Action Alert – CMS Proposed Inpatient Prospective Payment System


CMS Proposed Inpatient Prospective Payment System

New technologies such as drug-eluting stents and cardiac resynchronization therapy devices – low energy (pacing) and high energy (ICD) – continue to reshape the economic landscape associated with cardiovascular services. If not handled appropriately and with significant forethought, these technologies have the potential for creating major financial issues for hospitals nationwide. Drug-eluting stents, though not available presently, will be front and center in terms of utilization likely in the first quarter of 2003. Current predictions are that costs associated with this technology will be approximately two-thirds higher than existing stent technology with no change in reimbursement. Cardiac resynchronization therapy devices are presently available (approved by the FDA) and costs associated with these devices greatly exceed (relatively) similar pacing and ICD technology. While therapeutic benefit has been documented in major medical journals, reimbursement for the implantation of these devices is sorely lacking.

Attached are letters sent to CMS from the American College of Cardiology and the North American Society of Pacing and Electrophysiology suggesting improvements in reimbursement for these technologies as a part of CMS’s Fiscal Year 2003 inpatient Prospective Payment System:

* The American College of Cardiology’s (ACC) official position on CMS’s proposed inpatient Prospective Payment System for 2003. ACC has provided commentary on each of the relevant points in the CMS proposal related to the treatment of cardiovascular patients. 

* A letter sent to CMS as the North American Society of Pacing and Electrophysiology’s (NASPE) official position on CMS’s proposed inpatient Prospective Payment System for 2003. Specifically, NASPE’s comments are related to cardiac resynchronization therapy (CRT) for heart failure patients. In essence, NASPE has proposed the following:

   – CRT Pacers => code to DRG 515 (AICD Implant w/o EPS)    – CRT ICD => code to DRG 104 (Cardiac Valve and Other major

     Procedures w/Cardiac Cath)

It should be noted that ACC and NASPE have endorsed a single strategy related to the handling of cardiac resynchronization therapy (CRT). These changes, if approved, would enable reasonable financial performance in this new area of cardiovascular practice and will ensure that this therapy is made available to patients on a widely accessible basis.

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