Texas Joins Medicare AI Pilot to Cut Waste, Doctors Warn of Delays

Texas will join a Medicare pilot next year that uses AI to cut waste, but doctors warn it could delay care.

The WISeR Pilot

The pilot, called Wasteful and Inappropriate Service Reduction (WISeR), is a new prior‑authorization experiment launched by the Centers for Medicare & Medicaid Services. It will run from Jan. 1, 2026 to Dec. 31, 2031. Texas will be one of six states selected for participation. The program’s goal is to use artificial intelligence to review certain patient service requests.

What CMS Says About Waste

CMS reports that waste in health care harms patients and accounts for about a quarter of U.S. health care spending. The agency posits the WISeR model will improve patient outcomes, lower costs and reduce administrative burden. CMS says the new model will target services that are vulnerable to fraud, waste and abuse. Fourteen specific services have been identified for the pilot.

The 14 Services

CMS said the 14 services are “vulnerable to fraud, waste and abuse.” These services will be subject to the AI review process. CMS will monitor outcomes for each of these services during the pilot. The goal is to reduce unnecessary procedures and claims.

Physician Perspective – Dr. Jayesh Shah

“We’re not against WISeR, [as] its main goal is to decrease waste and abuse. We are just against anything that could delay care for patients and increase workload for our physicians,” said Texas Medical Association President Dr. Jayesh “Jay” Shah, who is also an internal medicine and wound care specialist.

Prior Authorization Explained

“Your insurance company basically looks at the documentation and decides if this is necessary for the patient,” Shah said. “Then they will decide whether to deny the claim or to approve it. And then the patient gets that service because there are several steps to this prior authorization.”

Concerns About Delays

“It sometimes causes a delay,” he continued. “That is what our main concern is with some of the prior authorization models that are out there.”

Historical Stance of the TMA

Historically, TMA has been opposed to authorization, Shah said, but physicians are hopeful WISeR will produce positive outcomes. “Some of the physicians are thinking this might be good if it works the way it is intended to do. But sometimes intentions are good, but in practice, when it rolls out, it can be harmful to our patients and may increase the workload for physicians,” Shah said.

Dr. Bob Teague’s View on AI

Dr. Bob Teague, a retired physician who now works in health technology strategy, said artificial intelligence will likely play a growing role in automating documentation and other administrative tasks in health care.

Concerns About the Human Review Requirement

But Teague said CMS’s new WISeR prior authorization model — which will require human clinical review — may not actually make the process easier for providers. “This seems a little bit clumsy in a way,” Teague said. “The intent of it, I think, is a reasonable request. I just wish that the rollout would have been just a little bit more seamless.”

The Program Timeline

The program will run from Jan. 1, 2026 to Dec. 31, 2031. Texas will begin participating in the pilot in 2026. The pilot will last for six years. CMS will evaluate the program’s impact at the end of the period.

Key Takeaways

• Texas joins a Medicare AI pilot aimed at reducing waste in health care.
• The WISeR program will cover 14 services vulnerable to fraud, waste and abuse.
• Physicians express concerns about potential delays and increased workload.

The pilot represents a significant effort by CMS to curb waste and improve patient care, but it also highlights the tension between technology and clinical workflow. As Texas prepares to roll out the program, stakeholders will watch closely to see whether the promised benefits materialize without compromising timely patient services.