CMS Is Cutting Reimbursements

Our field is under siege by CMS, which has proposed another draconian cut for cardiac electrophysiologists in 2023. In 2022, CMS decreased reimbursement for ablations by up to 35%. This year, they have proposed another 20% decrease for atrial fibrillation ablation, a 6.4% decrease for SVT ablation, and a 14.4% decrease for ventricular tachycardia ablation. These cuts are unprecedented and will cause significant harm to the future of cardiac electrophysiology. CMS has devalued our work, our duration of training, and the risks we take regularly. There has been no consideration given to the complexity and intensity of the procedures we perform; instead, we are evaluated by a flawed time-based methodology.

  • Mostly arbitrary and simplistic approach of cutting any CPT code that meets a 70% utilization threshold
  • Ablation procedures met the CMS watchdog threshold for overutilization merely by a % change in number between 2014 & 2019.
  • AF ablations in 2019 were over 10,000 procedures for a total of 2.3 million Medicare Population (A mere 0.04% of AF patients received ablations)
  • While the ablation codes might have met the threshold, they are still grossly underutilized for the demand that exists
  • Undue reliance or not on the RUC survey, which is 30 years old with old, impractical methodology
  • Over simplistic reliance on time-based value and disregard for the complexity of disease and skills sets required

The case against CMS Cuts

  • Economic case for cost savings of ablation vs. medical therapy in the longer term
  • Compromised access to care – inner city, underserved population (Latino, African American, rural, women)
  • Increased disease prevalence – so the number of procedures is going to go up
  • Required additional ablation/comprehensive eval for the complex AF patient may not be performed – Patient care suffers
  • Reduced ability to innovate and tailor ablation therapies
  • Negative impact on clinical practices ( lopsided market forces for staff and salary spends and practice expenses with inflation) and EP practices will shut down
  • Discourages trainees from entering the EP field
  • Increased healthcare costs – untreated patients and increased hospitalizations and associated complications/downstream costs

Not Every case is the Same, and Complexity Matters

  • Comprehensive evaluation necessary for an Individual patient is less likely to be performed
  • Non-paroxysmal AF patients are complex (example shown) and need additional ablation beyond pulmonary vein isolation (for AF triggers and treating complex, atypical atrial tachycardias).
  • ↓ in 93655 and 93657, reimbursement means ↓interest in doing additional required ablation, leading to ↓ success and increased re-do procedures. This will result in increased overall healthcare utilization and can ↓ patient safety.
  • Reduced ability to innovate and tailor ablation therapies for the patient (beyond pulmonary vein isolation).