An article in the Wall Street Journal on March 18, 2019 describes a battle among doctors, hospitals and insurers over federal reimbursement for TAVR. Up until now, due to the reimbursement policies of CMS, the procedure has been limited to about 600 larger centers which are able to perform at least 20 procedures per year. This number of centers represents about half of the facilities with open heart programs. CMS is expected to propose new rules in the near future which may expand the coverage universe. Many smaller facilities and device makers argue for an expansion of the reimbursement to facilitate care for patients closer to home, yet some studies have shown lower readmission rates when TAVR is performed at high volume centers. The American College of Cardiology is of the opinion that there is a correlation between higher volume and quality of TAVR procedures.
EHC Note: As we often find, a balance must be struck between patient access and safety. In a recurring theme (which has been recently discussed in the Review), low volumes of any type of complex procedures are often associated with poor outcomes. At the same time, as procedures and techniques are perfected, and clinicians are trained, it is reasonable to gradually expand the universe of centers offering the capability. It makes sense for major organizations including the ASA, ACS, AHA, AORN, etc. to create guidelines delineating a framework establishing educational requirements and proven procedural expertise for perioperative personnel to safely add new techniques and technologies to better care for their communities.
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