Advocacy Monthly: June 2019

New TAVR NCD Published 
Last week, the Centers for Medicare & Medicaid Services (CMS) published a new national coverage determination (NCD) for transcatheter aortic valve replacement (TAVR) that represents a yearlong effort to update the existing terms of Medicare coverage. The new NCD changes minimum procedure volume requirements to open and maintain a TAVR program and establishes new research questions for coverage with evidence development utilizing data from the STS/ACC TVT RegistryTM. Also, the decision no longer requires that two surgeons evaluate the patient prior to TAVR, but instead promotes a heart team approach, stating that a surgeon and an interventional cardiologist each must examine the patient. Earlier in the month, STS joined the American College of Cardiology (ACC), the American Association for Thoracic Surgery (AATS), and the Society for Cardiovascular Angiography & Interventions (SCAI) in reiterating support for this heart team approach after Congress sent a letter to CMS questioning the policy. More information on the TAVR NCD will be included in next week’s issue of STS News.

Societies Request Review of TMVR Medicare Coverage
STS, ACC, AATS, and SCAI also have requested that CMS reconsider the current transcatheter mitral valve repair (TMVR) NCD. This appeal was driven by new scientific evidence showing that TMVR is beneficial to patients with secondary or functional mitral regurgitation and the corresponding approval of this new patient indication by the Food & Drug Administration. CMS responded and stated that the agency will look at the NCD in the future; STS will provide updates as discussions progress.

CMS Adjusts Malpractice RVUs for Certain Procedures
CMS has corrected a series of low-volume cardiothoracic surgery procedure codes related to Professional Liability Insurance (PLI) Relative Value Units (RVUs). The changes take effect July 1 but are retroactive to January 1, 2019—meaning that, if applicable, you can resubmit claims for these services to be reprocessed and receive the updated Medicare reimbursement. This table provides a list of cardiothoracic surgery codes with the corrected PLI values. Please keep in mind that the table includes only the PLI values; it does not include the work, practice expense, or total RVUs.

STS Takes Action on ECMO Payments, Data Access, MACRA Implementation, Rehab Care Quality
The Society is working with national medical societies, public health groups, and research organizations on the following issues affecting cardiothoracic surgeons and their patients:

  • ECMO Payments—STS commented on several aspects of the Fiscal Year 2020 Medicare Inpatient Prospective Payment System Proposed Rule, including the proposal to reinstate original reimbursement levels for extracorporeal membrane oxygenation (ECMO) procedures—a goal achieved after months of lobbying by STS, the Extracorporeal Life Support Organization, and other stakeholders. The comment letter applauded this development, but noted that the proposed rule still erroneously conflates peripheral and percutaneous approaches for ECMO cannulation.
  • Interoperability and Data Blocking—The Society sent feedback to the Office of the National Coordinator for Health Information Technology regarding the Interoperability and Information Blocking Proposed Rule. STS supported increasing patient access to their personal health data, but also encouraged greater physician access to clinical data for care improvement. STS also signed a Registry Coalition letter regarding the proposed rule.
  • MACRA Implementation—A coalition letter sent to Congressional leaders emphasized the need for further refinements to implementation of the Medicare Access and CHIP Reauthorization Act, including positive payment adjustments for physicians that will replace the 6-year pay freeze stipulated in the statute, an extension of Advanced Alternative Payment Model bonus payments for an additional 6 years, and technical adjustments that will increase flexibility in scoring and reduce silos in the Merit-Based Incentive Payment System.
  • Rehabilitation Physician Certification—A new policy included in the Fiscal Year 2020 Inpatient Rehabilitation Facility Proposed Rule would loosen requirements for qualification as a “rehabilitation physician.” STS signed a coalition letter to CMS expressing concern that this lack of specific standards could result in suboptimal patient care.

James M. Levett, MD (far left) joined Rep. Abby Finkenauer (D-IA, right center) as she announced the Keep Physicians Serving Patients Act.

Society Endorses Bills on Physician Payments, Vaccines, Tobacco, Access to Care
STS has lent its support to several new pieces of legislation:

  • Keep Physicians Serving Patients Act—This bipartisan legislation would update Medicare’s practice expense and physician work geographic practice cost indexes. The inaccurate data currently being used by these indexes underestimate the costs of medical care in rural and underserved areas, exacerbating physician shortages. STS was represented at a press conference announcing the bill by James M. Levett, MD, who has worked with one of the bill’s sponsors, Rep. Abby Finkenauer (D-IA).
  • Vaccine Awareness Campaign to Champion Immunization Nationally and Enhance Safety (VACCINES) Act—This bill authorizes the development of a national vaccination rate surveillance system that would identify communities with low vaccination utilization or where vaccine misinformation is widespread. In addition, the bill would establish an evidence-based public awareness campaign on vaccines, as well as research grants to study vaccine hesitancy.
  • Tobacco-Free Youth Act and Tobacco to 21 Act—These two bills would raise the national tobacco purchasing age to 21. This would help prevent chronic disease and protect public health by restricting youth access to tobacco products.
  • Improving Seniors’ Timely Access to Care Act—This bipartisan legislation would create an electronic submission process for prior authorizations in the Medicare Advantage program, helping to reduce paperwork and speed approvals for cardiothoracic surgery procedures. STS urged the inclusion of language that would eliminate the need for prior authorization of rescheduled or follow-up procedures.

Key Contact Connect: Grassroots Advocate Meets with Congressional Staffer
Umraan Ahmad, MD, of St. Anthony’s Cardiothoracic Surgery in St. Louis, recently met with the health care staffer for Rep. Ann Wagner (R-MO). Dr. Ahmad described the meeting as very productive, noting that he took care to emphasize how the specialty’s legislative priorities align with many of the Congresswoman’s own areas of interest. If you’d like to visit the district office nearest you for a low-pressure advocacy experience, email Madeleine Stirling to get started.