With the ongoing changes in the health care environment impacting patient insurance coverage, eligibility and access to care due to the Affordable Care Act (ACA), the College sought to determine the access problems affecting cardiovascular patients and what can be done to provide assistance.

The October CardioSurve found that the three most common problems which cardiovascular patients face from their insurance plans are: denied pre-authorization of service, device or treatment (59%); high-cost deductible/co-insurance amount and/or high deductible plans (47%); and an inability to interpret plan benefits (35%).

Although the vast majority of patients have some form of insurance coverage, three out of four cardiologists say at least 25% or more of their patient populations are under-insured for their current plan and medical needs. Additionally, one out of two cardiologists indicate that half of their patients use Medicare as their insurance provider.

Most Common Services Practices Offer to Assist Patient Access to CareNearly half of cardiologists (47%) believe that their patients are comfortable initiating and discussing cost/barrier issues with their cardiologists. In these discussions, cardiologists have learned that “patients are generally dissatisfied and frustrated with their insurance companies.” The top two out-of-pocket expenses that patients find most challenging are their co-pay for pharmaceuticals (65%) and their deductible With the ongoing changes in the health care environment impacting patient insurance coverage, eligibility and access to care due to the Affordable Care Act (ACA), the College sought to determine the access problems affecting cardiovascular patients and what can be done to provide assistance.

The October CardioSurve found that the three most common problems which cardiovascular patients face from their insurance plans are: denied pre-authorization of service, device or treatment (59%); high-cost deductible/co-insurance amount and/or high deductible plans (47%); and an inability to interpret plan benefits (35%).

Although the vast majority of patients have some form of insurance coverage, three out of four cardiologists say at least 25% or more of their patient populations are under-insured for their current plan and medical needs. Additionally, one out of two cardiologists indicate that half of their patients use Medicare as their insurance provider.

Nearly half of cardiologists (47%) believe that their patients are comfortable initiating and discussing cost/barrier issues with their cardiologists. In these discussions, cardiologists have learned that “patients are generally dissatisfied and frustrated with their insurance companies.” The top two out-of-pocket expenses that patients find most challenging are their co-pay for pharmaceuticals (65%) and their deductible or co-insurance (57%). In addition, denied care due to preauthorization of services continues to be a key issue.

To help patients with these challenges, 92% of cardiologists’ offi ces provide services to assist patients with accessing care, and nearly seven out of 10 (69%) practices are making referrals for patients to programs offering free or reduced cost pharmaceuticals or presenting enrollment to their patients in pharmaceutical indigent drug programs (64%). Almost half of practices are helping to reconcile coding and billing errors (47%), providing assistance with appealing a denied claim for services (46%) or making a referral to charity care (45%).

The majority of cardiologists note that they would like their offices to provide additional services (93%), including education on Medicare Part D and assistance selecting an appropriate plan (27%); patient education materials to better understand insurance (20%); and referral to co-pay relief program (17%).

The ACC has been advocating for payment models that align payment incentives with evidence-based improvements in health care quality and outcomes. In addition, the ACC has long advocated for the use of appropriate use criteria and tools like Imaging in FOCUS, as an alternative to prior-authorization as prior-authorization is based on arbitrary criteria and denies access to care. As one cardiologist noted, “the focus needs to shift to maintaining wellness...prevention and good health should be rewarded.”