April 2010

While percutaneous aortic valve replacements have been performed for more than six years in Europe, the option is not available to U.S. patients with severe aortic stenosis (AS) who are not surgical candidates, except for the select few enrolled in the Edwards Lifesciences PARTNER trial. With Medtronic applying for an FDA investigational device exemption (IDE), and a few other players emerging in Europe, the market seems explosive, but many clinical, ethical and financial questions need to be addressed before this therapy becomes a standard part of clinical practicein the U.S.

Much attention in recent years has been focused on the growth in imaging volume in the U.S., especially the rise in tests performed in outpatient office settings. While in reality, the rate of imaging volume growth in Medicare has been slowing since 2005 and imaging spending dropped significantly from 2006 to 2007, there are ongoing attempts at both the state and national level to eliminate or severely limit the ability of cardiologists to provide diagnostic imaging services in their offices.

To ensure a smooth process, providers that proactively prepare for a recovery audit contractor (RAC) visit should apply a two-fold method by implementing a RAC taskforce and making sure accurate documentation and billing measures are in place, particularly with the help of health IT.

While nuclear cardiologists await a normal supply of molybdenum-99 (Mo-99), the parent isotope of technetium-99m (Tc-99m), they have found ways to cope, including using other radiopharmaceuticalswhich can challenge standard protocolsor by relying more on PET and CT imaging.

Piedmonts Family Heart Disease Program embraces the trend of preventive disease initiatives.

When I wrote an article two years ago for Cardiovascular Business (Sept/Oct 2008, page 40), I outlined the potential impact the severe 2008-2010 Medicare cuts would have on non-hospital outpatient cath labs (OPCLs). At that time, three OPCL members of the Cardiovascular Outpatient Center Alliance (COCA), an educational and advocacy association, had decided to either sell to local hospitals or close their doors. I anticipated that many more would likely follow their lead if COCA could not educate CMS to change the reimbursement mechanism for OPCLs.