• SCAI Statement on CMS MEDCAC Meeting Regarding TAVR Volume Requirements

    July 25, 2018

    Today, the Centers for Medicare & Medicaid Services (CMS) convened a panel of the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC). The panel was brought together to discuss the MEDCAC’s recommendations regarding procedural volume requirements for hospitals and heart team members to begin and maintain transcatheter aortic valve replacement (TAVR) programs. The MEDCAC specifically focused on an appraisal of the state of evidence for surgical aortic valve replacement (SAVR), TAVR, percutaneous coronary intervention (PCI) and other relevant structural heart disease procedural volume requirements.

    TAVR is a minimally invasive procedure to replace a narrowed aortic valve that fails to open properly (aortic valve stenosis). In May 2012, CMS finalized a national coverage determination (NCD) for TAVR that established specific requirements for coverage, including procedural volume requirements hospitals must meet to begin and maintain TAVR programs. 

    The Society for Cardiovascular Angiography and Interventions (SCAI) partnered with a group of leading medical organizations, including the American Association for Thoracic Surgery, American College of Cardiology, and the Society of Thoracic Surgeons to develop a comprehensive presentation to discuss both clinical and scientific evidence pertaining to procedural volume requirements for SAVR, TAVR, PCI and other relevant structural heart disease procedures as they relate to TAVR programs.

    During SCAI’s presentation, the Society highlighted the important need to focus on patient-centered care for aortic stenosis through consideration of the patient experience and pathway to care.  This includes patient education, physician education, and heart valve team evaluation combined with shared decision-making for patients and family.  SCAI Spokesperson, Ted Feldman, MD, MSCAI, of NorthShore University Health System highlighted that upon determination of treatment; it should always be “the right treatment for the right patient, at the right time.”

    Dr. Feldman also highlighted the importance of medical professionalism amongst physicians, noting the American Board of Internal Medicine’s physician charter which states that physicians are expected to work collaboratively to maximize patient care, be respectful of one another, and participate in the processes of self-regulation.

    The presentation concluded with an emphasis on SCAI’s continued commitment to quality and education – focusing on quality and patient outcomes. The Society strongly believes in patients having clear transparency in outcome reporting as they share in the decision-making with their heart care team in determining the best treatment option.