CMS 2004 IPPS

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Cardiac Advisor

Dear Colleagues,

The attached letter (PDF) has been sent to the Centers for Medicare and Medicaid Services (CMS) on your behalf.  The American College of Cardiovascular Administrators (ACCA) is actively pursuing improved hospital reimbursement for drug-eluting stents (DES) and implantable cardioverter-defibrillators (ICD).

As you know, CMS approved reimbursement for DES in a precedent setting move last August.  However, the reimbursement that was approved was based on an apparent one-for-one trade out of DES with bare metal stents.  The European experience has shown that per case utilization has

actually been 2.2 +/- 1.4 DES per case.  It is anticipated that adoption of DES in the United States will occur very rapidly and utilization rates per case will be closer to 2.5 stents per case.  As such, further improvement in reimbursement is warranted.

Implantable defibrillators have been a tremendously frustrating issue for cardiovascular program administrators over the past year.  In spite of the FDA’s adoption and the ACC/AHA/NASPE inclusion of MADIT II criteria as appropriate for ICD implantation, CMS has refused to provide

any improvement in reimbursement criteria for these devices.  The general cost of ICDs combined with zero reimbursement for MADIT II patients has spelled financial hardship for many programs.  CMS did convene an advisory committee on February 12 to discuss issues surrounding ICD implantation and MADIT II criteria, and the advisory committee provided a strong recommendation to CMS that reimbursement criteria for ICDs must be expanded to include new and clinically relevant findings such as MADIT II.  It remains to be seen whether CMS will formally take this recommendation into account with its 2004 IPPS proposal.

We will be reviewing the 2004 IPPS proposal upon its release and will be providing further comments.  This letter is a first step to register our thoughts on what should be formally addressed in the 2004 proposal.

I welcome your comments and look forward to seeing you in Chicago on March 28-29 at the ACCA Cardiovascular Administrators’ Management Conference.  If you have any specific questions about ACCA’s action, please contact me by phone at 203/688-8993 or email [email protected]

Sincerely yours,

Kyle Kramer

R. Kyle Kramer, FAAMA, FACCA President

American College of Cardiovascular Administrators

The American College of Cardiovascular Administrators (ACCA) is a specialty group of the American Academy of Medical Administrators (AAMA). 

PS.  Please be sure this information is passed along to your colleagues who may not be AAMA/ACCA members.