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CMS payment rules may signal cardiology shift to ASCs in 5-10 years

CMS' 2019 Medicare reimbursement guidelines have significant implications for ambulatory strategies in cardiology, according to three leaders who shared their thoughts with Cardiac Interventions Today.

Three perspectives to know:

1. CMS' 2019 Medicare reimbursement guidelines for ASCs were a significant step forward in the outmigration of percutaneous coronary intervention, said Tony Lafata, chief development officer of Edina, Minn.-based National Cardiovascular Partners.

2. Incline Village, Nev.-based ACA Cardiovascular CEO Marc Toth also suggested that percutaneous coronary intervention, along with the following three procedures, could migrate to ASCs in the next five to 10 years:

  • Transcatheter aortic valve replacement: 30-minute procedures for nonsymptomatic, low-risk patients
  • Endovascular aneurysm repair
  • Left atrial appendage occlusion

3. Certain commercial payers offer reimbursement for diagnostic catheterizations and interventional procedures in the ASC and [office-based lab] settings, creating a problematic lack of standardization, MedAxiom Consulting Vice President Jacob Turmell told Cardiac Interventions Today.

"So, although a practice could keep the private payer patient on the table and intervene on a blockage in the ASC setting, the same blockage and in a patient with Medicare coverage would have to be transferred," he said. "This difference in care and lack of standardization does not drive efficient care models, and we look forward to this discrepancy being eliminated, as well as the adoption of payment by more private payers that would ultimately follow the lead of CMS."

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