Read on TwitterWhat will new Medicare regulations on #TAVR mean for access? Come and find out!
https://jamanetwork.com/journals/jamacardiology/article-abstract/2763418
New article out in @JAMACardio! https://abs.twimg.com/emoji/v2/... draggable="false" alt="🚨" title="Police cars revolving light" aria-label="Emoji: Police cars revolving light">What will new Medicare regulations on #TAVR mean for access? Come and find out! https://jamanetwork.com/journals/... href="https://twtext.com//hashtag/CQOSpotlight"> #CQOSpotlight" title="https://abs.twimg.com/emoji/v2/... draggable="false" alt="🚨" title="Police cars revolving light" aria-label="Emoji: Police cars revolving light"> New article out in @JAMACardio! https://abs.twimg.com/emoji/v2/... draggable="false" alt="🚨" title="Police cars revolving light" aria-label="Emoji: Police cars revolving light">What will new Medicare regulations on #TAVR mean for access? Come and find out! https://jamanetwork.com/journals/... href="https://twtext.com//hashtag/CQOSpotlight"> #CQOSpotlight" class="img-responsive" style="max-width:100%;"/>
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
https://www.cms.gov/medicare-... href="https://twtext.com//hashtag/CQOSpotlight"> #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">https://twitter.com/MikeTPhD/...
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:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Upwards arrow" aria-label="Emoji: Upwards arrow"> Fewer beds, safety net, non-teaching hosp, care for less medically complex pts
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Downwards arrow" aria-label="Emoji: Downwards arrow"> Onsite cardiac ICU
#CQOSpotlight
#CQOSpotlight
Fewer beds, safety net, non-teaching hosp, care for less medically complex ptshttps://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Downwards arrow" aria-label="Emoji: Downwards arrow"> Onsite cardiac ICU #CQOSpotlight" title="Compared to current #TAVR hosp, candidate hosp were:https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Upwards arrow" aria-label="Emoji: Upwards arrow"> Fewer beds, safety net, non-teaching hosp, care for less medically complex ptshttps://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Downwards arrow" aria-label="Emoji: Downwards arrow"> Onsite cardiac ICU #CQOSpotlight" class="img-responsive" style="max-width:100%;"/>
Comp to current TAVR hosp, ineligible TAVR hosp
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Upwards arrow" aria-label="Emoji: Upwards arrow">https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Upwards arrow" aria-label="Emoji: Upwards arrow"> Rurally located, safety net hosp, fewer beds, less med complex pts, non-teaching hosp
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Downwards arrow" aria-label="Emoji: Downwards arrow">https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Downwards arrow" aria-label="Emoji: Downwards arrow"> Onsite cardiac ICU
#CQOSpotlight
#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
#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
- 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">https://ihpi.umich.edu/member-re...
More importantly, thankful for my wonderful colleagues for their expertise, wisdom, and support!
@AlexBresciaMD, Michelle Hou, @FPaganiMD, @d_sukul, @jdimick1, and @DLikosky
#CQOSpotlight
@AlexBresciaMD, Michelle Hou, @FPaganiMD, @d_sukul, @jdimick1, and @DLikosky
#CQOSpotlight
