“These denials can delay or prevent beneficiary access to medically necessary care; lead beneficiaries to pay out of pocket for services that are covered by Medicare; or create an administrative burden for beneficiaries or their providers who choose to appeal the denial,” the report notes. “These denials may be particularly harmful for beneficiaries who cannot afford to pay for services directly and for critically ill beneficiaries who may suffer negative health consequences from delayed or denied care.”
Denying needed care is not the best approach. The best care is the least expensive care. Optimal medical therapy for cardiometabolic disease dramatically improves clinical outcomes while reducing healthcare costs. Imaging studies like MRI or CT scanning are among the most frequently denied,
The best imaging decisions can reduce cost. Your primary care cardiometabolic team can order coronary CT angiography first for patients with chest pain or suspected coronary artery disease. It is a very accurate test to detect blockages and determine cholesterol plaque characteristics. That test only costs $401 and always involves a coronary calcium score first. If the calcium score is over 100, risk of heart attack is elevated and the patient needs optimal medical therapy (OMT). No further testing may be necessary. Invasive heart catheterization costs $2549. If the patient has chest pain, and you want to rule out left main coronary disease, the CT coronary angiogram can do that very accurately, and invasive heart artery catheterization is not necessary. Your primary care team can order the coronary CT angiogram and begin OMT. That is a much less expensive approach with better outcomes. The best care is less expensive care. Why wouldn’t you use that approach and make your Medicare Advantage program more successful?
Incidentally, we performed a direct comparison study of people with low calcium scores (<100) and high scores (>100) and found that people with low scores have various abnormal early stages of metabolic heart disease or ischemia due to early onset of atherosclerosis, not all of them are “disease free”. On the other side, the higher scores patients do have higher percentages with later stage coronary artery disease, however many, especially older patients, developed collateral circulations even though their coronary calcium scores are very high! These patients live to their 70’s 80’s even to the 90’s of age! They all have much better myocardial functionality then those without collateral circulation diagnosed with obstructive CAD at younger ages! We were able to sort out all these cases in various stages from the earliest to the collateral formation stage which is the natural recovery stage! Further more, our technology detected MANY women with microvascular coronary ischemia, nearly ALL of these owmn tested "ZERO" on the CT Caldicum test! The owners of the CT calcium testing centers refused to publish the data and threatened to sue for their financial motives. That was a shame!
Coronary calcium scores are not diagnostic for myocardial ischemia due to coronary artery obstructive disease. Multifunction Cardiogram Technology is the only technology that delivers early detection and monitor treatment effectiveness/outcomes of ischemia, metabolic causes of heart diseases, and any causes leading to supply and demand imbalance at 1/3 of the costs. Our technology will make your nurses into super diagnosticians. Bill, you should consider supporting our technology for the nurses.