ACP Addresses Novitas Venous Policy

By Robert Worthington-Kirsch

Novitas’ current policy contains several provisions which are not justifiable from the literature. The most onerous of these is a diameter requirement for treatment of either a truncal vein measuring 9.6mm or larger and a branch varicosity measuring 4.6mm or larger. However, the new policy is far more ridiculous. It appears to limit treatment to patients with C4b or worse disease, requiring both a 12 week trial of conservative therapy (even for patients with active venous stasis ulcers) and a minimum vein diameter of 9.6mm. If the policy is implemented as drafted, patients in Novitas jurisdictions will be forced to wait until they have irreversible changes from their venous disease to have any treatment.

I rearranged my schedule to allow me to drive to central PA and speak at the Open Meeting. I was the only speaker to address this issue, as the other speakers were all making comments on a draft policy regarding wound care. There was a ‘host’ Medical Director there personally and the other Novitas Medical Directors were (at least in theory) listening by conference call. I discussed the deficiencies in the draft policy at some length, speaking on behalf of AVLS, SIR, and my colleagues and patients within VCA. I also made the point of saying that I and all of the healthcare professionals I was representing are more than willing to cooperate with Novitas and any other payer to develop reasonable policies for the care of venous insufficiency following the best available evidence.

The host Medical Director did make a few notes while I was speaking, which is more than he did for other speakers. After I was done they had no questions, thanked me for my presentation, and asked me to provide my comments in writing along with supporting documentation.