Earlier this month, APMA wrote to Anthem to express its questions and concerns related to Anthem’s Clinical Appropriateness Guidelines for the Musculoskeletal Program, Appropriate Use Criteria: Small Joint Surgery, set to take effect November 1. APMA is also sending a joint letter with ACFAS, AOFAS, and AAOS to address our shared concerns.
APMA had a preliminary call earlier this month with Anthem’s new Office of External Affairs and its Medical Affairs staff from its subsidiary, AIM, to discuss its new guidelines, new prior authorization process, and peer-to-peer review process. Following the call, APMA’s Health Policy and Practice Committee leaders reviewed the guidelines, and APMA wrote to Anthem regarding several of its concerns and requested a delay in implementation to allow for additional stakeholder feedback. The Health Policy and Practice Committee also formed a workgroup to conduct a more in-depth review and to continue to collaborate with orthopedic and podiatric societies.