Insurer Takes Step That Could Restrict Vein Surgery

In a controversial move that critics say could eventually have implications for the entire United States, Blue Cross Blue Shield of Massachusetts (BCBS) has instituted a new policy that imposes a lengthy certification process on providers of treatments for varicose and spider veins.      The policy also allows only three types of doctor to perform the revolutionary new techniques of radiofrequency ablation (RFA) and endovenous laser treatment (EVLT), which are rapidly replacing the older and more painful vein-stripping method. (Ablation is removal of diseased or poorly functioning tissue.) The physicians the insurer would let be paid specialize just in the areas of interventional radiology, vascular surgery and general surgery. Their facilities must be approved by the American College of Radiology or the Intersocietal Commission for the Accreditation of Vascular Laboratories.

Nowadays, with EVLT, a tiny laser fiber is inserted through a micro-incision, under local anesthesia, into the offending vein and guided to the appropriate spot using ultrasound. When the laser is turned on, it causes the vein to collapse; the body redirects the blood flow naturally. Everything is the same with RFA, with the exception that a slender radiofrequency catheter is inserted into the vein. Both procedures have high success rates and few complications.
   
A recent issue of VEIN Magazine, a publication of HealthNews.org that focuses exclusively on venous disease, calls the policy “alarming and controversial,” and suggests it could make it tougher for sufferers of varicose and spider veins to find accessible and affordable treatment.
   
For its part, BCBS of Massachusetts, one of 39 regional BCBS independent companies nationwide, says its policy’s sole purpose is to maximize quality of care. The company points to the huge growth in RFA and EVLT during the last five years, marked by a large and diverse expansion of doctors performing them, and said it simply wants to ensure the safety and qualifications of everyone offering the procedures.
   
But critics in the medical community, the magazine says, assert that the new restrictions are unnecessary, because:

-- The risks connected with RFA and EVLT are in fact lower than with conventional vein stripping; the recovery process, for example, involves just a fraction of the time and discomfort there used to be.

-- Many doctors have the basic skills to perform the procedures, and have fully informed themselves about the causes and treatment of varicose and spider veins.

“It is generally believed, among medical specialists,” VEIN says, “that BCBS’s move is just another in a long history of cost-cutting measures. The formula, they say, is simple: As the safety and accessibility of a procedure increase, so does the number of people being treated, particularly for a common, uncomfortable and unsightly condition. More vein patients mean more claims, and every claim paid means a less robust bottom line for the insurer and its shareholders.”


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