August 26, 2005

The Centers for Medicare and Medicaid Services (CMS) hosted a meeting of the Advisory Panel on Ambulatory Payment Classification (APC) Groups, August 17-18, 2005. One of the items on the agenda covered Device-Related APC issues. The discussion included two specific APC groups, 0107 Implantation of Cardioverter-Defibrillator and 0108 Insertion/Replacement/Repair of Cardioverter Defibrillator Leads and Insertion of Cardioverter-Defibrillator, which have a direct impact on heart rhythm procedures performed in the outpatient setting.

There were three presentations that covered the potential consequences of the cuts proposed in the Outpatient Prospective Payment Services (OPPS) rule. The main issue is patient access to ICD therapy in the outpatient setting being restricted due to financial concerns. With the 2006 proposed payment rates being set below hospital cost, hospitals will incur financial loss on ICD implants.

The Advisory Panel will make the recommendation to CMS to create adequate levels for ICD procedures using 2005 payment rates plus the hospital update of 3.2% to create the 2006 final OPPS payment rates for APCs 0107 and 0108.

The Heart Rhythm Society will be submitting written comments to CMS supporting the Advisory Panel's recommendation. You may submit electronic (www.cms.hhs.gov/regulations/ecomments) or written comments to CMS supporting this recommendation to: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1501- P, P.O. Box 8016, Baltimore, MD 21244-8018. Comments are due to CMS September 16, 2005.

If you have questions or comments about the proposed rule, please contact Brian Outland at boutland@HRSonline.org or 202-464-3400.