In what is hoped to be a model for other states when it comes to ensuring appropriate use of medical imaging, the Delaware Insurance Commissioner announced on Sept. 13, 2011, that Blue Cross Blue Shield of Delaware (BCBSD) will support use of the ACC’s FOCUS: Cardiovascular Imaging Strategies tool by Delaware cardiologists to make decisions about certian diagnostic imaging tests.

Under the agreement, BCBSD will pay for cardiologists in the state to use the online tool, which allows for consistent application of appropriate use criteria to determine when cardiovascular imaging tests are needed. Importantly, the program also provides feedback reports on the patterns of appropriate use to physician practices and health plans. FOCUS participants then use the reports to complete action plans and share best practices.

This agreement follows investigations by the Delaware Insurance Commission and the Senate Commerce Committee into news reports about consumers being denied access to diagnostic imaging tests in Delaware. The Senate Commerce Committee and the Delaware Insurance Commission released reports of their investigations in May 2011, both of which affirmed the ACC’s position that pre-authorization companies not only increase administrative costs for physician, but also increase the time for diagnosing patients in need.

In announcing the program, Delaware Insurance Commissioner Karen Weldin Stewart said: “In order to solve this problem, we need to get everyone on the same page as to when the studies are appropriate. With this new program, BCBSD is using the best criteria developed by the expert physicians, The American College of Cardiology, and will pay to have Delaware physicians using the best medical criteria.”

The ACC Delaware Chapter played an important role in bringing about this solution and educating state policymakers, BCBSD and others about the benefits of appropriate use criteria. According to ACC CEO Jack Lewin, the Delaware Chapter and the Delaware Insurance Commission should be commended for providing a solution that is based on physician-developed appropriate use criteria. “We hope Delaware will be a model for managing medical costs by focusing on patient-centered decision making and quality care,” he said. “More importantly we hope this proactive solution will prevent future cardiovascular patients from being denied the right care at the right time.” To read the press releases from the event, click here.

Registration for the BCBSD program ran throughout January 2012. All cardiologists (except pediatric) and all radiology centers that order NUC Spect MPI tests were required to register.