The Insurance Intelligencer
4/28/11
The Agency for Healthcare Research and Quality: No agency, no research, no quality
Insurance company words always mean the opposite of what they appear to mean:
"Blue Cross and Blue Shield" is not on a sacred (cross) mission to protect (shield) us from danger.
"Reasonable and customary" reimubursement is "unreasonable and unusual."
The job of the "Rapid Response Resolution Team" is to never under any circumstances call you back.
We are going to see what happens when government words join with insurance company words -- for the sole purpose of denying your treatment. Hang onto your pocketbooks, it's a wild ride ...
*****
AHRQ: What is it?
I was studying Anthem's Medical Policy Statement for bioimpedence spectroscopy the other day.
The policy declared this test "experimental." I went directly to the "Government and other agencies" section, to see which groups they used to justify their negative policy. I was expecting to find one of the usual questionable suspects there -- Hayes (a private company), NCCN (a private company), NICE (guidelines from the UK).
I only found one entity who is supposedly "against" this medical test: The Agency for Healthcare Research and Quality. My first thought was, as always, "Who are these people?" They sounded like a government entity. Were they?
It took me about ten minutes to discover that "AHRQ" means the opposite of what it appears to mean:
Agency: The guidelines put out by this supposed impartial "agency" are written by private companies -- with no government oversight.
Research: No research is done by the AHRQ. They simply use information from private, for-profit companies.
Quality: The AHRQ could not possibly judge the quality of treatments -- because they have no measure for what "quality" is.
The AHRQ goes to great lengths to paint themselves as a busy beehive of activity. We imagine the world's best medical researchers, studying all manner of treatments in gleaming laboratories, and giving their expert, unbiased opinions on which treatments your insurance company needs to pay for.
Guess what? There are no scientists, there are no laboratories, there is no research. The Agency for Healthcare Research and Quality does not DO anything.
The EPCs: Who are they?
There are many private guidelines companies who cater to insurance companies -- Hayes Technology Assessments, NCCN Guidelines, Milliman Guidelines, and so on. I have read a number of these guidelines; I have never found one that had any scientific validity. These companies exist to provide insurance companies and other payors with documents which help justify treatment denials. Their names sound official, and most people never actually read the guidelines, to see if there is any real substance to them.
However ... a few of us out here are getting hip to the obvious bias -- and lack of real science -- in these guidelines.
This is where the Agency for Healthcare Research and Quality comes in. The AHRQ functions like a money launderer. They take the same old private, biased sources of information, filter it through a nonexistent government entity -- and magically transform it into something that looks respectable, reliable, and impartial. Let's see how it works ...
If the AHRQ doesn't do the research -- then who does the research? The AHRQ has designated fourteen "Evidence-Based Practice Centers (EPCs)." The EPCs write the guidelines. Then, these privately produced guidelines are turned into "Evidence-Based Practice Guidelines."
"Evidence-based" is one of those insurance company words; it means the opposite of what it appears to mean. When you see a website slinging the phrase "evidence-based" around the way they do on this AHRQ website ... you know that somebody is trying a little too hard to convince you.
It has been my experience that anything called "evidence-based" by insurers really has no evidence behind it at all. Newsflash: Insurance companies are not practicing evidence-based medicine, they know that they are not practicing evidence-based medicine, and they are not concerned about whether or not you receive treatments for which there is any proof or evidence.
In my appeals, I provide a hundred times more evidence that the insurer could provide for many treatments which they routinely offer.
We have followed the thread from the ultra-official-looking AHRQ government website -- all the way to the EPCs. Who are these so-called Evidence-Based Practice Centers, the ones who provide all of the proof/evidence/research which decides which treatments our insurers will allow us to have? The first of the fourteen Evidence-Based Practice Centers is ...
BLUE CROSS AND BLUE SHIELD ASSOCIATION
Huh??? An insurance company gets to write guidelines that determine what treatments insurance companies will have to pay for? With a government agency acting as the go-between to make their pronouncements seem impartial, substantial, and acceptable? Since when is Blue Cross Blue Shield a "practice center"? The last time I checked, Blue Cross and Blue Shield was an insurance company -- not a medical center or research laboratory.
The government just put the fox in charge of the hen house. I thought that you might want to know.
Peaceful Insurance Warrior-ing,
Laurie Todd
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