New article out in @JAMACardio!

What will new Medicare regulations on #TAVR mean for access? Come and find out!

https://jamanetwork.com/journals/jamacardiology/article-abstract/2763418

#CQOSpotlight

So what is the context? @CMSGov recently revised its reimbursement policy to facilitate broader access to #TAVR in light of recent low-risk trials. See the new rules here: https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=293

#CQOSpotlight

My colleague and coauthor @d_sukul wrote an editorial in @CircOutcomes about the potential impact of these changes last year, which I broke down in a previous #CQOSpotlight. https://twitter.com/MikeTPhD/status/1109105019557765127?s=20

A central (but not the only) part of the revised rules are changes to surgical volume requirements. Here are the new requirements: #CQOSpotlight

The question we sought to answer was: how many hospitals might be able to start new #TAVR programs based on revised surgical volume requirements? #CQOSpotlight

We used Medicare FFS Part A claims to estimate surgical volume for all acute-care non-federal hospitals and categorize them:

Main finding: the number of CT surg hosp providing #TAVR could DOUBLE under new surgical volume requirements (485 to 9xx). Wide variability in # of TAVR hosp across the country. #CQOSpotlight

Compared to current #TAVR hosp, candidate hosp were:
Fewer beds, safety net, non-teaching hosp, care for less medically complex pts
Onsite cardiac ICU
#CQOSpotlight

Comp to current TAVR hosp, ineligible TAVR hosp
Rurally located, safety net hosp, fewer beds, less med complex pts, non-teaching hosp
Onsite cardiac ICU

#CQOSpotlight

Takeaway 1 - # of CT surg hosp providing TAVR could DOUBLE, providing more access across the US. But will they go to places that need it? #CQOSpotlight

Takeaway 2 - Candidate hospitals smaller and potentially less resourced. Are they sufficiently equipped to manage #TAVR patients? #CQOSpotlight

Takeaway 3 - Wide variability in #TAVR centers likely remains, with rural and safety net hospitals less likely to expand TAVR access. What will this mean for patients?

#CQOSpotlight

Future need to research:
- How do we track quality in new/low volume #TAVR hosp?
- Where will new TAVR centers emerge?
- How will policy impact surgical volume (and PCI volume)?

#CQOSpotlight

Very thankful to @UM_IHPI for funding this work through its Policy Sprint grant mechanism. More info here: https://ihpi.umich.edu/member-resources/policy-engagement-external-relations/ihpi-policy-sprints

More importantly, thankful for my wonderful colleagues for their expertise, wisdom, and support!

@AlexBresciaMD, Michelle Hou, @FPaganiMD, @d_sukul, @jdimick1, and @DLikosky

#CQOSpotlight

...and a nice graphic from @UM_IHPI to boot! #VisualAbstract