MD Labs Offers Turnkey PGx Program for Cath Lab Implementation
Heart disease kills 1 in 4 men and women in the United States each year, according to the National Institute of Heart, Lung, and Blood Institute (NHLBI). Additionally, coronary heart disease (CHD) is the number one killer for women. (NHLBI) (National Heart, Lung, and Blood Institute, “What Causes Heart Disease,” April 2014).
Risk factors, such as traits, conditions, and habits raise the risk for coronary heart disease and heart attacks in female patients. More than 75 percent of women from ages 40 to 60 have one or several risk factors for CHD. Despite this, heart diseases can affect women all of ages with symptoms starting as early in childhood (NHLBI).
2017 CMS Payment Updates & Potential Savings
Under the Centers for Medicare and Medicaid Services (CMS) FY2017 hospital inpatient final rule as reported in Cath Lab Digest (Cath Lab Digest, “The FY 2017 Financial Future: How the Cath Lab Impacts the Hospital Bottom Line,” October 2016), all cardiovascular (CV) services will receive increases for inpatient payments with hospitals gaining more in reimbursements. Adjustments will decrease based on evidence of financial productivity, documentation, coding, and adjustments under the Accountable Care Act. There will only be an increase in two-midnight policy adjustments.
There is mounting evidence on the cost saving opportunities to hospitals utilizing Pharmacogenetic (PGx) testing for pharmacotherapy following cardiovascular services. In concert with an interventional cardiologist, MD Labs has developed a PGx protocol for Catheter Labs that hospitals are in the process of adopting across the U.S.
CMS Inpatient and Outpatient Payments will Affect Hospital Budgets in 2017
The CMS proposed the “cardiac bundle” Episode Payment Model (EPM), directly impacting cardiovascular services. CMS recognizes the role that cardiac rehab plays in the 90-day post-discharge continuum of care, and is encouraging hospitals by providing additional payment: $25 per session for the first 11 sessions and $175 per session for each additional session, up to a total of 36 sessions.
This EPM will follow the Comprehensive Joint Replacement (CJR) model and will include Coronary Artery Bypass Graft (CABGs) and the Acute Myocardial Infarction (AMI) services. AMIs is one of the highest reasons for patient readmission.
This proposal will also introduce payment models that calculate the costs for Medicare inpatients plus 90 days post discharge for 98 randomly selected Metropolitan Service Areas (MSAs).
Since close to 50% of Cath lab procedures are paid as outpatients, CMS recommends that payments for this population must also be seriously considered. “CMS continues to aggressively shift outpatient payments to a true prospective payment system,” according to the Cath Lab Digest article.
EPM Model Incentives Care
The EPM proposal will begin July 2017 and continue on a calendar year basis until 2021, called a Performance Year. Throughout the EPM, hospitals, providers, and suppliers will continue to bill and still collect in the fee-for-service payment systems. After a performance year, all claims data for an episode are put together for an actual episode payment. Then, the actual episode payment will be adjusted compared with a quality adjusted target price.
Target prices will be created with a hospital and regional historical data. If the actual payment is less than the target price, the hospital will profit which is called the reconciliation payment. If the actual payment is more than the target price, CMS will receive reimbursement from the hospital.
With the proposed EPM model, the efficiency and quality of cardiovascular services is expected to improve and PGx testing will play a crucial role in determining appropriate pharmacotherapy, as bolstered by research such as Expert Opinion on Drug Metabolism & Toxicology “The pharmacogenetic control of antiplatelet response: candidate genes and CYP2C19” (July 2015) which surveyed clinical outcomes of using pharmacogenetics to guide antiplatelet therapy used for preventing ischemic events in patients with acute coronary syndromes (ACS), percutaneous coronary intervention (PCI) and other indications. The pharmacogenetics of available antiplatelet agents – Aspirin, Clopidogrel, Prasugrel and Ticagrelor – were analyzed.
Cath Lab Digest “The FY 2017 Financial Future: How the Cath Lab Impacts the Hospital Bottom Line” (October 2016).
National Heart, Lung, and Blood Institute “What Causes Heart Disease” (April 2014).
National Heart, Lung, and Blood Institute “Who Is at Risk for Heart Disease” (April 2014).
MayoClinic “Heart Disease in Women: Understand Symptoms and Risk Factors” (June 2016)