FROM: Theodore O. Will, Chief Executive Officer
DATE: Jan 27, 2006
SUBJECT: FINAL MEDICARE HOSPITAL PAYMENT MONITORING SPECIAL PROJECT REPORT: IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (ICD)
IPRO CONTACTS:
Kathy Terry, Ph.D., Sr. Director, Data, Medicare/Federal Health Care Assessment at 516-326-7767, Ext. 226;
Monty Bodenheimer, M.D., Medical Director, Medicare/Federal Health Care Assessment at 516 326-7767, Ext. 539
The enclosed report provides the final results of IPRO's 7th Scope of Work (SOW) special study to determine the appropriateness of Implantable Cardioverter Defibrillator (ICD) 1 insertions for New York State Medicare beneficiaries. As described in detail in the enclosed report, the final results of our special study indicate that changes in treatment protocol, QIO educational efforts and subsequent hospital improvements, and National Coverage Determination (NCD) guideline changes have all contributed to a reduction in denials for ICD cases.
In conducting the review, IPRO used the American College of Cardiology/American Heart Association (ACC/AHA) Guidelines that define the clinical indications for ICD use. In addition, IPRO utilized the Medicare National Coverage Guidelines for ICD insertion that define the clinical indications that must be present for Medicare to cover payment.
Although the proportion of inappropriate ICD insertions in NY has declined, the volume of claims submitted for ICD procedures has risen substantially over the past several years. An average of 321 ICD procedures per month was billed to Medicare in calendar year 2004. Medicare claims data for January 2005 through September 2005 demonstrated an increase to 400 cases per month. Since the volume of claims appears to be growing rapidly and ICD implantation is a relatively costly procedure, IPRO highly recommends vigilance on the part of hospital compliance and auditing personnel, as well as heightened awareness on the part of clinicians performing ICDs, in the continuing effort to reduce unnecessary ICD insertions in New York State. Moreover, please be reminded that CMS now requires that any Medicare patient receiving an ICD as primary prevention of sudden cardiac death be reported in the ICD Registry. Information in regard to the Registry may be accessed at www.cms.hhs.gov. In addition, CMS has recently announced that effective April 1, 2006, the American College of Cardiology's National Cardiovascular Data Registry's (ACC-NCDR) ICD Registry will become the new national repository for ICD information. More information about the new registry can be found at https://www.accncdr.com.
Should you have any questions in regard to this memorandum or the final report, please contact Monty Bodenheimer, MD, Medical Director at 516-326-7767 extension 539 or Kathy Terry, Ph.D., Sr. Director, Data Analysis at 516-326-7767 extension 226.
1 An implantable cardioverter defibrillator (ICD) is a device that is implanted in a patient's chest to monitor their heart rhythm. The ICD delivers an electrical shock when a life-threatening ventricular arrhythmia is detected.