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  • 09.15.11

    Access To Medical Imaging Coalition Applauds Adoption Of National Medical Society-Developed Appropriate Use Criteria By Blue Cross Blue Shield Of Delaware

    ACCESS TO MEDICAL IMAGING COALITION APPLAUDS ADOPTION OF NATIONAL MEDICAL SOCIETY-DEVELOPED APPROPRIATE USE CRITERIA BY BLUE CROSS BLUE SHIELD OF DELAWARE
    Order by Delaware Insurance Commissioner Will Help Patients Receive the Right Scan at the Right Time

    Washington D.C. – The Access to Medical Imaging Coalition (AMIC) today applauded the decision of the Delaware Insurance Commissioner requiring Blue Cross Blue Shield of Delaware (BCBSD) to adopt the American College of Cardiology’s (ACC) FOCUS program, based on national medical society-developed appropriate use criteria. The order comes on the heels of questions from patients and the media regarding effective delivery of care under BCBSD’s use of prior authorization for cardiac nuclear imaging via radiology benefit managers (RBM), which were used as a gatekeeper for access to medical imaging.

    “Prior authorization and radiology benefit managers that prevent patients from receiving lifesaving and timely care are of serious concern to us,” said Tim Trysla, Executive Director of AMIC. “AMIC has long advocated the adoption of national medical society-developed appropriate use criteria to ensure proper utilization of innovative medical imaging technologies and help physicians make clinically effective decisions about the care their patients receive.”

    Trysla also noted that there is no research showing that RBMs achieve the long term cost savings that proponents claim they do. Rather, prior authorization often simply means delaying or denying care.  In a recent American Medical Association survey of 2,400 physicians, 63 percent said that they typically wait several days for a response to a prior authorization request and 13 percent said they generally wait more than a week.  Alternatively, appropriate use criteria programs using clinical decision support and education have proven effective and successful in driving quality care without compromising patient access, across a host of medical settings and studies.

    “This decision reinforces what so many patients and physicians already know: that RBMs and other prior authorization systems are administrative burdens that impede patient access to care. It is unfortunate that patients needed to take their case to the press to receive the scans they need,” said Trysla.

    “Yesterday’s decision by the Delaware Insurance Commissioner will help doctors to make appropriate decisions regarding care and drive down costs, while still ensuring that patients are able to access the right scan at the right time,” said Trysla.

    For more information about the ACC’s FOCUS program in Delaware please click here.

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    The Access to Medical Imaging Coalition represents more than 100,000 physicians, medical providers, and patient organizations throughout the U.S. It also includes health technology firms that manufacture imaging equipment and supplies and that employ tens of thousands of workers. Thus, AMIC represents those who develop medical imaging technologies, those who apply it, and those who benefit from it.

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