Last week a team of SCAI advocates convinced Oregon’s Health Evidence Review Commission (HERC) that its initial draft coverage policy on treating stable angina requires significant revision before it can be considered for implementation. If the draft policy had been implemented, it would have been extremely restrictive, ultimately denying one-third of Oregon’s citizens access to evidence-based care of their stable angina. The policy would have completely denied coverage to anyone over age 75 and anyone with multi-vessel disease. 

Dr. Arthur Lee, a member of SCAI’s Advocacy Committee, represented SCAI at the meeting. Dr. Ed Toggart, also a member of our Advocacy Committee, had planned to represent the Society but was added to the panel as an expert consultant. They both were able to work with the panel to help them realize that –

• The key treatment question in the stable angina patients is not optimal medical therapy (OMT) vs PCI but how to treat patients for whom OMT doesn’t work well.
• The technology and evidence in this field are evolving rapidly, and the evidence base is both enormous and challenging to interpret.

With their new understanding of the complexities of this issue and the limitations of their initial draft coverage policy, Oregon officials will now revise their initial draft and reconsider it at their February meeting.  

We were impressed that the Oregon panel was open to input from experts in the field. We are making every effort to work collaboratively with the HERC, and the Oregon Chapter of the ACC, to help the State revise its approach to this coverage decision. Whether or not you practice in Oregon, please stay tuned for updates on this evolving issue because Oregon is a trailblazing state in healthcare policy.

MOC Update

Meanwhile, SCAI’s is also serving as the voice for all of Cardiology at the American Medical Association House of Delegates meeting that started this weekend in Dallas. Representing the Cardiology Section Council (which includes representatives from SCAI, ACC, HRS and ASE), SCAI Past President Dr. Joe Babb spoke about life-long learning and the challenges inherent in the current ABIM Maintenance of Certification (MOC) program. Dr. Babb discussed the progress made to date – and the work still to be done – to persuade ABIM to reform the MOC model. As you know, we are emphasizing:

• One test only for recertification
• No more punitive labels for physicians who do not complete MOC requirements
• More value and less cost for Parts II and IV requirements
• Alignment of MOC and CME to avoid unnecessarily burdensome and costly requirements on physicians

Watchman Testimony

SCAI was the only medical society that participated in the recent FDA Circulatory System Devices Panel considering the Watchman Left Atrial Appendage Occluder. Testifying for SCAI, Dr. Zoltan Turi stressed that there is strong evidence indicating that the Watchman device can help address a major unmet clinical need to prevent stroke. SCAI urged approval of the device specifically for patients with reasons to avoid chronic anticoagulation. SCAI also recommended a requirement for “additional data collection and analysis to help establish best practices, enhance quality improvement, identify anomalies, and establish the causes of adverse events.”
The panel voted unanimously (12-0) that the device is safe for the proposed indication, but were split on efficacy (6-6), with the chair breaking the tie with a "no" vote. On the risk/benefit question, six panelists voted "yes", five panelists voted "no" and one abstained.

2015 Medicare Physician Fee Schedule

The recently issued 2015 Medicare Physician Fee Schedule demonstrates that SCAI’s voice is also being heard by policymakers. For example, CMS accepted SCAI’s request, and the RUC’s recommendations, for valuation of the new transcatheter mitral valve repair (TMVR) codes. SCAI Structural Committee Chair and Trustee Dr. Cliff Kavinsky, who also represents SCAI to the RUC, was instrumental in securing the values received for the new TMVR codes. The code for the initial clip placement (33418) was assigned a Medicare reimbursement rate of $1,923. The code that will be used to report second and subsequent clips placed (33419) received a value of $451. To put the values of the new TMVR codes in perspective, the percutaneous femoral TAVR code (33361) has a payment rate of $1,396. However, the TAVR code requires co-surgeon status for its performance, translating to each operating receiving payment of $872.

CMS agreed with SCAI’s recommendation to assign higher malpractice risk factors to several cardiac catheterization and angioplasty services that were initially overlooked in CMS preliminary assessment.
The Final Rule also shows CMS moving forward with the elimination of all 10- and 90-day global period valuations. SCAI softly supported this proposal for its potential to bring greater accuracy to the Medicare Physician Fee Schedule. 

The Final Rule also includes new provisions for enhanced transparency in rate-setting and tracking claims from off-campus provider-based departments.

Midterm Elections:  What They Mean for Interventional Cardiology

This year was the first year that candidates backed by SCAI’s Political Action Committee (SCAI-PAC) competed in elections. I am pleased to report that overall the candidates that we supported won big on Tuesday night. Seven of the 11 candidates we supported won outright, only two lost and the other two are facing a recount and a runoff election.
 

The SCAI-PAC Board supports candidates based on their positions on issues that impact the delivery of specialty medicine and their knowledge of the value of physician-driven, quality care on cardiovascular patients.

In the last few days, SCAI has received dozens of invitations to meet with elected officials, including those who just won their races. Clearly, SCAI’s PAC may very well be the most important tools that interventional cardiologists and cath lab teams have for influencing our ability to provide optimal care for patients. I urge you to support SCAI-PAC so that the Society can continue this important work.

Watch for More News

In the next few weeks, you will receive SCAI’s Fall newsletter in the mail as well as my quarterly update email. Please review these and other materials from SCAI and then pass them on to a colleague so that all in our profession stay up-to-date SCAI’s many efforts on behalf of us and our patients. The active engagement of our growing membership is the key to our success. Please join the effort.

Contact me anytime at [email protected].

Best regards,

Charles Chambers, MD, FSCAI
SCAI President, 2014-15