Gore has applauded the recent reclassification of endovascular abdominal aneurysm repair (EVAR) by the Centers for Medicare and Medicaid Services (CMS) to a new Medicare Severity Diagnosis-Related Group (MS-DRG) classification that will result in an increase in the hospital reimbursement for these procedures.
The new classification, effective from 1 October 2015, applies to minimally invasive catheter based interventions used for the repair of abdominal aortic aneurysms (AAAs). As a result, AAA treatment with devices such as the Gore Excluder AAA endoprosthesis will be classified into two new diagnosis-related groups along with 12 other high cost aortic and cardiac conditions.
This decision was initiated following a data analysis effort conducted by Gore over the past two years aimed at improving the alignment of payment and cost. According to a study published in the Journal of Vascular Surgery, the average hospital cost of EVAR was roughly US$20,000, while the mean reimbursement rate came in at just under US$19,000. Since then, treatment of AAA patients with EVAR has transitioned to include complex cases where previously surgery was the standard option. As such, the costs of EVAR have risen while reimbursement has remained relatively flat.
Under the new classification, the reimbursement base rate for non-complex procedures will see an approximate 15% increase in payment while complex cases will receive an approximate 24% increase in payment. The increase in reimbursement provides relief to hospitals, and will help ensure that patients continue to have access to this therapy in their communities.
“As standard of care shifts from open surgery to minimally invasive forms of treatment, different types of resources are used. Hospital payments may not always reflect that change simply due to rate-setting methods,” said Don Goffena, director of reimbursement, Health Economics division at Gore. “It is important for Gore to monitor how reimbursement rates are keeping pace with hospital costs as therapies evolve and gain in popularity. We noticed a disconnect in this case, and in collaboration with others committed to the advancement of EVAR, we were able to work with Medicare to make a change that will improve the alignment of cost and payment for the benefit of the patients, hospitals, and physicians.”
EVAR procedures originally evolved as an alternative to highly invasive open surgical repair of AAA. Since the first reported North American use of EVAR in 1992, EVAR has been adopted as the standard of care for the treatment of clinically significant AAA. Today, it is estimated that EVAR accounts for nearly 80% of all intact AAA repair in the USA. This adoption reflects the quality improvements associated with EVAR over open surgical approaches, the advancements in technology which have furthered the applicability of the therapy to a broader set of patients, as well as reimbursement structures enabling patient access to these minimally invasive technologies.