Current hospital reimbursement for Calendar Year 2017, Abiomed Fiscal Year 2018
MS-DRG
215, Heart Assist System Implant, was recently confirmed for an Impella catheterization lab implant
and ICU care in October 2016 through an update by the American Hospital Association (AHA) Coding Clinic publication. In addition to the October 2016 update, a recent AHA Coding Clinical publication in March 2017 added clarification of coding
for implant of
bi-ventricular
Impella heart support along with the removal of the device provides hospital payment in
MS-DRG
1 or 2 depending upon severity of illness.
Abiomeds Impella technology is now most commonly reimbursed under four
MS-DRG
categories including: 1)
assistance in the catheterization lab only in
MS-DRGs
216-221;
2) implant, assistance and removal after leaving the catheterization lab in
MS-DRG
215; 3) right and left side heart support known as
bi-ventricular
and removal in
MS-DRG
1-2,
and; 4) hospitals receiving transferred patients with removal of the device in
MS-DRG
268-269. In
prior years, Impella
was primarily reimbursed in only one category of
MS-DRGs
216-221. The
American Hospital Association (AHA) and Centers for Medicare and Medicaid Services (CMS) have
facilitated a system of care around the utilization of percutaneous heart pumps for the catheterization lab, ICU support, and transfer of patients to specialized centers. This progress also represents the expansion of Impella FDA indications for
High Risk PCI, AMI Cardiogenic Shock, and
bi-ventricular
support.
Table A. Summary of common
MS-DRGs
for illustration only.
|
|
|
|
|
|
|
|
|
|
|
|
|
Common Impella Procedures*
|
|
MS-DRG
|
|
|
Current Rate
(Sample 100 Impella
sites)
|
|
|
Current Rate
(All Hospitals)
|
|
Impella assistance in catheterization lab only
|
|
|
216
|
|
|
$
|
70,299
|
|
|
$
|
57,460
|
|
Impella implant with care after catheterization lab
|
|
|
215
|
|
|
$
|
117,413
|
|
|
$
|
95,971
|
|
Biventricular implant
|
|
|
1
|
|
|
$
|
197,548
|
|
|
$
|
161,472
|
|
ICU care and removal of Impella, after transfer from outlying hospital
|
|
|
268
|
|
|
$
|
45,957
|
|
|
$
|
37,564
|
|
*
|
Actual
MS-DRGs
may vary based on procedure.
|
Examples provided with Major Comorbidity or MCC.
All Hospitals include 3,405 medicare hospitals, and only approximately 1,400 have cath labs or operating rooms. Sample includes
100 Impella sites.
Centers for Medicare and Medicaid Services (CMS) Proposed Rule for the Inpatient Prospective Payment System (IPPS)
On Friday, April 14, 2017, the Centers for Medicare and Medicaid Services (CMS) released a draft of hospital payment levels proposed for
patient discharges after October 1, 2017. The Proposed Rule for the Inpatient Prospective Payment System (IPPS) is available on the CMS website at cms.gov and is open for public comment until June 13, 2017. All discharges prior
to October 1, 2017 would remain under the current payment levels, and the final rulemaking is expected to be released in August 2017. The final rulemaking may differ substantially from this proposal.
The text of the Proposed Rule did not discuss any specific information relating to payment, coding or
MS-DRG
assignments for Impella, percutaneous heart assist, or related technology. Data tables also released with the Proposed Rule include changes for all
MS-DRGs
which included a proposed reduction for
MS-DRG
215 of 34.8%. The remaining
MS-DRG
categories have proposed changes ranging from
-7%
to +3.5%. All current
MS-DRG
rates will remain in place until October 2017.
Table B. Summary of common
MS-DRGs
from the Proposed Rule for illustration only.
|
|
|
|
|
|
|
|
|
|
|
|
|
Common Impella Procedures*
|
|
MS-DRG
|
|
|
Proposed FY2018 Rate
(Sample 100 Impella
sites)
|
|
|
Proposed FY2018 Payment
(All Hospitals)
|
|
Impella assistance in catheterization lab only
|
|
|
216
|
|
|
$
|
69,455
|
|
|
$
|
57,622
|
|
Impella implant with care after catheterization lab
|
|
|
215
|
|
|
$
|
76,525
|
|
|
$
|
63,487
|
|
Biventricular implant
|
|
|
1
|
|
|
$
|
183,776
|
|
|
$
|
152,464
|
|
ICU care and removal of Impella, after transfer from outlying hospital
|
|
|
268
|
|
|
$
|
47,580
|
|
|
$
|
39,474
|
|
*
|
Actual
MS-DRGs
may vary based on procedure.
|
Examples provided with Major Comorbidity or MCC.
All Hospitals include 3,405 medicare hospitals, and only approximately 1,400 have cath labs or operating rooms. Sample includes
100 Impella sites.
A new formula for calculating all Medicare
MS-DRG
base weights, the calculation used to
determine hospital payment level, was described in the Proposed Rule. However, no Impella patient claim data related to the change in the October 2016 American Hospital Association (AHA) Coding Clinic publication was included in the analysis
for the proposed
MS-DRG
rate changes. Abiomed is reviewing the detailed data within the tables and will be discussing the appropriate DRG rates with CMS during the open comment period to confirm it
accurately reflects the hospital resources required to treat these very ill patients.