Cardiovascular procedure payments would rise slightly in fiscal year 2017, under rates proposed by the Centers for Medicare & Medicaid Services (CMS) — with one exception.
Whereas cardiovascular procedures reimbursement would increase 2.7% on average overall, transcatheter aortic valve replacement (TAVR) payments would be cut by 0.5% compared with the current fiscal year.
In contrast, the proposed Inpatient Prospective Payment System (IPPS) would give a raise to the following:
- Left atrial appendage closure devices (up 5.5%)
- Surgical valves (up 3.4%)
- Ventricular assist devices (up 3.1%)
- Drug-eluting stents (up 2.0%)
- Implantable cardioverter defibrillators (up 1.8%)
- Pacemakers (up 1.2%)
Kim A. Williams, Sr., MD, of Rush University Medical Center in Chicago and immediate past president of the American College of Cardiology, told MedPage Today that the 2.7% average increase is “hopefully very close to the increase in the cost of living.”
This means “a neutral change or a slight pay cut,” he said. Though the changes may have little effect on patient access to health services, hospitals and doctors will feel the pressure of pay that does not match increases in cost of living. “This may mean the difference between continuing to survive or not for smaller hospitals,” Williams said.
Williams suggested that TAVR compensation may have gone down to reflect the decrease in cost, adding that the arrival of two new TAVR manufacturers in the near future could put “downward pressure” on the device’s price, saving hospitals money.
“Then a small decrease won’t be so bad,” he said.
CMS’s new technology add-on payment has been extended through 2017 for the CardioMEMs heart monitor and two drug-coated balloons, the Admiral and the Lutonix.
The MitraClip, meanwhile, will lose its new technology add-on payment status in exchange for getting a higher diagnosis-related group (DRG), for a net of around $4,000 more per procedure.
CMS will accept comments from the public on the proposed rates until June 16, 2016. A final ruling will be released by Aug. 1 for rates that will go into effect on Oct. 1, 2016.
Williams declared no relevant conflicts of interest.