CareCore National Data Proves Preauthorization Reduces Wasteful Repeat Procedures
BLUFFTON, S.C.--(BUSINESS WIRE)-- A new CareCore National analysis of heart disease diagnoses shows that more than $890 million is wasted on unnecessary tests each year that do not improve the quality of medical care. CareCore, the nation’s largest specialty benefits management company, conducted its analysis after recognizing that the use of transthoracic echocardiography (TTE) has increased dramatically, especially in the outpatient setting. Self-referral and poor imaging quality has, in part, been implicated and may lead to further unnecessary diagnostic testing and therapy.
The American College of Cardiology Foundation (ACCF) in conjunction with the American Society of Echocardiography (ASE) published appropriate use criteria (AUC) to promote proper use of the test to diagnose cardiovascular disease1. Studies2 show that use of TTE has increased by 10 percent each year in the United States. Additionally, analyses show that 10-153 percent of TTE studies performed do not meet appropriate use criteria, many of which are performed on outpatients and younger patients as well are duplicative procedures 4. In January 2011, subsequent revision of the ACCF/ASE AUC for TTE5 was performed and included a two-fold increase in the number of indications. CareCore, which began Evidence-Based Guideline prior authorization of outpatient TTE in 2007, has incorporated these recommendations and directed its efforts at outpatient TTE request, with a focus on assuring the medical necessity for follow-up studies.
“Embracing the best proven standards of care—in this case, prior-authorization—through the use of evidence-based models reduces the unnecessary use of TTE without compromising the quality of care,” said Dr. Russell Amico, executive vice president of CareCore National and chief operating officer of CareCore Cardiology. “Prior authorization ensures physicians are only ordering medically appropriate tests for patients, ensuring they ultimately get the right treatment or test based on their personal medical history and personal needs.”
To ensure that approved TTE procedures provide the most actionable results, CareCore National also encourages health plans to require that the procedures be performed at nationally qualified labs and by providers who have demonstrated proficiency in echocardiography. The providers and labs should follow standards promoted by the ACC, ASE, National Board of Echocardiography (NBE), and the Intersocietal Commission of Echocardiography Laboratories (ICAEL). CCN believes implementing these quality standards will further reduce the need for additional follow up studies.
To learn more about how CareCore National assists with the management of cardiac care and prior authorization programs that help organizations prevent unnecessary ICD implants, please visit: http://www.carecorenational.com/cardiology-program-overview.asp.
About CareCore National
CareCore National, LLC (www.carecorenational.com) is the nation’s largest specialty benefits management company. It has been in business since 1994, at which time it began to offer services for radiology benefit management only. Since that time it has developed programs and management specific technology in cardiology, medical oncology, radiation oncology, pain management, sleep apnea, lab services, and, in 2011, musculoskeletal services. CareCore currently contracts with more than 25 health plans with over 50 million insured. The company is headquartered in Bluffton, SC and has more than 1000 employees.
1.Douglas PS, Khandheria B, Stainback RF, Weissman NJ. ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 appropriateness criteria for transthoracic and transesophageal echocardiography. J Am Coll Cardiol 2007
2 Evolving Trends in the Use of Echocardiography Alan S. Pearlman, MD, FACC,* Thomas Ryan, MD, FACC, † Michael H. Picard, MD, FACC, ‡ Pamela S. Douglas, MD, MACC†, Journal of the American College of Cardiology, Vol. 49, No. 23, 2007
3 New appropriateness criteria continue ACC/ASE efforts to minimize echo misuse Reed Miller MARCH 30, 2011 Heartwire http://www.medscape.com/viewarticle/740057.
4 Prospective Evaluation of the Clinical Application of the American College of Cardiology Foundation/American Society of Echocardiography Appropriateness Criteria for Transthoracic Echocardiography, JACC: Cardiovascular Imaging, Vol. 1, No.5, 2008
5 Douglas PS, Garcia MJ, Haines DE, Lai WW, Manning WJ, Patel AR, Picard MH, Polk DM, Ragosta M, Ward RP, Weiner RB. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography, Journal of the American College of Cardiology (2010), doi:10.1016/j.jacc.2010.11.002.
Cohn & Wolfe for CareCore:
Rhena Wallace, 212-798-9832
KEYWORDS: United States North America South Carolina
INDUSTRY KEYWORDS: Health Cardiology Hospitals Public Policy/Government Healthcare Reform Other Health Public Policy General Health