Is BNP A Better Marker of Disease, Prognosis and Response To Treatment Than Left Ventricular Function (Reduced EF)?
A recent review in the October 11, 2004, issue of the Archives on Internal Medicine addressed 20 studies of B-type Natriuretic Peptide and its Diagnostic Accuracy for Heart Failure (Arch Intern Med. 2004;164:1978-1984).
Included in the review were four studies that utilized NT ProBNP. While the authors’ concluded that BNP was accurate in diagnosing heart failure, as defined by reduction in ejection fraction (EF), it did even better in identifying those with “clinical” heart failure. As a consequence, they made an interesting observation: “The diagnostic accuracy of BNP was greater when the definition of disease used as the reference standard included patients who were diagnosed as having heart failure but who had 'preserved left ventricular systolic dysfunction'.”
This raises the question of whether BNP could be a better marker of disease, prognosis and response to treatment than left ventricular function (reduced EF) and whether comparison with echocardiographic criteria of left ventricular function may, in fact, be a comparison with a “silver” standard.
To date, almost all of the trials of treatment for heart failure have been conducted in patients with impaired left ventricular function. Essentially, they are saying that BNP and NT ProBNP may be identifying early diastolic dysfunction before the EF falls.
ExamOne's Schedule Now* Program
Continues to Exceed Expectations
ExamOne's Schedule Now program continues to exceed expectations in addressing the scheduling of paramedical appointments through the LabOne Insurance Service Group’s teleunderwriting service.
To date, Schedule Now has been utilized in combination with nearly 2,000 teleinterviews. Through the Schedule Now process, the average turnaround time has been just under 4 days. In cases where the applicant has needed to reschedule, the completion of services is occurring in less than 8 days.
Unlike the traditional scheduling process and pre-set appointments used by paramedical companies today, the Schedule Now process, unique to ExamOne, uses a real-time available appointment calendar of the ExamOne office handling the case.
ExamOne will continue to expand the Schedule Now system throughout the year and into 2005. In the upcoming year ExamOne will provide the Schedule Now service to all ExamOne.com members.
ExamOne would like to thank all of their LabOne Insurance Services Group clients whose invaluable input helped refine the innovative Schedule Now system. Due to the large number of examiners we work with, this program is critical to enhancing the current model.
To learn more about ExamOne's Schedule Now program, please contact your LabOne or ExamOne Sales Representative.
*Schedule Now allows the LabOne teleinterviewer to schedule an appointment with the applicant at the time of the teleinterview by displaying a real-time available appointment calendar of the ExamOne office handling the case. This option eliminates the need for "blind" preset appointments, decreases calls to the applicant, improves turnaround time and enhances the overall applicant experience.
LabOne and Ingenix Integrate Prescription History Delivery Systems
LabOne and health information vendor Ingenix®, Inc. have entered into a strategic alliance that will combine the power of both prescription claims history products for the life insurance industry.
ScriptCheck™ will utilize Ingenix MedPoint to deliver pharmaceutical histories on life insurance applicants to customers of LabOne’s Insurance Services Group. The Ingenix MedPoint data network gives ScriptCheck access to more than 7 billion pharmaceutical claims.
The enhanced product, which will be called ScriptCheck, powered by Ingenix MedPoint, will contribute new functionality to LabOne’s customers, including:
- Expanded access to prescription data. Customers will have access to a data network that contains a vast amount of information.
- Detailed prescribing physician information. Within the ScriptCheck results, customers will have up-to-date information on an applicant's prescribing physicians, including phone number, mailing address and specialty.
- Rx-to-Dx (drug-to-disease) functionality. Utilizing Ingenix predictive modeling technology, MedPoint analyzes pharmaceutical claims data to determine the likelihood an applicant is suffering from a potential disease condition.
- Quick turnaround time. The Ingenix MedPoint data network usually provides results in minutes.
ScriptCheck powered by Ingenix data will be available by January of 2005 via LabOne’s CaseView software or a system to system interface. ScriptCheck can be ordered in a variety of ways, including automatically per customer specific rules based on lab ID slip information or reflexed automatically based on a variety of lab results.
Please contact your LabOne Sales Representative to learn more. Existing ScriptCheck customers will be contacted within the next month.
MVR State Fees – Budget Higher MVR Expense in 2005
Several states have adjusted their state fees upward the last few months and we anticipate others may follow suit. Therefore, we suggest that you budget for an increase in state fees for MVRs of 10% for 2005 vs. 2004 to account for full-year impact of recent increases and expected future ones.
If you write a lot of business in a particular state that had a large increase in 2004 (e.g., Delaware), you might consider budgeting even more for state fees. The average state fee for September 2004 was $5.56. Thus, if you write across the U.S. following current population figures, we suggest you use about $6.10 plus our MVR handling fee to budget MVR expenses in 2005.
Obviously, an increase by a more populous state could push the average state charge even higher. Since July, the following states have increased their fees:
| State | Price Change | Effective Date |
| Delaware | $5.50 to $16.50 | July 1, 2004 |
| Indiana | $5.00 to $6.00 | August 1, 2004 |
| Maine | $5.00 to $7.00 | September 1, 2004 |
| Maryland | $7.00 to $9.00 | July 1, 2004 |
| Mississippi | $9.00 to $11.00 | October 15, 2004 |
| New Mexico | $1.50 to $2.25 | (anticipated by year-end) |
| Oklahoma | $12.00 to $12.50 | September 1, 2004 |
| Tennessee | $6.00 to $7.00 | November 1, 2004 |
| Wyoming | $3.00 to $5.00 | (anticipated by year-end) |
Consumer privacy has always been a top priority for LabOne. We have intentionally restricted access to MVR information to a minimum to protect consumers’ confidential information. In the past decade, three important events have shaped how we access MVRs:
- Driver’s Privacy Protection Act (DPPA), effective
September 1997
- Enacted that the federal government had the right to restrict or prohibit the release of personal information of persons licensed to drive or own vehicles.
- Defined what constitutes ‘personal information.’
- Cited 14 specific permissible uses that are not restricted from accessing personal information of persons licensed to drive or own vehicles. Importantly for our insurance customers, (6) For use by any insurer or insurance support organization, or by a self-insured entity, or its agents, employees, or contractors, in connection with claims investigation activities, anti-fraud activities, rating, or underwriting.
- Provided licensees the opportunity to request that the state
not release their personal information (other than for permissible
uses) – known as the “opt-out” provision.
- Public Law 106-09, effective June 2000
- Eliminated the “opt-out” provision and replaced it with an “opt-in” policy – that is, the consumer has to specifically request to have their personal information released or it will NOT be.
- Defined ‘sensitive personal information.’
- Supreme Court Ruling – Reno vs. Condon declared that DPPA was constitutional, reversing a decision of the U.S. Fourth Circuit Appeals Court.
The effects of DPPA have been tremendous. Nearly every state had to make changes via new legislation or administrative rule. And, as in the past, when state legislatures looked at privacy issues, the door was opened to many ideas and proposals from groups on both sides of privacy issues. Unfortunately, changes effected by the states created a myriad of new procedures, forms, and vendor agreements. In addition to these procedural changes, managers of the states’ MVR databases had to program systems to ensure compliance. Several states now require special forms be completed by each ‘end user’ of MVRs prior to accessing their databases.
The effects of Public Law 106-09 have also been profound. To comply, states essentially had to eliminate sales of marketing lists, sales of records containing addresses to “casual” requesters, and sales of bulk or database formats to information vendors and database compilers. By adding a new category of personal information called 'sensitive personal information,' DL photos, social security numbers, medical and disability information could not be released without the expressed written consent of the consumer — with four exceptions, and one of those was use by any insurer or insurance support organization. Every state using SSN as their DL number had to change their laws and procedures to ensure that the consumer had to expressly request the SSN be used if the DL number was to remain the SSN. Several states no longer include SSN on their result files – regardless of the 'insurer exception.'
Most states continue to review their procedures, database structures, and data security to ensure compliance with these laws and to further protect consumer privacy. Hopefully, most of the states have completed any major changes and compliance with further interpretation will be straight forward. LabOne will continue to keep you informed of changes and actions you may need to take to comply with them.
LabOne will roll out an updated version of APS case management software in December 2004. In addition to making significant improvements to the logic the system uses to ensure cases are followed up at the appropriate time, this new release is a crucial step towards integrating the ScanTech APS operation with LabOne’s APS operation.
The APS development team is currently working on the last major project required before the integration of the two APS operations can be completed. This final project will completely redevelop LabOne’s APS web site and provide customers greater access to APS information and statistics. Online reporting, greater search capabilities, and an improved user interface that can be used to communicate with the employees processing your APS cases are among the improvements that will be part of the new web site.
LabOne is committed to continually improving the APS retrieval process through innovations in technology and streamlining of processes. The integration of our ScanTech and LabOne operations is just another step in simplifying the process with customer's needs in mind.
LabOne's Superblind® Program is a quality improvement tool that measures test accuracy and precision, monitors all aspects of laboratory operations and provides an excellent way to evaluate new tests in the laboratory.
Focus areas during the third quarter of 2004, included checking the lower and upper reporting ranges for quantitative tests, monitoring pH reporting for drugs of abuse, and examining the reporting parameters for new tests and interfaces.
Quality Improvement staff also routinely check all data entry for patient demographics, purposely mismatch barcodes on blood samples and ID slips, request additional tests, call Client Services for information, submit inadequate or invalid samples and review billing for each applicant. The Superblind program is truly a comprehensive and thorough review of all LabOne operations.
During the third quarter, 449 pseudo insurance applicants were submitted and 11,053 challenges were evaluated—99.6% of the challenges evaluated were error-free.
The annual AHOU Conference was held October 3– 6, at the Chicago Sheraton Hotel and Towers. LabOne was proud to be a sponsor and exhibitor for this very important meeting.
On Tuesday evening, LabOne hosted a customer appreciation reception at the John G. Shedd Aquarium. More than 290 people joined us for dinner and cocktails in the world's largest indoor marine mammal pavilion and Aquarium featuring more than 8,000 aquatic animals from around the world. After dinner, the comedy team from the Second City performed their classic sketch comedy as well as a few industry-specific scenes written just for our insurance audience.
LabOne extends a sincere thank you to all who attended. We enjoyed the evening and look forward to next year's conference in San Diego!
NAILBA
ExamOne will exhibit at the NAILBA
meeting November 18-20, 2004 in Boca Raton Resort and Club. Please come
see us at booth #321.
WIFS
ExamOne will exhibit at the Women in Insurance and Financial
Services Conference October 23-26 at the Westin Atlanta North at Perimeter.
We hope to see you in Atlanta!
