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New specialty designation marks major advance for interventional cardiology
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It is difficult to briefly summarize the field of interventional cardiology today. From the time of its inception in 1977, interventional cardiologists could offer angioplasty to select patients with coronary disease with only the few options of balloon catheters based on limited studies and mostly anecdotal experience. Fast-forward to 2015 and it is clear that the knowledge base and expertise required to truly understand interventional cardiology have exploded in the manner of Moore’s law for computers.
In addition to coronary atherosclerosis, interventional cardiologists are now consulted to assess transcatheter options for cardiac assist devices, peripheral arterial and venous disease, valvular heart disease, thromboembolic venous disorders, congenital heart disease and lesions of exceeding complexity, such as chronic total occlusions, to name just a few. As a field, interventional cardiology has created one of the most prolific stockpiles of evidence-based medicine, with large randomized trials, registries and quality improvement measures continually altering our daily practice.
Chandan Devireddy
Implications, impact
In 2015, the unique practice and skillset of interventional cardiologists have finally been recognized by CMS as a unique specialty, independent of general internal medicine or cardiology. Outside of titles and semantics, this unique specialty designation has far-reaching implications for our day-to-day practice. The obvious change is that the time and effort spent evaluating patients referred by other noninterventional cardiologists can be fairly reimbursed. Given the complexity of revascularization options, pharmacologic decisions and constantly changing guidelines and clinical science, an interventional cardiology consult uniquely enhances the care of the CV patient.
The less obvious benefits impact how modern medical insurance companies, payers and health systems track providers and their outcomes. As a uniquely tracked specialty, independent of cardiology as a whole, the unique comorbidities and disease states of the patients we treat can now be better collected and understood. In the age of “big data,” interventional cardiologists must ensure that health policy decisions impacting our field are driven by accurate statistics and evidence. Patients and policymakers will better understand our field, and we will better understand ourselves.
Steps for change
I hope it is obvious to all interventional cardiologists that this unique specialty designation is long overdue and necessary. However, each of us must individually ensure that CMS changes our “official” primary specialty. This does not occur automatically and requires, yes, paperwork to officially authorize the change. A nice summary of the steps is described here.
The efforts of SCAI and ACC catalyzed this necessary change. It honors interventional cardiology pioneers, such as Andreas Gruentzig, who would have welcomed this progress. Now, more than ever, we must respectfully exercise appropriate judgment and honor the founders of this field, our specialty and ourselves.
It will be exciting to witness how our “new” specialty continues to improve patient care and public health.
Have you changed your specialty with CMS? Please comment to share suggestions and insights into the process.
Chandan Devireddy, MD, FACC, FSCAI, is an interventional cardiologist, associate professor of medicine and assistant director of the interventional cardiology fellowship program at Emory University, Atlanta. He specializes in coronary, peripheral and structural heart interventions.
Disclosures: Devireddy reports no relevant financial disclosures.