Improving Access for all Patients with Heart Valve Disease

There is an expanding gap in the U.S. for minorities to access innovative health care, and the Centers for Medicare and Medicaid Services (CMS) is preparing to make important decisions that may widen it even further.

In June, CMS decided to reconsider its nationwide policy on whether, and under what circumstances, Medicare will pay for a less-invasive heart valve disease treatment called transcatheter aortic valve replacement (TAVR). TAVR is an innovative alternative to open-heart surgery that uses a catheter inserted into a patient’s artery to guide and deploy a new aortic heart valve for the treatment of severe aortic stenosis.

Several studies have shown that patients with severe aortic stenosis that undergo TAVR, compared to those who have open-heart surgery, experience a much shorter hospital length of stay and faster recovery times, better quality of life measures, and lower incidence of some major complications.

This sounds like great news for anyone with severe aortic valve disease, but data show that 94% of patients receiving TAVR are white; more than 90% of TAVR procedures are performed in hospitals that are urban, teaching hospitals; and 78% of patients served by these hospitals are in higher income zip codes. Additionally, “safety net hospitals”—those public hospitals that are often providers of last resort, especially for African Americans and ethnic minorities —perform only about 20% of TAVR procedures.

The disparities that exist based on race, ethnicity, income, and where people live — ultimately impact