Medicare was the primary payer for 90 percent of transcatheter aortic valve replacement (TAVR) hospitalizations over a recent three-year period, according to a March 19 report in JACC: Cardiovascular Interventions. With that in mind, the recent proposal to cut $473 billion from the CMS budget over the next decade could limit access to the increasingly popular procedure, researchers noted.
“Medicare beneficiaries may not be able to withstand anticipated cuts, and if cutting health care payments is inevitable, we need to make dedicated efforts to make sure life-saving procedures such as TAVRs are not affected,” wrote senior author Pankaj Arora, MD, with the University of Alabama at Birmingham, and colleagues. “We need to focus our efforts on customizing health care reforms by involving all the relevant stakeholders in the restructuring of Medicare.”
The researchers studied the National Inpatient Sample to identify all TAVR hospitalizations from 2012 to 2014 and propensity-matched those individuals to similar patients undergoing surgical aortic valve replacement (SAVR) over the same period.
Medicare shouldered 90 percent of the 40,875 hospitalizations for TAVR during the study period, contributing approximately $2.1 billion. TAVR hospitalizations increased from 6,865 in 2012 to 17,295 in 2014, and are expected to continue going up if reimbursement doesn’t become a barrier. The procedure was initially only recommended for patients with severe aortic stenosis in whom surgery was deemed too risky, but recent evidence has demonstrated TAVR is also a reasonable alternative to SAVR for patients at intermediate surgical risk.
In the propensity-matched analysis, the index hospital cost of TAVR was found to be significantly lower than that of SAVR ($57,290 versus $61,792).
But Arora and colleagues noted CMS has already indicated it plans to cut reimbursement for TAVR hospitalizations by 6 percent beginning this year.
“The aforementioned policy changes will jointly create stringent financial burden on Medicare beneficiaries seeking TAVR procedures,” they wrote. “Although TAVR procedures are rapidly increasing, they may lose sustainability due to an adverse economic environment as well as major reliance on the Medicare program. Having said that, actual impact of these health care policy changes on TAVR would be influenced by the state laws, health expenditure, and market dynamics.”
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.