The U.S. Senate Commerce Committee and the Delaware Insurance Commission last Friday released separate reports on the results of their investigations into consumer access to imaging tests in Delaware. Both reports were commissioned in 2010 after the Wilmington, Del., newspaper ran a story on a Delaware man that was denied a cardiac stress test by MedSolutions, BCBS of Delaware's “radiology benefit manager (RBM).”  The man ultimately was admitted to the ER, and then received CABG. NBC Nightly News ran a story on it yesterday, as did TheHeart.org and Cardiovascular Business.

The report highlights ACC's concerns with RBMs, such as the administrative burdens for doctors and patients, the non-transparent decision-making tools, and the chronic lack of best science and appropriate use criteria in their methodologies. Let's face it, RBMs are designed to save money, not improve care. 

The investigation's significant findings were: 

• After an outside consultant reviewed the denied cases, MedSolutions denied a significant number of both inappropriate and appropriate test requests
• The RBM's pre-authorization process is burdensome and confusing for consumers and health care providers, and this confusion is compounded by conflicting “evidence-based” cardiac testing guidelines
• According to their own professional guidelines, Delaware doctors routinely order unnecessary nuclear stress tests

But, there may be a happy ending here:  The ACC is working to implement the FOCUS imaging appropriate use criteria (AUC) tool in many states that are beginning to express interest in saving money AND improving careas as an alternative to RBMs, and we're making great progress! Yesterday's ACC Advocate has more about the findings and "next steps" of the report. The Senate report is available here: Consumers' Access to Diagnostic Heart Tests in Delaware.

Does this report surprise you? Have you had any similar experiences with RBMs?

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