Advocacy Monthly: August 2019

August 2019

TAVR Approved for Low-Risk Patients
The Food and Drug Administration (FDA) has expanded the indications for transcatheter aortic valve replacement (TAVR) devices to include patients at low surgical risk. The change will provide aortic stenosis patients in all risk categories with access to this transformative technology. As part of the approval, device manufacturers will participate in the STS/ACC TVT RegistryTM to provide the FDA with long-term follow-up data. Read more about the benefits of TAVR for low-risk patients in the summer 2019 issue of STS News.

STS Fights Reductions to Surgical Reimbursement
The Society, along with members of the Surgical Coalition and the American Medical Association, recently sent a letter to the Centers for Medicare & Medicaid Services (CMS) criticizing the agency’s proposal that could reduce the value of evaluation and management codes for office/outpatient visits by 7%. The letter asserts that the CMS proposal is “inappropriate” because it improperly lowers the value of the global surgical period relative to other services in the Medicare physician fee schedule, violates current law by creating specialty differentials, and ignores recommendations endorsed by nearly all medical specialties. STS will vigorously fight to prevent CMS from finalizing this proposed cut, as well as separate efforts that could result in additional surgical reimbursement cuts of 20%.

ECMO Payment Fixes Finalized
STS, the Extracorporeal Life Support Organization, and a broad coalition of stakeholders succeeded in convincing CMS to reverse detrimental policy changes to hospital coding and reimbursement for extracorporeal membrane oxygenation (ECMO). In a final rule released earlier this month, the agency confirmed that reimbursement for ECMO will be based on patient acuity and resource needs, rather than cannulation approach, starting October 1, 2019 (fiscal year 2020); however, no action will be taken to retroactively address the damaging payment policy that is in effect for the current fiscal year.

In response to a request from STS, the American College of Cardiology (ACC), the American Association for Thoracic Surgery, and the Society for Cardiovascular Angiography & Interventions, CMS has reopened the National Coverage Determination (NCD) for transcatheter mitral valve repair (TMVR). The existing NCD only covers patients with degenerative mitral regurgitation. Earlier this year, however, the FDA approved TMVR for use in patients with functional mitral regurgitation as well. The societies are asking CMS to update its coverage policy so that surgeons are reimbursed for performing TMVR in this patient population.

STS Intensifies Action to Curb Tobacco Use
In light of soaring e-cigarette usage rates, combined with at least one death and nearly 200 cases of severe lung illness connected to vaping products, the Society has intensified its efforts to reduce tobacco use, especially among minors. STS has signed coalition letters urging the FDA to expedite implementation of policies that would limit access to e-cigarettes and encouraging Congress to increase funding for the Centers for Disease Control and Prevention’s Office on Smoking and Health. The Society also is drafting a policy paper on tobacco and nicotine to serve as a guide for future advocacy efforts. In addition, STS has endorsed the Reversing the Youth Tobacco Epidemic Act, which would raise the minimum age for purchasing tobacco products to 21, prohibit online sales, and ban flavoring. You can help support this effort by sending a message to your lawmakers and asking them to pass this important legislation.

FDA Pushes for Graphic Warnings on Cigarette Packs and Ads
A new proposed rule issued by the FDA would require cigarette packages and advertisements to carry prominent, graphic warnings describing the negative health effects of smoking. The agency was charged with issuing such regulations under the 2009 Family Smoking Prevention and Tobacco Control Act; however, its last attempt in 2011 was blocked after a legal challenge by tobacco companies. Public comments on the new warnings will be accepted until October 15, 2019, and the final rule will be released by March 15, 2020.

Key Contact Connect: Rosengart Promotes the Specialty at District Meeting
Todd K. Rosengart, MD, from Baylor College of Medicine in Houston, Texas, recently met with Rep. Dan Crenshaw (R-TX) at the Congressman’s district office to discuss the Society’s advocacy priorities. Rep. Crenshaw is serving his first term in the House.

“Rep. Crenshaw was supportive of our priorities, and I think he could be a great ally to the Society, cardiothoracic surgeons, and our patients,” Dr. Rosengart said.

Now is a great time to plan district meetings with your lawmakers. Congress will be in recess September 30 to October 14, allowing legislators to head home and visit with constituents. If you would like to set up a meeting, email Madeleine Stirling with your home address to get started.