‘A troublesome trend’: Top imaging groups slam insurer-directed test substitution policies
Imaging tests must be ordered based on shared decisions and not insurance mandates, leading cardiovascular imaging societies argued in a new position statement.
Over recent years, private insurers and radiology benefits managers have started forcing providers to use one diagnostic test over another. These test substitution policies have become a “troublesome trend” that can lead to delays in care, patients undergoing incorrect exams or unnecessary testing.
Top cardiovascular imaging groups, including the American Society of Nuclear Cardiology (ASNC) and American College of Cardiology Imaging Council, recently denounced such policies in a statement published in the September issue of JACC.
“Cardiovascular test selection is highly nuanced and needs to reflect numerous variables, including individual patient factors, local expertise and access, and technology-related details,” ASNC’s immediate past President and senior author Sharmila Dorbala, MD, MPH, said. “Insurers' push to use a single first-line test in all patients with chest pain is not supported by evidence and may undermine a patient's confidence in, and adherence to, their treatment plan.”
Focusing specifically on imaging for chest pain, the authors want more research on the impact of these substitution directives. They mentioned five consensus principles:
1). Physicians will accept tests ordered under appropriate guidelines and relieve insurers of liability and reduce administrative burdens and costs.
2). Patient care should be top priority for physicians and insurers.
3). Short-term cost savings should not direct substitution policies.
4). Personalized testing based on clinical factors is better than a one-size-fits-all approach.
5). There is no “clear justification” for recommending one strategy over another when looking at appropriate use criteria and identical diagnostic accuracy between tests.
“This statement points to the unmeasured harm that may be caused by overly assertive managed care and test substitution and calls for more research in this area,” ASNC President Randall C. Thompson, MD, explained while pointing out the significance of major cardio imaging groups coming together under one cause.
The document is also endorsed by leadership at the American Society of Echocardiography, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine and Molecular Imaging.
Read the entire statement here.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.