ASCRS calls on Aetna to rescind new policy delaying cataract surgery

Last Thursday, Aetna put into effect a new insurance company that requires prior authorization for all cataract surgery procedures.

In response, members of the American Society of Cataract and Refractive Surgery (ASCRS) and the American Academy of Ophthalmology (AAO) are calling on the company to rescind the policy.

ASCRS President Richard S. Hoffman, MD, said in a news release that the best two people qualified to determine if cataract surgery is necessary are the patient and their ophthalmologist — not an insurance company.

 “Having an insurance company, such as Aetna, determine if a patient should have surgery does nothing to enhance patient care and adds the potential for delaying sight-restoring surgery and is at its worst rationing of care,” he said.

During a meeting with the company last week, ASCRS and AAO raised transparency concerns and discussed concerns from ophthalmologists about the inconsistent instructions from Aetna staff and the inability to get prior authorization approval for cataract surgery, according to the ASCRS release.

The organization stated that Aetna failed to provide concrete reasoning for the implementation of its new policy as well as any examples or rationale behind why all cases moving forward will be subject to precertification.¹

ASCRS further stated that Aetna failed to address the organization’s concerns regarding the operational aspects of the program and offered no relief for the short implementation timeline and its inoperable portal.

Additionally, the company neglected to address the general support line that has resulted in complete confusion for ophthalmologists and, as of July 1, cancelations of cataract surgeries for the beginning of July, according to ASCRS. 

Delaying cataract surgery procedures — typically scheduled out weeks in advance and performed in one eye at a time —could potentially result in several issues, including, as outlined in the news release:

Further hardening of the lens, increasing the risk for cataract surgery complications or the need for more invasive surgical procedures.²

• Association with physical safety concerns such as increased risk of car crashes,³ increase risk of falls,⁴ etc.
• Reduction in a patient’s quality of life⁵
  
• Permanent blindness or impaired visual function, particularly in children (where timeliness is critical to the developing brain’s pathways).⁶

With ophthalmology taking a hit more than any other specialty due to the COVID-19 pandemic,⁷ cataract surgeries have faced significant delays,⁸ according to research.

This existing backlog of patients that ophthalmologists are currently working to treat is being further delayed with Aetna’s new prior authorization policy, the release stated.

“This policy creates an overly burdensome amount of unwarranted work for our teams and unnecessarily restricts access to this essential surgery for patients suffering from sight- threatening cataracts,” said Hayley Boling, MBA, COE, member-at-large, American Society of Ophthalmic Administrators (ASOA) Board of Directors, in a statement. “This mass application of preauthorization requirements sets a dangerous precedent for other insurance companies and creates a slippery slope for other medical services and specialties.”

References

1. ASCRS. Insurance company policy delays sight-restoring surgery, puts patients in jeopardy. Available at: https://ascrs.org/news/ascrs-news/ascrs-press-release-regarding-prior-authorization-policy. Accessed 7/6/2021.

2. Gogate P, Wood M. Recognizing 'high-risk' eyes before cataract surgery. Community Eye Health. 2008 Mar; 21(65): 12–14.

3. Schlenker M, Thiruchelvam D, et al. Association of cataract surgery with traffic crashes. JAMA Ophthalmol. 2018;136(9):998-1007.

4. Brannan S, Dewar C, Clarke D. A prospective study of the rate of falls before and after cataract surgery. Br J Ophthalmol. 2003 May; 87(5): 560–562.

5. Lamoureux E, Fenwick E, et al. The impact of cataract surgery on quality of life. Curr Opin Ophthalmol. 2011 Jan;22(1):19-27.

6. Birch E, Stager D. The critical period for surgical treatment of dense congenital unilateral cataract. Invest Ophthalmol Vis Sci. 1996 Jul;37(8):1532-8.

7. Changes in Medicare Physician Spending During the COVID-19 Pandemic. Economic and Health Policy Research, American Medical Association, April 2021. PDF.

8. Aggarwal S, Jain P, Jain A. COVID-19 and cataract surgery backlog in Mediciare beneficiaries. J Cataract Refract Surg. 2020 Jul 17 : 10.1097