Place the oven racks so that one is in the upper third position and one is in the lower third position. Preheat the oven to 350 degrees. Line two baking sheets with parchment paper. In the bowl of a stand mixer (or a large bowl), whisk together the bisquick, Italian seasoning, garlic, and onion powder.
Add the water, hot sauce, worcestershire, and sausage to the dry ingredients.
Using the dough hook or paddle attachment, an electric mixer, or a large spoon, mix on low speed until the sausage is completely incorporated.
Add all of the cheese and mix again on low until combined.
Using a cookie scoop or spoon, scoop the mixture into a 2 Tablespoon ball (golf ball size). Roll into a ball.
Line each baking sheet with about 20 balls. These do not spread so they can be close together.
Bake for 23-26 minutes, rotating the baking sheets halfway through, until golden brown. The internal temperature should be at least 170 degrees.