CMS Fields Many Suggestions And Criticisms On Proposed VAD Policy

Article preview from Medtech Insight - September 27, 2013

Several stakeholders are still pushing CMS to recognize “bridge-to-decision” heart failure patients who may eventually be suitable for a heart transplant but are not so at the time they receive a ventricular assist device.

CMS Fields Many Suggestions And Criticisms On Proposed VAD Policy

Article preview from Medtech Insight - September 27, 2013

Several major cardiology societies are asking the US Centers for Medicare and Medicaid Services (CMS) to reconsider its position on so-called bridge-to-decision candidates for ventricular assist devices (VADs) instead of maintaining the old bridge-to-transplant and destination-therapy categories in its proposed Medicare coverage policy for the devices.

In new comments to the agency about CMS’ August 1 draft decision memo for a new VAD coverage policy, several hospitals, transplant cardiologists and physician organizations argue that Medicare coverage should extend to the roughly one-third of VAD patients in the “bridge-to-decision" or “bridge-to-candidacy” category instead of just those in the standard categories that CMS has covered for more than a decade: bridge-to-transplant for patients on the transplant list, and destination therapy for patients ineligible for a transplant.

Bridge-to-decision patients are not suitable for a heart transplant at the time they are implanted with a VAD, but might become eligible for a transplant if their overall health improves while supported by the VAD. Many patients with severe heart failure have modifiable risk factors like kidney, lung or liver disease that may or may not be resolved with time on VAD therapy, as well as other comorbidities affecting transplant suitability – like obesity, smoking status, substance abuse – that may change over time.

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