Medicare Compliance & Reimbursement

VAD facilities will have to meet accreditation standards.

Hospitals that perform heart transplants now have more opportunities to collect Medicare reimbursement for ventricular assist devices. In an Oct. 1 decision memo (CAG 00119N), the Centers for Medicare & Medicaid Services says it plans to expand coverage for VADs - and increase reimbursement for the procedure. Currently, VADs - mechanical pumps that perform some of the functions of a damaged heart - are only covered as a bridge to heart transplant or when implanted after open-heart surgery. Under the new coverage policy, VADs will become a "destination therapy" - a permanent mode of cardiac support - for certain patients. When it goes into effect, Medicare will pay for VADs for patients who have chronic, end-stage heart failure, aren't transplant candidates, and meet the criteria outlined in the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial. "We are also making a payment correction that will increase the per procedure payment to ensure appropriate access to this new potentially lifesaving device," says CMS Administrator Tom Scully. In the memo, CMS says it plans to develop accreditation standards for facilities that implant VADs. Once those standards are implemented, Medicare will consider VAD implantation reasonable and necessary only at accredited facilities. To see the memo, go to www.cms.gov/ncdr/searchdisplay.asp?id=79.