STS Strongly Opposes Proposed PFS Rule
The Society has submitted its official comments to the proposed Medicare Physician Fee Schedule (PFS) rule for 2021, which was released earlier this summer. The rule, scheduled to go into effect on January 1, slashes Medicare payments by as much as 9% for the specialty. The Centers for Medicare & Medicaid Services (CMS) is expected to publish the final rule in December.
Also as part of the fight against the proposed reimbursement cuts, STS was among 22 organizations that sent letters to every member of the House of Representatives, urging them to take immediate action and prevent the steep declines in Medicare payments. In addition, today concludes a “Week of Action” organized by the Society and the Surgical Care Coalition. The week featured several advocacy initiatives designed to highlight the role of Congress in preventing the impending cuts. But the battle goes on, and STS members are strongly encouraged to continue taking action by connecting with their members of Congress via email or phone. STS can help with scheduling or talking points.
Specialty Societies Support Easing Rules for Artificial Hearts, VADs
STS, the American College of Cardiology (ACC), the Heart Failure Society of America (HFSA), and the American Association for Thoracic Surgery (AATS) have submitted comment letters to CMS about proposed updates to coverage policies for artificial hearts and ventricular assist devices (VADs). The changes are expected to help expand the use of these devices, lessen the paperwork burden, and ensure a more patient-centered approach to treating end-stage heart disease. If the proposal is finalized, CMS will remove the unnecessary distinction between bridge‐to‐transplantation and destination therapy for coverage of durable VAD implantation—an update that is supported by the group. On the other hand, STS, ACC, HFSA, and AATS reiterated their opposition to eliminating national coverage for artificial hearts and related devices. CMS is set to issue a final national coverage determination (NCD) by mid-November; the Society will continue to monitor and provide updates.
OPPS Rule Proposes Elimination of Inpatient Only List
CMS released its Outpatient Prospective Payment System (OPPS) proposed rule for 2021 last month, and STS quickly submitted feedback on the planned changes. The Society’s comments addressed the proposed elimination of the inpatient only list, regulations that govern inpatient hospital admissions under Medicare Part A, and the addition of new hospital outpatient department services that will require prior authorization. The final OPPS rule should be released later this fall.
Shortcomings in TMVR NCD Could Impact TVT Registry
In response to recommendations from the Society and several other organizations, CMS has offered changes to the NCD for mitral valve transcatheter edge-to-edge repair (TEER), previously known as transcatheter mitral valve repair (TMVR). While the proposed NCD features expanded coverage for patients with functional mitral regurgitation (FMR), it does not include a “coverage with evidence development” requirement for TEER in patients with degenerative mitral regurgitation (DMR) and FMR. This means that participation in a registry such as the STS/ACC TVT Registry would not be required as a condition of coverage. In addition, CMS declined to continue national coverage for DMR, proposing instead to leave DMR coverage decisions to Medicare administrative contractors. The Society and several other organizations submitted comments, urging CMS to reevaluate its position on these and other issues. A final decision from CMS is expected soon.