Cigna will no longer require prior authorization for some CT scans of the heart, a move that providers said will relieve administrative burdens among physicians and result in better outcomes for patients.
On Feb. 1, Cigna will end prior authorizations for CT angiogram of the heart, coronary arteries and bypass grafts with contrast material. This includes 3D image post-processing. Cigna also removed prior consent for fractional flow reserve-computed tomography. Patients must have stable chest pain and an intermediate risk of coronary artery disease for coverage under the policy.
Dr. Julie Kessel, medical officer of coverage policy at Cigna, said the policy change reflects the insurer's regular process of examining its prior authorization requests and will result in better health outcomes for Cigna members.
"By removing the pre-authorizations for CTA and FFR-CT Analysis when medically necessary, providers can now move more quickly to help customers who are experiencing chest pain and are at risk of coronary artery disease," Kessel wrote in an email.
Dr. Dustin Thomas, chair of the advocacy committee at the Society of Cardiovascular Computed Tomography, said he believes Cigna is the first payer to remove prior authorization for these scans but hoped that its move will set a precedent for other insurers. By using a coronary CT scan to evaluate individuals with chest pain, providers can view cholesterol plaque built up in heart arteries and institute preventative care measures like prescribing cholesterol-lowering medications, aspirin and blood pressure medicine. In addition to allowing providers to identify pre-clinical disease, Thomas said patients are more likely to adhere to therapies if they know they are at risk for heart disease.
"It's a great thing for the medical practices to have an opportunity to pursue what those of us in the sector think is the single best test for the evaluation of coronary disease without having to work through all those various barriers that do make our work sometimes challenging," Thomas said.
He said multiple double-blind studies have shown that CT scans of the heart can lead to a 40% reduction in myocardial infarction and cardiovascular death.
Although he called coronary CT scans the best test for identifying disease and measuring heart health, he said industry use of these procedures has been modest. Thomas blamed the low uptake of these tests, in part, on the administrative barriers physicians face around prior authorization and the low reimbursement rates offered through Medicare. Private payers offer better payment for the service, Thomas said, and Cigna removing the prior-authorization requirement around these scans of coronary CT scans for some patients will hopefully drive uptake.
The move follows Cigna's Evercore benefit manager last year releasing a guideline that essentially eliminated the necessity of a separate approval request for a coronary CT scan of existing patients. At the same time, Thomas said the payer also promoted the use of coronary CT scans to its physicians by promoting its pre-approval policy among physicians submitting authorization requests for different testing modalities.
Thomas said Cigna's new guideline around prior-authorization is the next iteration of this policy.
"I think this is a really exciting opportunity to get better access to this testing modality for patients," he said. "It's certainly an opportunity to do some research and see if removing these kinds of barriers does impact utilization and quality."
Anders Gilberg, senior vice president of government affairs of the Medical Group Management Association, said lifting prior authorization around coronary CT scans represented an essential step in better patient care, as well as lowering overall healthcare spend. He said MGMA surveys its 45,000 members every year, and the number one administrative burden respondents list is always prior-authorization. In 2019, 83% of respondents called prior authorization "very or extremely burdensome."
In 2018, MGMA released a statement with six other physicians, hospital and payer organizations that called for a uniform prior authorization standard among insurers. He hoped Cigna's move would help push the healthcare industry forward on this proposal.
"Because there is no national standard, because each insurance company does their own thing, has their own interpretations of the science, patient procedures are often unnecessarily delayed and then physicians face a tremendous administrative burden," Gilberg said.