• CLINICAL INTEREST SECTIONS: Coronary Peripheral SCAI TAVR Center

  • SCAI This Week
  • October 19, 2012

    In This Issue:

     


     

     


     

    Legislators Voice Opposition to Discounting of Diagnostic CV Services

    Echoing comments SCAI submitted to the Centers for Medicare and Medicaid Services last month, the Coalition for Patient-Centered Imaging – of which SCAI is a member – has garnered the support of legislators to oppose CMS’s proposed discounting of diagnostic cardiovascular services. In early September, SCAI vehemently communicated concerns about plans outlined in the proposed 2013 Medicare physician fee schedule to apply a 25 percent multiple procedure payment reduction (MPPR) to the technical component of certain diagnostic cardiovascular and ophthalmology services when these services are furnished by the same physician/physician group to the same patient on the same day. SCAI pointed out that the services under discussion are not commonly performed together and the potential for economies asserted by CMS is highly questionable. The result, SCAI stressed, is “a seriously flawed methodology” that would unfairly penalize physicians who are able to schedule multiple diagnostic tests on the same date of service for their patients’ convenience.

    Most importantly, SCAI urged CMS to focus on the best interests of patients: “There is grave concern that such a reduction in value for these services will drive these diagnostic tests to the more expensive hospital outpatient setting,” possibly discouraging diagnostic tests that enable the early detection of potentially serious conditions.    

    Read the Letter of Support From Legislators

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    Registry Report Provides Snapshot of Interventional Cardiology

    A report from the CathPCI Registry, a data registry that includes information from 85 percent of the heart catheterization laboratories in the United States, is providing a vivid snapshot of the current practice of invasive cardiology. SCAI collaborates with the ACC on the CathPCI Registry.

    The report analyzes data from 1.1 million patients undergoing diagnostic cardiac catheterization procedures and 941,248 patients who underwent angioplasty and stenting, known as percutaneous coronary intervention or PCI, from Jan. 1, 2010, through June 30, 2011.

    “These data will be of interest to the cardiovascular community because they show us where we are and where we can find opportunities for quality improvement,” said Gregory J. Dehmer, MD, FSCAI lead author.

    Highlights from the report:

    • Patient risk factors:  Almost 80 percent of angioplasty and stent patients were overweight, including 43 percent who were obese. Other risk factors were also prevalent:  80 percent had high blood cholesterol levels, and 82 percent had high blood pressure. Almost 28 percent of patients who underwent PCI were current or recent smokers.
    • Access to arteries for assessment and treatment:  During the time period analyzed, patients’ arteries were more likely to be accessed through an artery in the thigh – known as femoral access – than through an artery in the wrist (transradial access).  Femoral access was used in just over 90 percent of procedures vs. single-digit use of radial access. (8.3 percent for diagnostic tests and 6.9 percent for angioplasty and stenting procedures). 
    • Patient presentation: Among the patients undergoing angioplasty and stenting, 70 percent presented with heart attack or other acute symptoms, while approximately 18 percent had stable angina and 12 percent had atypical symptoms or no angina.
    • Procedural volume per facility:  Twenty-six percent of the facilities were low-volume facilities, performing fewer than 200 angioplasty and stent procedures a year but these facilities accounted for only 4 percent of the total number of angioplasty and stent procedures during the study period.
    • Door-to-Balloon Time: Patients suffering a severe heart attack (ST-elevation myocardial infarction, or STEMI) who arrived at an angioplasty-capable hospital, the average time from hospital arrival to treatment was 64.5 minutes. Patients who required transfer to another hospital, the average time from arrival at the first hospital to treatment was 121 minutes. 

    More on this Report

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    In Case You Missed It! Society Launches Quality of Life Initiative

    On Wednesday SCAI President J. Jeffrey Marshall, MD, FSCAI announced that the Society was launching a Quality of Life initiative with the release of results from a new survey that found four out of five (81 percent) patients say their lives have changed for the better following angioplasty.

    “The results show a nearly two-fold reduction in symptoms such as chest discomfort and shortness of breath following angioplasty, and many of the patients reported having tried medical therapy for as long as seven to eight years to try and achieve similar results,” said Dr. Marshall. “We see it every day in our patients. They come in with debilitating symptoms that interfere with their quality of life and we are able to get them back to living their lives not long after their procedure.

    Simultaneously, the Society published a comprehensive review of research on quality of life following angioplasty and stenting. The paper offers recommendations to guide healthcare providers in choosing the best cardiovascular treatment to benefit patients and enhance their quality of life. The consensus paper, "Effect of Percutaneous Coronary Intervention on Quality of Life: A Consensus Statement from the Society for Cardiovascular Angiography and Interventions" appears in Catheterization & Cardiovascular Interventions (CCI).

    More Information You Need to Know and Discuss From the Survey Results

    Download the Consensus Paper on Quality of Life

    If You Missed It, Review Dr. Marshall's Announcement of This Initiative

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    SCAI Supports Legislation to Improve RAC, Other National Audit Programs

    SCAI is urging its members and their facilities to support the Medicare Audit Improvement Act of 2012 currently circulating in the House of Representatives. This bill takes steps to improve the Recovery Audit Contractors (RAC) program and other national audit programs.

    Earlier this year SCAI successfully fought for the indefinite delay of RAC pre-payment audits of PCI. RACs were first authorized as a Medicare demonstration program via the Medicare Modernization Act of 2003, and made permanent by the Tax Relief and Health Care Act of 2006. RACs were extended to the Medicaid program through the 2010 Patient Protection and Affordable Care Act.

    These recovery auditors are paid contingency fee payments, a potential conflict of interest. In addition, recovery auditors are not targeting widespread payment errors and are making subjective decisions on short-stay cases; their operational problems are persistent and widespread. Hospitals are experiencing a significant number of inappropriate denials amounting to hundreds of thousands of dollars in unjust recoupment payments for medically necessary care. According to data from the American Hospital Association, hospitals are successfully overturning RAC denials 75 percent of the time.

    The Medicare Audit Improvement Act of 2012 provides much needed guidance for medical necessity audits, keeping auditors out of making medical decisions that should be between patients and their physicians.

    This legislation would:

    • Establish a consolidated limit for medical record requests;
    • Improve auditor performance by implementing financial penalties and by requiring medical necessity audits to focus on widespread payment errors;
    • Improve recovery auditor transparency;
    • Restore due process rights under the AB Rebilling Demonstration;
    • Allow denied inpatient claims to be billed as outpatient claims when appropriate; and
    • Require physician review for Medicare denials

    Urge Your Representative to Support Medicare Audit Improvement Act

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    Deadline for ABVM General and Endovascular Exams is Today at 5 PM!

    The deadline to sign up for the ABVM General and Endovascular Exams is today at 5 PM ET!

    Why should you become ABVM certified? Here are some reasons:

    • Certification provides assurance to the public, your colleagues and the medical profession that you have successfully completed an accredited course of education and training in vascular medicine and have passed an additional rigorous examination in vascular medicine. This demonstrates a high standard of physician excellence.
    • Certification by the American Board of Vascular Medicine signifies that you have documented your commitment to continued professional development in vascular medicine.
    • ABVM certification contributes to enhanced professional stature and credibility in the field of vascular medicine and provides stronger credentials for enhanced professional and advancement opportunities.
    • ABVM certification will enhance the collegial relationship with others who share a commitment to training, education, expertise, and long-term professional development in vascular medicine.
    • ABVM certification demonstrates that you have the knowledge, skills and commitment to provide quality patient care in vascular medicine.

    Apply Now!

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    eLearning Spotlight: IFI/ICI Sites Continue to Grow With Exciting Additions

    Revised content for SCAI's Interventional Fellows Institute and Interventional Cardiologists Institute eLearning Courses is now online. Visit the site now and join SCAI members and thought leaders in viewing a new modules on acute MI management and transradial catheterization.

    The IFI/ICI curriculum continues to grow with updates by SCAI membership on the latest information on a variety of exciting topics. Stay up to date and consider getting involved to participate as a future contributor for many more upcoming modules.

    Also, be sure to take a look at other exciting offerings from SCAI's eLearning Library including:

    • High-Risk PCI Online Curriculum
    • Peripheral Vascular Disease (PVD) Online Curriculum
    • SCAI 2012 On Demand
    • SCAI's Quality Improvement Toolkit (SCAI-QIT) Webinar Series
    • SCAI Radial Summit Online

    Visit the ICI/IFI eLearning Courses

    View Additional Online Offerings at SCAI's eLearning Library

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