Breaking News
January 16, 2018 - The Salk Institute and Indivumed collaborate for cutting-edge cancer research
January 16, 2018 - Study reveals negative long-term effects of heavy cannabis use on brain function and behavior
January 16, 2018 - Many gym-goers injure themselves by pushing harder to be better than friends
January 16, 2018 - Risankizumab Meets All Primary Endpoints Reporting Positive Results in Fourth Pivotal Phase 3 Psoriasis Study
January 16, 2018 - Federal Junk Food Tax Feasible, Study Says
January 16, 2018 - Do girls have stronger teeth than boys?
January 16, 2018 - New high-sensitivity blood tests could aid faster diagnosis and treatment for heart attack
January 16, 2018 - TherapeuticsMD Announces FDA Acceptance of New Drug Application and Prescription Drug User Fee Act (PDUFA) Date for TX-004HR
January 16, 2018 - Morning Break: Food Pharmacies; Obamacare Sign-ups Dip; Top Pot Studies
January 16, 2018 - Blood pressure declines 14 to 18 years before death
January 16, 2018 - Researchers use immune-mimicking biomaterial scaffolds to fast track T cell therapies
January 16, 2018 - Bile acids could directly burn away lipids in the fat depots
January 16, 2018 - Cycling does not negatively impact sexual and urinary health finds study
January 16, 2018 - Severe peer victimization in childhood may contribute to mental health issues in adolescence
January 16, 2018 - Exelixis Announces U.S. FDA Approval of Cabometyx (cabozantinib) Tablets for Previously Untreated Advanced Renal Cell Carcinoma
January 16, 2018 - Just How Often Do Patients Turn Post-Surgical Opioids Into a Habit?
January 16, 2018 - Opioid addiction – Genetics Home Reference
January 16, 2018 - Incomplete revascularization in PCI linked to higher mortality
January 16, 2018 - Machine learning algorithm uses brain scans to predict language ability in deaf children
January 16, 2018 - Penn scientists identify new therapeutic target for treatment of melanoma
January 16, 2018 - The London Clinic exhibits innovative technology to treat Parkinson’s disease at Arab Health
January 16, 2018 - Early influenza testing is critical to prevent serious complications
January 16, 2018 - Study Gets to the Core of Back Pain in Runners
January 16, 2018 - Year in Review: Ophthalmology | Medpage Today
January 16, 2018 - ClinicalTrials.gov: Marijuana Use
January 16, 2018 - Researchers create novel compound targeting melanoma cells
January 16, 2018 - FDA grants approval for first drug to treat inherited breast cancer
January 16, 2018 - Researchers develop remote-controlled mechanogenetics system to target and kill cancer cells
January 16, 2018 - Fresh, Frozen Embryos Equal in IVF
January 16, 2018 - Research shows biological clocks could improve brain cancer treatment
January 16, 2018 - Dire view from within accident and emergency wards of England and Wales
January 16, 2018 - Study reveals how devastating mitochondrial diseases strike families without any previous history
January 16, 2018 - Experts look for ways to standardize treatments for pediatric rheumatic diseases
January 16, 2018 - Teens who watch TV shows with ads likely to eat more junk food
January 16, 2018 - Aztec apocalypse found to be Salmonella outbreak
January 16, 2018 - Stealth BioTherapeutics Granted Fast Track Designation for Elamipretide for the Treatment of Leber’s Hereditary Optic Neuropathy
January 16, 2018 - Three Ineffective Institutional Approaches to Quality Improvement in Healthcare
January 16, 2018 - New technology accelerates autism diagnosis and treatment
January 16, 2018 - Preterm babies likely to experience delays in auditory brain development, study reveals
January 16, 2018 - Research sheds new light on genetic, environmental factors that promote prostate cancer metastasis
January 16, 2018 - Mitochondrial impairment may actually protect the brain in Parkinson’s disease, study shows
January 15, 2018 - Energy drinks can have adverse health effects on youth, study reveals
January 15, 2018 - 60° Pharmaceuticals (60P) Submits New Drug Application to US FDA for Antimalarial Drug Tafenoquine
January 15, 2018 - Wanted: ‘Breathalyzer’ for Cannabis Use
January 15, 2018 - Surfers more likely to get antibiotic resistant E. coli in their guts
January 15, 2018 - “Baby brain” a real clinical entity finds study
January 15, 2018 - Whole of Britain to be put on a diet plan come March
January 15, 2018 - Neighborhood Deprivation Linked to Heart Failure
January 15, 2018 - Omega-3 and Omega-6 fatty acid intake may affect lupus outcomes
January 15, 2018 - Scientists discover new enzyme that could reduce obesity rates
January 15, 2018 - Evidence suggests two patterns of early symptoms precede and predict later BD risk
January 15, 2018 - Harm minimization approach for smoking cessation with e-cigarettes
January 15, 2018 - Surgery or Antibiotics for Appendicitis? Here’s What Patients Chose
January 15, 2018 - ASH: Frailty Screening Tool Guides Therapy in Elderly
January 15, 2018 - Study shows video games could cut dementia risk in seniors
January 15, 2018 - Common Food Additive Promoting C. diff?
January 15, 2018 - Mild traumatic brain injury causes long-term damage in mice
January 15, 2018 - Circadian clock proteins set the pace of plant growth
January 15, 2018 - Two proteins shown to regenerate brain in Parkinson’s disease
January 15, 2018 - Jotting down tasks may ease falling asleep, study says
January 15, 2018 - Chi-Med Initiates Fruquintinib U.S. Clinical Trials
January 15, 2018 - Cell-Free DNA May Help Pinpoint Breast Ca Survival
January 15, 2018 - What goes on inside a medically supervised injection facility?
January 15, 2018 - Research provides new model to better ascertain HIV mortality rates in Zambia
January 15, 2018 - Genetic analysis can enhance outcomes of depression treatment
January 15, 2018 - Variations in bacterial strains can trigger varying immune responses, study states
January 15, 2018 - TherapeuticsMD Announces Resubmission of New Drug Application for TX-004HR
January 15, 2018 - HIV Vaccine Shows ‘Positive Signal’ in Small Study
January 15, 2018 - Researchers demonstrate RAS dimers are essential for cancer
January 15, 2018 - Groundbreaking report highlights plan to end bowel cancer
January 15, 2018 - Doc Aspires to Bring ‘Medicine the Musical’ to Off-Broadway
January 15, 2018 - Does an exploding brain network cause chronic pain?
January 15, 2018 - Researchers use novel PET tracer to assess myelin damage in mouse models of MS
January 15, 2018 - Survival strategy of mRNAs during sugar deficiency in the cell
January 15, 2018 - Hormone Therapy May Ease Depression Linked to Menopause
January 15, 2018 - Pain Sensitization Declines After Bariatric Tx in Obese Patients
January 15, 2018 - C7 nerve transfer improves function in spastic arm paralysis
January 15, 2018 - Australian kids are drinking and smoking far less than before
January 15, 2018 - Worsening of anxiety symptoms may be early indicator of Alzheimer’s disease
January 15, 2018 - Early testing for influenza symptoms can limit severe, life-threatening disease
Pearls From: Mary Norine Walsh, MD

Pearls From: Mary Norine Walsh, MD

image_pdfDownload PDFimage_print

Those physician-to-physician phone calls required to get insurer authorization for cardiac imaging tests, among many others, aren’t just a time-sucking nuisance. They can be a patient safety issue in some cases, says American College of Cardiology President Mary Norine Walsh, MD, of St. Vincent Medical Group in Indianapolis.

In addition to documenting experiences with prior authorizations using the ACC’s Prior Authorization Reporting (PAR) tool, she recommends not backing down.

“We really have to advocate for our patients,” Walsh says in this exclusive MedPage Today video interview, “by not changing our mind about doing an indicated test but rather to go forward and engage this physician who is working on behalf of the insurer and really make certain that it’s well known that these are indicated tests that our patients need.”

A transcript of the interview follows:

The issue that we’re facing more and more in cardiology — also other fields, but I will speak only about cardiology — is the requirement that many payers now have, insurance companies, for us to get on the phone and speak to another physician before they will authorize payment for a in particular an imaging test for one of our patients. These tests include stress echocardiogram, SPECT myocardial perfusion imaging, CT scan, and now most recently we’ve even seen with rest echocardiograms.

So many insurers are now kind of putting a barricade in front of the patient really in having an indicated test by asking the doctor to speak to another doctor on a phone call, in essence to fight to have this study done for this patient. These are not studies that are not indicated. These are for, in the case of my patients, heart failure patients who need to have their left ventricular ejection fraction reassessed because they’ve been on guideline-directed medical therapy for several months. And the guidelines recommend that we reassess ejection fraction before we take the next step, be that a device or other therapy.

So the barrier to this has been that in the office we are frequently are faced with the fact that on a given day that the test is scheduled, we have to then put everything down and talk to another physician on the phone. So the ways we’ve chosen to deal with this in our practice is to do it for every patient every time and really challenge this process by getting on the phone and really going through the guidelines with the doctor on the phone.

One of the things the American College of Cardiology has done is to provide us with a tool called the PAR tool that we can use. It takes about 2 minutes to fill all the data out on what our experience was in trying to obtain this guideline-indicated test for our patient so we can better get a set of data saying exactly what’s happening in different parts of the country. So I think this is something that patients don’t know a lot about, because their doctors and nurse-clinicians are doing it behind the scenes. But, in some cases, this is actually a patient safety issue, where we can’t really move forward with patient care until we achieve the approval to get this study done.

So I think advice to other clinicians out there: We really have to advocate for our patients by not changing our mind about doing an indicated test but rather to go forward and engage this physician who is working on behalf of the insurer and really make certain that it’s well known that these are indicated tests that our patients need.

2017-12-19T10:30:00-0500

Tagged with:

About author

Related Articles