Improving Access for all Patients with Heart Valve Disease

whether someone is steered toward contemporary valve interventions —are quite significant.

Last month, CMS held an advisory committee meeting to ask experts whether the government should continue to require a minimum number of annual surgical and interventional cardiac procedures for a hospital to maintain a TAVR program.

This may sound like a reasonable medical debate over the criteria necessary to ensure delivery of the best health outcomes for patients. However, the reality is that these criteria are fewer guardrails and more barricades to the democratization of care. These criteria may further exacerbate lack of access to patients that qualify for TAVR as these hospitals may not be able to meet the minimum requirements as set by CMS.

Studies have also shown that proximity to a hospital that offers TAVR impacts access to this minimally-invasive treatment option. Despite this evidence, the Society for Thoracic Surgeons (STS) has suggested more than doubling the annual procedural volume requirements for hospitals to maintain their TAVR programs.

This is not only illogical, but it threatens to shut off Medicare coverage for 207 (38%) of the existing 540 TAVR programs across the country that won’t meet the increased requirements. Not surprisingly, states with counties populated with 20% or more African Americans (i.e., Alabama, Georgia, Louisiana, Mississippi, and North and South Carolina) will be some of the hardest hit.

In addition, CMS recently released its 2019 Inpatient Prospective Payment Systems (IPPS) Rule, effective October 1, 2018, which decreased the weighted national average payment for TAVR by 4.4% from the previous year, primarily driven by continued significant reductions in length of stay, TAVR procedural efficiencies, and improved patient outcomes.

Conversely, open-heart surgical valve replacement payment increased by