The general public, and much of the medical profession, has unfortunately little understanding of the connection between varicose veins and more serious manifestations of chronic venous disease, represented by higher CEAP classes. This is a fact that keeps many with vein disease from obtaining, or even considering, treatment. Fortunately, public education concerning venous disease and its potential complications, including chronic venous insufficiency and deep venous thrombosis, is growing.
Organizations such as the American College of Phlebology, the American Venous Forum, the Society for Vascular Surgery, and the Venous Disease Coalition have established educational and screening programs to heighten awareness concerning varicose veins, their signs and symptoms, and how they can be treated. As a result of mounting popular and professional awareness, and the enlarging availability of effective, less invasive, and more tolerable treatment options for superficial venous insufficiency, utilization of venous treatment has increased.
Although many have welcomed this change, some insurers have viewed this phenomenon with skepticism, while in others it has caused apparent near panic. Consequently, insurance carriers have instituted a seemingly endless number of, often unannounced, policy changes that consist of rigorous measures requiring patient endurance and arduous physician documentation so that treatment approval can be obtained. Insurers will say that these measures have been put into place in an effort to ensure quality of patient care; most doctors and much of the public are convinced that the reasons that carriers have made treatment approval policies so draconian is to limit access to appropriate care, decrease utilization, and to not spend money.
All insurers have mandated the wearing of graduated compression stockings for variable periods of time and many require documentation of varicose disease through photography. Some want proof that veins are of a certain size on ultrasound. A few even restrict the physicians who are allowed to do certain procedures, based on their specialty rather than their experience and expertise. None of these policies are evidence-based. It seems clear that medical policy writers create policy first and then try to find literature to support the decisions they have already made. As a result, medical necessity policy for the treatment of chronic venous disorders has become fragmented and inconsistent among private and government insurers across the United States.
This lack of consistency amongst insurers causes an enormous amount of frustration, irritation, and anger amongst patients and their healthcare providers. Clearly this is an unproductive situation for everyone involved. We, as members of medical societies with a deep understanding of vein disease, find it necessary to call for an end to the lack of uniformity concerning vein treatment policies that exists amongst insurance carriers. In so doing, we, as an intersocietal coalition, ask private and government insurers to join us is creating a practical, uniform policy on vein treatment that can be used productively to satisfy the needs of the patient, the physician and the insurer.
Ted King is National Medical Director of Vein Clinics of America.
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