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Changing Landscape of Interventional Cardiology
New in 2015, CMS recognizes interventional cardiology as its own specialty.
Interventional cardiologists now have the option of being identified by payers as interventional cardiologists, rather than general cardiologists or internists. Effective Jan. 5, interventional cardiology has been designated as its own unique specialty by the CMS.
The new specialty designation, C3, marks a major advance for interventional cardiology. The specialty has existed since 1977, when Andreas Gruentzig, MD, performed the first balloon angioplasty, has had its own board examination since 1989, and has since been recognized as a separate specialty by the AMA. However, the CMS had not distinguished interventional cardiologists from other cardiologists until hearing requests from the Society for Cardiovascular Angioplasty and Interventions and other professional medical organizations a few years ago.
Chandan Devireddy
“Outside of titles and semantics, this unique specialty designation has far-reaching implications for our day-to-day practice,” Chandan Devireddy, MD, FACC, FSCAI, interventional cardiology, associate professor of medicine and assistant director of the interventional cardiology fellowship program at Emory University, wrote in an “Eye on Intervention” blog post on Healio.com/Intervention.
Impetus for Change
The process to effect the change was lengthy not because of resistance from the CMS, but because agency procedures for making such changes move slowly, James C. Blankenship, MD, MHCM, FSCAI, MACC, president-elect of SCAI and director of cardiology at Geisinger Medical Center in Danville, Pennsylvania, told Cardiology Today’s Intervention.
“This did not happen by accident,” he said. “This was the result of 10 years of purposeful advocacy by the [SCAI]. It would not have happened any other way except that it was recognized by the SCAI as being important for its physician members.”
Peter L. Duffy, MD, MMM, FACC, FSCAI, secretary of SCAI and chair of the SCAI advocacy and government relations committee, said interventional cardiologists “make up a distinct group of individuals practicing cardiology and should be recognized aside from general cardiologists and even our colleagues who are invasive but not interventional cardiologists. More accurate physician profiles and fair comparison are critical to our success in the future.”
Benefits of Designation
The new designation will result in improved reimbursement opportunities and quality metric comparisons, among other advantages, according to the SCAI.
Improved performance metrics
Performance metrics have become a more important component of the reimbursement process, according to Duffy, who also is director of the cardiovascular service line at Reid Heart Center at FirstHealth of the Carolinas, Pinehurst, North Carolina.
Peter L. Duffy
“We recognized that as we were moving from a pay-for-volume system to a pay-for-value system, we were going to have to demonstrate value across the board for cardiology, and frankly, for all specialties,” he said. “In recognizing that, we saw that a lot of the work we were doing is different from some of the work our colleagues were doing. Some of the metrics that were being used — or that we were anticipating being used — to judge interventional cardiology appropriately would be resource utilization, length of stay, 30-day mortality and readmission rates. And those are different for different specialties of cardiology.
“What we really wanted to do is be sure … we were comparing ourselves appropriately to each other for what it is we were doing on a daily basis. Performance scores are linked to your professional profile, and in order to do better, you have to have accurate metrics that reflect what you do on a daily basis,” Duffy said.
Fairer compensation
By having a separate designation, the CMS now recognizes that interventional cardiologists have a unique set of skills that differ from general cardiologists, Blankenship said. Now, when an interventional cardiologist and a general cardiologist from the same practice participate in a patient’s care, they can both receive fair reimbursement for their own distinct work, without worrying about duplicate claims, according to the SCAI.
One example, Blankenship said, is a general cardiologist who performs a diagnostic catheterization and then consults with an interventional cardiologist about the results and to make recommendations as to which interventional services might be appropriate.
“Recognizing that the interventional cardiologist in that setting has a unique set of skills that he or she brings to a patient’s care would then allow the payment for those special services. Until now, we have been providing those services as curbside consults or completely without recognition that it is an additional service,” he said.
Devireddy said: “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.”
Advantages for patients
Although the benefits of the new designation may be obvious for interventional cardiologists, patients will derive benefit as well, Blankenship told Cardiology Today’s Intervention. For example, patients are likely to receive more comprehensive evaluations than before.
James C. Blankenship
“In the past, when these services weren’t recognized, they would often be done on the fly. Now that they are being recognized, I would anticipate that they will be done in a more formal way. The CMS has documentation requirements, so if you want to be reimbursed for [a consultation], the doctor is going to have to satisfy those documentation requirements, and that will likely provide for a more thorough evaluation of patients from the interventional viewpoint,” Blankenship said.
The new designation also will help patients find and evaluate doctors who can provide any interventional services they might need, Duffy said.
“As more interventional cardiologists register with the CMS, we will be able to figure out how many people are actually doing interventions in the [United States]. That is not clear based on the information we currently have,” he said.
That information could also benefit the CMS and other payers, Duffy said. Payers will be more easily able to identify opportunities to assist interventional cardiologists in improving care, and interventional cardiologists will be better able to educate payers, he said.
Appropriate quality metrics and better identification of who is performing interventional procedures also are important for hospital systems, which will now have better tools to make decisions about hiring, contracting and giving bonuses and administrative roles to physicians, and for the media, whose members will now have a better idea of what interventional cardiologists do and how well they do it, and can more accurately convey that to the public, Duffy said.
Symbolic Importance
Interventional cardiology has come a long way since 1977, and because of that, the new specialty designation is symbolically important, Blankenship said.
“It indicates that interventional cardiologists have a unique set of skills, both intellectual and technical, that we bring to patient care,” he said. “Gaining this specialty designation reflects the pride that we have in our work, and acknowledges the valuable services we provide to patients with heart disease. – by Erik Swain
Sidebar: How to change your specialty designation with CMS