Drs. Michael Liu and Rishi Wadhera Discuss CMS's WISeR Medicare Demonstration
This past summer CMS, more specifically CMMI, announced a six-year Medicare Part A demonstration that would require hospitals in six states to submit claims for prior authorization (PA) approval by non-medical, CMS-contracted, 3rd party entities using enhanced technologies, i.e., AI, for 17 medical items and services. Private/commercial Medicare or Part C Medicare Advantage plans have for years extensively used PAs though data suggests Medicare Advantage PA use has been excessive, e.g., a very high percentage of PA denials are reversed upon appeal) and widely viewed as a tool to enhance profit taking. CMMI-contracted tech/AI companies will be compensated based on a share the money saved from PAs contractors’ deny though subject to meeting quality criteria. The WISeR demo has attached a fair amount of criticism, e.g., 12 Senate Democrats and 17 House Democrats each wrote letters to HHS/CMMI noting their concerns that include the demo will present patient roadblocks, cause some patients to abandon care, risk denying necessary care, inflict substantial administrative burden on clinicians, perversely incent AI contractors and they argued Americans do not want AI involved in their healthcare decisions. The July 1 Federal Register WISeR notice is at: https://www.govinfo.gov/content/pkg/FR-2025-07-01/pdf/2025-12195.pdf.The CMS/CMMI WISeR website is at: https://www.cms.gov/priorities/innovation/innovation-models/wiser.Liu and Wadhera’s NEJM Perspective essay re: the WISeR demo is at: https://www.nejm.org/doi/abs/10.1056/NEJMp2510451. Don Berwick and Andrea Ducas’s STAT opinion essay re: the WISeR demo is at: https://www.statnews.com/2025/07/25/medicare-advantage-prior-authorization-cms-innovation-center-wiser-project/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com
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Mr. Michael Millenson Discusses the (Tragic) State of Patient Safety
The World Health Organization (WHO) defines patient safety as “a framework of organized activities to reduce risks, lower the occurrence of avoidable harm, make errors less likely, and minimize their impact when they occur.” Over this past summer the HHS Office of the Inspector General (OIG) published three patient-safety reports. (Since 2008 the OIG has published at least 24 related studies.) One published in July found hospitals failed to capture half of harm events that occurred among hospitalized Medicare patients, few were investigated and even fewer led to hospitals making PS improvements. These findings were sadly unsurprising since the OIG previously found in 2008 that 27% of Medicare patients experienced harm during hospital stays, a decade later, or in 2018, still 25% experienced harm. In an July 24 OIG letter to CMS Administrator, Dr. Mehmet Oz, the OIG noted in part that while CMS and states require hospitals to publicly report just 15 of 94 harm events, hospitals reported only 5 of 15, or 5% of all 94 harm events. HHS has yet to publicly respond to the OIG’s recent reports much less recognize them. Dedicated podcast listeners may recall I’ve previously discussed patient safety in 2015, 2017 and in 2020.A summary of the HHS OIG’s adverse events/patient safety work with a list of its publications can be found at: https://oig.hhs.gov/reports/featured/adverse-events/. Information regarding Mr. Millenson is at: https://millenson.com/.Mr. Millenson’s recent medical errors essay in Forbes is at: https://www.forbes.com/sites/michaelmillenson/2025/09/12/lessons-from-the-medical-error-that-orphaned-a-cabinet-secretary/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com
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Prof. Elizabeth Wrigley-Field Discusses Excess Deaths
Recently published research by Prof. Wrigley-Field and her colleagues found that between 1980 and 2023 the total number of US excess deaths equaled 14.7 million. Between 2010 and 2023 excess deaths ranged between 120% and 130% higher compared to other HIC (High Income Countries). Possibly more disturbing the authors found US excess deaths were moreover among working-age adults, for example, in 2023 excess deaths among US adults aged 25-44 were 2.6 times higher than in other HIC. That same year excess deaths remarkably made up almost 23% of all deaths and 46% of excess deaths were among people younger than 65 years. The causes of excess deaths since 1980 have on balance largely been the result of preventable cardiometabolic causes and drug overdoses. About these findings, Prof Wrigley-Field’s coauthor, Prof. Jacob Bor, commented, “if the US simply performed at the average of our peers, one out of every two US deaths under 65 years is likely avoidable. Our failure to address this is a national scandal.” Prof. Wrigley-Fields writings discussed during this podcast are at: https://jamanetwork.com/journals/jama-health-forum/fullarticle/2834281https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829783https://www.annualreviews.org/content/journals/10.1146/annurev-soc-031021-105213 This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com
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Devin Kellis Argues for Extinction Medicine as a Medical Specialty
The greatest threat to human health is us. Humans are the only species capable of self-annihilation. For at least the past 30 years it has been acknowledged that the earth is presently experiencing its sixth mass extinction entirely caused by anthropogenic GHG emissions. Per research published in 2023, current generic extinction rates are 35 times higher than expected background rates prevailing in the last million years under the absence of human impacts. Research published in Proceedings, the National Academy of Sciences (PNAS) in 2022 concluded, “There is ample evidence that climate change could be catastrophic. We could enter such “endgames” at even modest levels of warming.” “Facing a future of accelerating climate change while blind to worst-case scenarios is naïve risk management at best and fatally foolish at worst.”Mr. Kellis’s August article (and related podcast), “Why Should Extinction Medicine Be a Specialty?” appears in the recent AMA Journal of Ethics special issue on extinction medicine, at: https://journalofethics.ama-assn.org/issue/existential-health-care-ethicsThe recent SSRN pre-print on extinction medicine is at: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=5109482The recent IPPNW-AMA Journal of Ethics webinar on the ethics of human extinctions: To sign up for the Extinction Medicine Reading Group, a new IPPNW Medical Student Movement initiative that will promote international, intergenerational, and interdisciplinary discussion on writings on the science, ethics, and medicalization of human extinction, go to: https://forms.gle/pLspc5URhu9VcuS37Mr. Kellis can be reached via : www.devinkellis.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com
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The Sabin Climate Law Center's Dr. Maria Antonia Tigre Discusses the ICJ's Recent Climate Advisory Opinion
On July 23rd the United Nations’ International Court of Justice (ICJ) announced its highly-anticipated climate advisory opinion. The opinion represents a watershed moment because the court ruled states or countries are accountable for contributing to anthropogenic warming or for their GHG emissions. Consequently, the ICJ concluded countries are legally obligated to ensure the climate is protected from GHG emission, if not, countries - and private actors such as healthcare - can be held culpable for failing to do so. Though an advisory opinion the ICJ ruling has significant implications for US healthcare largely because US healthcare annually accounts for a massive amount of GHG emissions at over 600 MMT of CO2e and the federal government has neither enacted legislation nor promulgated regulations that require healthcare mitigate its GHG emissions. Not surprisingly, healthcare has ignored the 2023 UN resolution that requested the ICJ opinion and now the opinion. The ICJ opinion is at: https://www.icj-cij.org/case/187/advisory-opinionsThe Columbia University Sabin Center’s Climate Change Law Blog ICJ symposium writings are at: https://blogs.law.columbia.edu/climatechange/category/blog-series/ This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com
About The Healthcare Policy Podcast ® Produced by David Introcaso
Podcast interviews with health policy experts on timely subjects.
The Healthcare Policy Podcast website features audio interviews with healthcare policy experts on timely topics.
An online public forum routinely presenting expert healthcare policy analysis and comment is lacking. While other healthcare policy website programming exists, these typically present vested interest viewpoints or do not combine informed policy analysis with political insight or acumen. Since healthcare policy issues are typically complex, clear, reasoned, dispassionate discussion is required. These podcasts will attempt to fill this void.
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Implementation of the Affordable Care Act
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Federal health care regulatory oversight, moreover CMS and the FDA
Healthcare research
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