TY - JOUR
T1 - The pathway to physician reimbursement for cardiac implantable electronic devices (CIEDs)
T2 - A history and brief synopsis
AU - Roka, Attila
AU - Schoenfeld, Mark H.
N1 - Funding Information:
When the CMS expanded coverage for ICD implantation for primary prevention, a national ICD database was initiated with mandatory participation for providers requesting Medicare reimbursement. The registry is funded by hospital fees and grants from device companies and payers. Although data submission is only mandatory for primary prevention ICDs, 78 % of hospitals are submitting data on all ICD implants—in total, these data account for 90 % of the ICD implants. A study of 111,707 patients found that 22.5 % had non-evidence-based ICD implantation and had higher risk of in-hospital death and rate of postprocedural complications. The incidence of non-evidence-based implants did not decrease from 2006 to 2009; however, physician training did affect it: 36.1 % for thoracic surgeons, 24.8 % for non-electrophysiologists, and only 20.8 % for electrophysiologists [22]. The most common causes for noncompliance were heart failure <3 months duration, followed by myocardial infarction within 40 days, class IV heart failure, and CABG with 90 days.
PY - 2013/3
Y1 - 2013/3
N2 - Cardiac implantable electronic devices (CIEDs), despite their proven effectiveness in large clinical trials for a wide range of patients with arrhythmia and heart failure, are frequent targets for criticism regarding cost-efficiency and alleged overuse. Newer indications, such as sinus node dysfunction for pacemakers and primary prevention for implantable cardioverter-defibrillators, increased eligible patient population significantly. This lead to heightened scrutiny from payors and legislative agencies, such as prior authorization and mandatory registry participation. Despite the significant administrative burden, the efficiency of these measures to decrease abuse is not clear. In addition, professional societies, regulatory agencies, and payors may not always agree whether use of a device is appropriate for a given patient. The review focuses on past and current issues related to utilization of CIEDs, which lead to increased regulatory oversight, and the effort of professional societies, payors, and governmental agencies to improve access to these life-saving therapeutical modalities while maintaining a just and cost-efficient healthcare system.
AB - Cardiac implantable electronic devices (CIEDs), despite their proven effectiveness in large clinical trials for a wide range of patients with arrhythmia and heart failure, are frequent targets for criticism regarding cost-efficiency and alleged overuse. Newer indications, such as sinus node dysfunction for pacemakers and primary prevention for implantable cardioverter-defibrillators, increased eligible patient population significantly. This lead to heightened scrutiny from payors and legislative agencies, such as prior authorization and mandatory registry participation. Despite the significant administrative burden, the efficiency of these measures to decrease abuse is not clear. In addition, professional societies, regulatory agencies, and payors may not always agree whether use of a device is appropriate for a given patient. The review focuses on past and current issues related to utilization of CIEDs, which lead to increased regulatory oversight, and the effort of professional societies, payors, and governmental agencies to improve access to these life-saving therapeutical modalities while maintaining a just and cost-efficient healthcare system.
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U2 - 10.1007/s10840-012-9747-5
DO - 10.1007/s10840-012-9747-5
M3 - Review article
C2 - 23242735
AN - SCOPUS:84884173290
VL - 36
SP - 137
EP - 144
JO - Journal of Interventional Cardiac Electrophysiology
JF - Journal of Interventional Cardiac Electrophysiology
SN - 1383-875X
IS - 2
ER -