ASNC Comments to Independence Blue Cross on Nuclear Cardiology Pre-certification Criteria
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June 16, 2005
On June 15, ASNC joined with the Pennsylvania Chapter of the American College of Cardiology (ACC) in providing comments to Independence Blue Cross (IBC) regarding the carrier's proposed adoption of nuclear cardiology pre-certification criteria developed by American Imaging Management (AIM). In its June 15 letter to IBC Medical Director Steven J. Brown, M.D., the two groups raised a number of concerns regarding the negative impact of AIM's criteria on patient care in eastern Pennsylvania:
- In comparing the scant criteria laid out by AIM with the 2003 ACC/AHA/ASNC guidelines, it is clear that AIM failed to incorporate a number of critical indicators, which would preclude a number of specific patient groups from receiving access to timely and appropriate nuclear cardiology diagnostic imaging.
- AIM used an unclear methodology for developing its guidelines for nuclear cardiology - especially given that it appears that they relied heavily on appropriateness criteria developed by the American College of Radiology (ACR).
- IBC should wait until the beginning of the year to implement these criteria to allow time to better evaluate literature and guidelines developed by other medical specialties, such as ASNC, the ACC and the American Heart Association.
- The lack of timely avenues for appeal of pre-certification denials will negatively impact both the provider community and patients by adding extra minutes to an already overly bureaucratic system, especially in emergent or urgent settings where lost time could equate to lost "muscle" or even "lost lives."
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