SCAI 2018 Think Tank Proceedings: “What should the role of the surgeon be in TAVR, both as a co-operator and in-patient evaluation for TAVR?
Molly Szerlip M.D.
Giri, J. S., M. Szerlip, C. Devireddy, D. A. Cox, C. Kavinsky, P. Genereux, S. S. Naidu, C. Bruner, J. Struck, J. Kurz and J. Dunham (2018). “SCAI 2018 Think Tank Proceedings: “What should the role of the surgeon be in TAVR, both as a co-operator and in-patient evaluation for TAVR?” Catheter Cardiovasc Interv Oct 24. [Epub ahead of print].
The Society for Cardiovascular Angiography and Interventions (SCAI) Think Tank is held annually bringing together expert opinion from interventional cardiologists, administrative partners, and select members of the cardiovascular industry community in a collaborative venue . . . Over the past decade, transcatheter aortic valve replacement (TAVR) has been promulgated in the United States under unique circumstances; as a paradigm‐shifting procedure in which two operators from different specialties (interventional cardiology and cardiac surgery) are mandated to perform each case as “co‐surgeons” in order to receive Centers of Medicare and Medicaid Services (CMS) reimbursement for services. This is accomplished by a “mandated 62‐modifier”, which represents the CMS designation for a procedure performed by two operators entitling both to a total of 125% (ie, 62.5% each) of the professional fees assigned to the procedure by the CMS fee schedule. While use of 62‐modifiers is relatively common in a variety of complex procedures, TAVR is unique as the only procedure in which use of the 62‐modifer is mandated in all cases by CMS . . . While this has been the structure of TAVR evaluation and performance since its introduction to the US market, there have been tremendous advances in TAVR over the last decade, both related to technology and processes of care. Examples include: fully percutaneous access, moderate sedation, fast track protocols, dramatically reduced device profiles resulting in an overwhelming majority of cases being performed via transfemoral arterial access, and improvements in pacemaker and paravalvular leak rates. Nearly, all of these advances have served to make the procedure simpler, more consistent, and more efficient. Ongoing improvements in technology aim to further simplify the procedure allowing for rapid, accurate and consistent valve delivery by a single operator. These developments compelled us to re‐evaluate the appropriateness of the current system of care. [Four points of consensus from the SCAI discussions are described.] (Excerpt from text, p. 1-2.)
