Interventional Radiologists Push Back Against New Medicare Pilot Program

The Society of Interventional Radiology (SIR) has come out strongly against a new federal initiative that would use artificial intelligence to restrict certain image-guided procedures, warning the plan could jeopardize patient safety and access to care.

The program, known as the Wasteful and Inappropriate Service Reduction—or WISeR—Model, was unveiled by Medicare officials in June and is scheduled to launch January 1. It will run as a five-year pilot in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. The model enlists technology companies to apply AI-based tools in reviewing requests for more than a dozen interventional procedures that the government views as potentially overused, such as vertebral augmentation, epidural steroid injections, and spinal decompression.

SIR, which represents more than 8,000 interventional radiologists, argues the program contradicts the administration’s stated goal of reducing paperwork and administrative burden in healthcare. In a September 22 letter addressed to CMS Administrator Mehmet Oz, MD, MBA, society leaders described the plan as “fundamentally at odds” with the principles of patient-centered care.

“Prior authorization already imposes significant barriers in interventional radiology, where patients often require timely access to minimally invasive, image-guided procedures,” the group wrote. “Adding another layer of delay risks worsening outcomes, particularly for elderly Medicare beneficiaries with painful and debilitating vertebral compression fractures.”

SIR underscored the strong body of evidence supporting vertebral augmentation, a procedure that uses bone cement to stabilize fractured vertebrae. A landmark 2020 trial showed that the technique not only improves pain and function but may also improve survival. By introducing new approval hurdles, the society cautioned, Medicare could inadvertently increase mortality.

The organization’s own projections are sobering: delays tied to WISeR could result in as many as 96 avoidable deaths in the first year of the program among Medicare patients awaiting vertebral augmentation. Scaled across the entire population, this number could rise to several hundred—or even thousands—of preventable deaths over the course of the five-year pilot.

SIR President Robert Lookstein, MD, and CEO Eve Lee, MBA, emphasized that even under conservative assumptions, the model’s consequences are likely to be severe. “These numbers reflect a significant and preventable loss of life attributable solely to administrative delay,” they noted in their joint statement.

The society is urging CMS to exclude vertebral augmentation from the new program and to collaborate more closely with interventional radiologists and other frontline specialists before implementing policies that could impact urgent care delivery. They have also formally requested a meeting with federal officials to discuss alternatives that would preserve program integrity without endangering patients.

SIR’s stance has gained support from other medical organizations, including the Medical Group Management Association, the American Osteopathic Association, and the Congress of Neurological Surgeons. Lawmakers have also begun weighing in, with two members of Congress warning that the WISeR model, if implemented as designed, “will kill seniors.”

As the January start date approaches, the debate underscores broader tensions between efforts to curb low-value care and the risks of restricting proven, life-saving interventions. For interventional radiologists, the message is clear: safeguarding patient access must remain the priority.