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New Jersey Physicians Challenges Insurance Companies on New Rules for Heart Tests, Colonoscopies
Doctors Say Rules Deter Cancer Screenings; Delay Heart Care
TRENTON, NJ -- NJ Physicians (www.njphysicians.com), a statewide organization for medical doctors, is challenging two insurance companies over new managed care edicts that, if enacted, may delay life-saving tests for patients with heart disease, and deter patients from getting screened for colon cancer.
"Decisions concerning what tests are necessary and how those tests should best be performed should be made by patients in consultation with their physicians, not by managed care companies seeking to cut costs," said Ron White, M.D., J.D., the president of NJ Physicians and a Bergen County surgeon.
NJ Physicians delivered letters on Wednesday to the New Jersey State Board of Medical Examiners protesting a new edict by Horizon Blue Cross Blue Shield of New Jersey requiring cardiologists to obtain pre-certification before administering three common diagnostic heart procedures: echo stress tests, echocardiograms and diagnostic heart catheterizations.
Doctors say the new rule will delay what could be life-saving tests for patients, dramatically increase administrative burdens and -- in instances when the insurer denies coverage -- interfere with their obligation to provide appropriate care.
"This is bureaucratic interference by Horizon compromising good medical care", said John Ciccone, M.D., F.A.C.C., an Essex County cardiologist and director of the Invasive Cardiovascular Lab at St. Barnabas Medical Center in Livingston, New Jersey. "When it comes to diagnosing and treating heart disease, any delay increases risk. Based upon past experience, precertification can take up to two weeks to obtain. The precertification criteria utilized by the insurance company or outside agencies contracted by them are at times at odds with nationally published criteria. Furthermore, this process substitutes bureaucracy for the clinical judgment and expertise of the physician. Patients are understandably anxious and nervous when heart disease is suspected. They should not be subjected to delays imposed by a managed care company in order to obtain diagnosis and treatment deemed necessary by their physician."Representatives of NJ Physicians are also scheduled to meet Friday with officials from Aetna about its decision to stop paying for anesthesia during colonoscopies as of April 1st.
"Anesthesia during a colonoscopy eliminates patient discomfort and avoids many of the after effects associated with other forms of sedation, including grogginess and amnesia," White said. "Knowing that the procedure will be performed without pain and without significant after effects encourages more people to get screened for colorectal cancer and reduces unnecessary deaths."White pointed out that colorectal cancer is the second leading cause of cancer death in the United States and, according to the U.S. Centers for Disease Control and Prevention, as many as 60 percent of these deaths can be prevented by routine screening, including colonoscopy.
"Aetna's cost cutting efforts could seriously impact the public health and dramatically increase cancer deaths. It should not be permitted to unilaterally decide what medical care a patient can or cannot obtain, especially when patients' lives are at stake," he said.
NJ Physicians said it is holding off on seeking state action against Aetna until it had an opportunity to discuss the change with company officials on Friday.
NJ Physicians was launched in 2007 to address increasing concerns that the quality of medical care and the future of the practice of medicine are in jeopardy. Ending improper interference by managed care companies in patient care decisions has been one of the organization's top priorities.
As part of that effort, the organization is set to launch an on-line registry for doctors to show how edicts such as these are impacting medical care. On this registry, doctors will be able to report cases of patient injury resulting from managed care's denial of physician recommendations for care, diagnosis or treatment. The group believes the registry will provide strong evidence that medical decision-making must be left to physicians and their pa |