaccines authorized under a prescription, including a physician-issued public health standing order. With the timing of the next ACIP meeting uncertain, ADHS worked with the Arizona Board of Pharmacy to issue statewide standing orders for the flu and COVID-19 vaccines, which function as a prescription allowing pharmacists and physicians across Arizona to administer them to anyone who wants one. ADHS Medical Advisor Weighs In "Vaccines are one of the most important tools we have to protect our communities. The Influenza and COVID-19 vaccines have been proven safe and effective at preventing severe illness, hospitalization, and death. Vaccines help us limit the spread of disease, reduce pressure on our healthcare system and reduce costs," said Dr. Richard Carmona, ADHS public health medical advisor and the 17th U.S. Surgeon General. "We have issued these standing orders to ensure safe and timely access to the vaccines in alignment with scientific and evidence-based guidance." What Arizonans Should Know The standing orders do not require every pharmacy to offer vaccinations, and they do not guarantee insurance coverage for administration. Coverage and out-of-pocket costs vary by plan, so Arizonans should check with their insurance provider before scheduling an appointment. 

Arizona Asks Supreme Court to Halt Prison Health Care Takeover

By Admin User • September 18, 2026
State attorneys seek an emergency stay after lower courts reject bids to delay receivership of the prison health care system. State Makes a Last-Ditch Appeal Attorneys for the Arizona Department of Corrections, Rehabilitation and Reentry asked the U.S. Supreme Court this week to delay a court-ordered receivership of the state's prison health care system. The request comes after both a federal district court and the 9th U.S. Circuit Court of Appeals declined to pause the takeover. In the recent application, former U.S. Solicitor General Paul Clement, a representative of the department, argued that the state deserves more time to make its case before surrendering control of its operations, including oversight of its employees and health care budget. Roots of the Case The dispute began in 2012 when inmates sued the department, alleging the prison system's inadequate medical, mental health, and dental care amounted to cruel and unusual punishment under the Eighth Amendment. The case went through years of litigation and a failed settlement agreement. In 2023, U.S. District Judge Roslyn Silver ruled that the health care system was "grossly inadequate." The court ordered the prison healthcare system to comply with more than 150 "quality indicators," but according to court-appointed monitors, the department failed to comply with 131 of the measures. In light of this finding, Silver named Annette Chambers-Smith, former director of the Ohio Department of Rehabilitation and Correction, to take over as receiver effective Oct. 19. Arguments on Both Sides Clement argues receivership should be the last resort and that Silver moved to it too quickly. He asserts that the department has made measurable progress, including growing its health care staffing by more than 50%, expanding substance-use treatment access, and adopting a new care model. Corene Kendrick, deputy director of the American Civil Liberties Union National Prison Project, which represents the roughly 25,000 people incarcerated in Arizona prisons, called the department's request a "Hail Mary" and said Silver had given the department years of opportunities to comply before ordering receivership. What Happens Next The Supreme Court has not yet set a deadline for the plaintiffs to respond to the stay request. Separately, the 9th Circuit is now reviewing the merits of the receivership order itself. The department filed its opening brief on Sept. 15, and the plaintiffs' response is due Oct. 15. Information in this article was sourced from the Arizona Mirror .