美国单一州和多州运营商在静脉消融覆盖政策方面的差异和不一致。
Variations and inconsistencies in venous ablation coverage policies between single-state and multistate carriers in the United States.
机构信息
Division of Vascular Surgery and Endovascular Therapy, Yale School of Medicine, Yale University, New Haven, CT.
Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA.
出版信息
J Vasc Surg Venous Lymphat Disord. 2024 Jan;12(1):101685. doi: 10.1016/j.jvsv.2023.07.012. Epub 2023 Sep 11.
BACKGROUND
Vein ablation is a common and effective treatment for patients with chronic venous insufficiency. The overuse of vein ablation despite the existence of evidence-based guidelines has resulted in insurance companies developing restrictive policies for coverage that create barriers to appropriate care. This study compares the insurance coverage by single-state carriers (SSCs) and multistate carriers (MSCs), highlighting the variations and inconsistencies in the various policies.
METHODS
The American Venous Forum Venous Policy Navigator was reviewed for the various policies available in the United States. The policies were divided into SSCs and MSCs. The characteristics of the policies, including the anatomic and hemodynamic criteria for specific veins, duration of conservative treatment, disease severity, symptoms, and types of procedures covered, were compared between the two groups. SAS, version 9.4 (SAS Institute Inc) was used for statistical analysis.
RESULTS
A total of 122 policies were analyzed and divided between SSCs (n = 85; 69.7%) and MSCs (n = 37; 30.3%). A significant variation was found in the size requirement for great saphenous vein ablation. Although 48% of the policies did not specify a size criterion, the remaining policies indicated a minimal size, ranging from 3 to 5.5 mm. However, no significant differences were found between SSCs and MSCs. Similar findings were encountered for the small and anterior accessory saphenous veins. MSCs were more likely to define a saphenous reflux time >500 ms compared with SSCs (81.1% vs 58.8%; P = .04). A significant difference was found between the SSCs and MSCs in the criteria for perforator ablation in terms of size and reflux time. MSCs were significantly more likely to provide coverage for mechanochemical ablation than were SSCs (24.3% vs 8.2%; P = .03). SSCs were more likely to require ≥12 weeks of compression stocking therapy than were MSCs (76.5% vs 48.7%; P = .01). No significant differences were found in the clinical indications between the two groups; however, MSCs were more likely to mention major hemorrhage than were SSCs.
CONCLUSIONS
The results of this study highlight the variations in policies for venous ablation, in particular, the striking inconsistencies in size criteria. MSCs were more likely to cover mechanochemical ablation and require a shorter duration of conservative therapy before intervention compared with SSCs. Evidence-based guidance is needed to develop more coherent policies for venous ablation coverage.
背景
静脉消融术是治疗慢性静脉功能不全患者的一种常见且有效的方法。尽管有循证指南，但静脉消融术的过度使用导致保险公司制定了限制保险覆盖范围的政策，从而为提供适当的治疗制造了障碍。本研究比较了单一州承运人（SSC）和多州承运人（MSC）的保险覆盖范围，突出了各种政策中的差异和不一致。
方法
审查了美国美国静脉论坛静脉政策导航器中提供的各种政策。这些政策分为 SSC 和 MSC。比较了两组之间政策的特征，包括特定静脉的解剖和血流动力学标准、保守治疗的持续时间、疾病严重程度、症状和涵盖的手术类型。使用 SAS 版本 9.4（SAS 研究所）进行统计分析。
结果
共分析了 122 项政策，分为 SSC（n=85；69.7%）和 MSC（n=37；30.3%）。大隐静脉消融的大小要求存在显著差异。虽然 48%的政策没有指定大小标准，但其余政策表明最小尺寸为 3 至 5.5 毫米。然而，SSC 和 MSC 之间没有发现显著差异。小隐静脉和前辅助隐静脉也发现了类似的结果。与 SSC 相比，MSC 更有可能定义>500 毫秒的隐静脉反流时间（81.1% vs 58.8%；P=.04）。SSC 和 MSC 在穿孔消融的大小和反流时间标准方面存在显著差异。MSC 比 SSC 更有可能提供机械化学消融的覆盖范围（24.3% vs 8.2%；P=.03）。SSC 比 MSC 更有可能需要>12 周的压缩袜治疗（76.5% vs 48.7%；P=.01）。两组之间的临床指征没有发现显著差异；然而，MSC 比 SSC 更有可能提到大出血。
结论
本研究结果突出了静脉消融政策的差异，特别是在尺寸标准方面存在显著不一致。与 SSC 相比，MSC 更有可能覆盖机械化学消融，并在干预前需要更短的保守治疗持续时间。需要循证指导来制定更一致的静脉消融覆盖政策。
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