The Center for Medicare and Medicaid Innovation (CMMI) at CMS has one mission: to design and test payment models that reduce healthcare costs while improving patient-centered care. Over the years, it has launched numerous initiatives with varying results.
One of its newest models, Wasteful and Inappropriate Service Reduction (WISeR), is set to launch in January 2026. This model directly addresses one of Medicare’s biggest challenges—wasteful spending on low-value services—and takes a big step toward value-based care.
The Problem of Wasteful Medicare Spending
Waste in healthcare is more than an economic problem—it undermines quality, efficiency, and patient trust. Research from research organizations and independent congressional agency like MedPAC reveals:
- 25% of healthcare spending is wasteful.
- Medicare alone spends $1.9–$5.8 billion annually on services without proven benefit.
- The most problematic areas include Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), hospice care, and certain lab tests.Traditional Medicare (Parts A & B) lacks a consistent framework for reviewing medical necessity before services are provided. WISeR aims to change that.
What is the WISeR Model?
WISeR falls under the Disease-specific and Episode-based Models category within CMMI’s payment model portfolio.
Its primary tool is Prior Authorization—a process that ensures services meet evidence-based medical necessity standards before Medicare coverage is approved.
How the Prior Authorization Process Works
WISeR will be implemented in 4 Medicare Administrative Contractor (MAC) jurisdictions, with one model participant per jurisdiction.
Step-by-step process:
- Providers or suppliers voluntarily submit a prior authorization request to either the model participant or the MAC.
- The model participant reviews the request for coverage criteria and medical necessity.
- The request is affirmed (approved) or non-affirmed (denied).
Providers can:
- Deliver the service anyway (but risk claim denial).
- Appeal through Medicare’s standard process.
- Skip prior authorization (but claims will be subject to pre-payment review).
Targeted Services Under WISeR
Initially, WISeR focuses on low-value services that research has flagged as having questionable necessity, including:
- Stimulator services such as Electric Nerve Stimulators
- Incontinence-related services
- Skin substitutes
Reporting and Performance Monitoring
Like every CMMI models the WISeR model participants will be subject to performance measurement. They will be assessed for the quality of the Prior authorization processes, stakeholder experience (providers/suppliers/beneficiaries) and the overall clinical quality outcome.
Payment Incentives for Model Participants
WISeR rewards model participants based on demonstrated cost reductions resulting from non-affirmed services which do not go through a repeated request. The payment will further be impacted by the model participants performance factors.
Potential Impact on Value-Based Care
Although it’s too early to predict WISeR’s long-term impact, the program represents a major policy shift—moving Medicare from a fee-for-service model toward value-based purchasing.
If successful, WISeR could serve as a blueprint for reducing unnecessary services across the U.S. healthcare system, while safeguarding patient outcomes.
Conclusion: Moving Medicare Toward a Sustainable Future
Healthcare systems worldwide are seeking ways to maintain quality while controlling costs. WISeR’s targeted, evidence-driven approach could help Medicare achieve that balance. By reducing waste and focusing on services that truly benefit patients, CMS is taking an important step toward a sustainable, patient-focused future.