Washington Scene: CMS Reviews Volume Requirements for New TAVR NCD

STS News, Fall 2018 -- The Centers for Medicare & Medicaid Services is reevaluating the scientific evidence supporting volume requirements for hospitals and heart team members who perform transcatheter aortic valve replacement (TAVR) procedures.

The current TAVR National Coverage Determination (NCD), which was released in 2012, requires that hospital programs and heart team members perform a certain number of surgical aortic valve replacements and percutaneous coronary interventions in order to begin or maintain a TAVR program.

On July 25, a Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) panel met in Washington, DC, to hear recommendations regarding procedural volume requirements. Among the presenters were Joseph E. Bavaria, MD, David M. Shahian, MD, and Thoralf M. Sundt, MD. During the presentation, Dr. Bavaria stressed that programmatic TAVR volume requirements are essential: “Quality cannot be reliably determined at low-volume centers—good or bad. That is the conundrum.”

The MEDCAC panel will now advise CMS as the agency prepares a new TAVR NCD due for release in June 2019. In addition, CMS will consider written comments, including those in a joint letter from STS, the American Association for Thoracic Surgery (AATS), the American College of Cardiology (ACC), and the Society for Cardiovascular Angiography and Interventions (SCAI).

Prior to the MEDCAC meeting, the four societies published an expert consensus document on TAVR in each of their respective peer-reviewed journals, including The Annals of Thoracic Surgery. The writing committee for the “2018 AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Aortic Valve Replacement” was co-chaired by Dr. Bavaria and Carl L. Tommaso, MD. The document updates a 2012 version and identifies criteria for performing TAVR procedures safely, while optimizing patient outcomes. A related editorial, “TAVR 2.0: Collaborating to Measure, Assure, and Advance Quality,” by Dr. Shahian and colleagues, also was published in The Annals.

Read the multisociety comment letter, the expert consensus document, the editorial, and slide decks from the MEDCAC meeting below.

Meet Your Lawmakers at Home

One of the best times to connect with your legislators is when they’re at home in their districts. Take advantage of their proximity and schedule time to advocate for cardiothoracic surgery. Read about the different opportunities available to you below, and then contact Madeleine Stirling, Government Relations Coordinator, to get the ball rolling.

Facility Tour
Site visits are a great way to provide your legislators with firsthand knowledge about the challenges you face delivering high-quality patient care. Once scrubbed in, it’s impossible for them to ignore your message as you proceed to show them around your facility. This is the most hands-on way to make an impression on your elected officials. Time Commitment: 1 hour or more

Fundraising Event 
Members of Congress rely on contributions, both big and small, to run their campaigns and continue working for you. If you believe your representative is doing a great job, a huge way to show your support is to participate in or host a political event. Depending on the circumstances of your district, STS staff may be able to arrange your participation. Time Commitment: 1 hour

District Office Meeting
A one-on-one meeting at your legislator’s local office is an excellent way to bring important issues to the forefront. STS can help you schedule the meeting and can thoroughly prepare you with relevant materials. Time Commitment: 30 minutes

Town Hall
If your schedule makes daytime meetings difficult, attending a town hall might be perfect for you. Town halls, which are often held in the evening, allow constituents to gather in a public space and speak with their Senators and Representatives. The presence of a physician is always welcome, and your perspective is sure to be respected. STS staff can help you prepare a question and reasonable argument in advance. Time Commitment: variable

Phone Call 
If you can’t make it out to a district office but really want to educate your member of Congress on your priorities, a phone call may fit the bill. Just like a meeting, STS staff will handle scheduling and briefing materials so that you’re prepared. Time Commitment: 20 minutes