President's Message
Appropriate Use, FOCUS, and What Is the ACC Doing for Me? There has been a great deal of attention placed on the inappropriate use of imaging in medicine. The value of diagnostic testing is unquestioned, but these tests have contributed to the rising costs of health care. The response of health insurers has been to implement radiology benefit managers (RBMs). These entities, which are in some cases owned by the insurers that use them, create onerous and often arbitrary barriers to the ordering of tests. These barriers may consume extraordinary amounts of time for office staff and delay the implementation of these tests and increase expenses for the patient and the physician. Most importantly, an appropriate diagnosis may never be made because the patient never has the test performed. The American College of Cardiology advocates that the right test be performed on the right patient at the right time and has developed Appropriate Use Criteria (AUC) to guide physicians. The AUC will identify a test as appropriate, uncertain, or inappropriate depending on the clinical scenario where testing is being considered. The ACC's FOCUS tool is a decision support tool than can assist physicians in evaluating candidates for testing and provide education on testing guidelines. I believe that the FOCUS tool is a superior alternative to RBMs since it can provide real-time feedback on test appropriateness without delaying the test. In Delaware, the state insurance commissioner recently fined Blue Cross and Blue Shield of Delaware $325,000 for not approving or paying for tests ordered by physicians as a result of its pre-authorization process. In addition, the insurance commissioner ordered Blue Cross and Blue Shield of Delaware to enter into a new pilot program utilizing the ACC's FOCUS tool. This is clearly a win for the many patients in Delaware who will be able to receive appropriate testing without the hassle of the pre-authorization process. It is also a win for the cardiologists in Delaware who will be able to deliver more efficient care to their patients. So what should you do? I would encourage everyone to become familiar with the AUC and to learn more about the ACC's FOCUS tool: go here and here. I would also encourage you to let me or anyone else from ACC know about egregious situations in which testing is denied. Indiana-ACC members met with the Indiana State Insurance Commissioner last year to educate him about the usefulness of the FOCUS tool as an alternative to RBMs. If we meet with him again, it will be nice to provide him with specific examples of denied testing. Indiana-ACC Members Go to Washington On a different note, a large contingent of Indiana-ACC members recently returned from the ACC Legislative Conference in Washington, DC. We were represented by physicians, nurses, nurse practitioners, and practice administrators. We spoke to legislative aides to encourage them to fix the SGR and avert the 29.5% cut in physician reimbursement that will occur in January 2012. I want to personally thank all who took the time away from their busy practices to attend this conference. Your participation is extremely important and demonstrates the dedication of Indiana providers to advancing the initiatives of the ACC. 
Thanks again,
John S. Strobel, MD, FACC
President, Indiana-ACC | 
