ACA Implementation

The Affordable Care Act’s (ACA) individual mandate for health insurance coverage took effect Jan. 1. The medical community, including cardiology, is watching and working to adjust as payment models change and more patients have access to medical care. Some heart disease patients may see a cardiologist for the first time as they get access to care through plans established because of the ACA. In addition, reporting under the Physician Payments Sunshine Act will begin as of March 31. The Act requires applicable manufacturers and group purchasing organizations (GPOs) to begin reporting all payments or transfers of value to physicians and teaching hospitals, as well as ownership or investment interests held by physicians or immediate family members of physicians in such manufacturers and GPOs.

SGR Permanent Fix

Congress seems closer than ever to passing a fix to the flawed formula for calculating physician pay under Medicare enacted almost two decades ago. In February, the House Ways and Means and Energy and Commerce Committees, in conjunction with the Senate Finance Committee, unveiled a bipartisan legislative proposal that would permanently repeal the sustainable growth rate (SGR) payment formula and establish the framework for a new Medicare payment system that would reward high quality, evidence-based care. A permanent repeal would be good news for Medicare patients, as many physicians would be unable to continue to see Medicare patients if payments for physicians were cut so dramatically. It would also stop the almost annual exercise of Congress approving a last-minute patch.

Development of PCSK9 Inhibitors

Multiple trials are in progress for this anticipated new class of drugs that dramatically decrease LDL cholesterol, known as “bad” cholesterol. PSCK9 inhibitors mimic a gene found in people with naturally low LDL. The drug interferes with the destruction of the LDL receptor. The new class could have a big impact on the treatment of patients not able to tolerate statin medications or those with very high LDL who have not responded to other treatments.

Rollout of Mitral Valve Clip

In October 2013, the U.S. Food and Drug Administration approved a transcatheter procedure for treatment of prohibitive risk patients with severe degenerative mitral regurgitation, a heart disorder in which the mitral valve does not close properly when the heart pumps blood. This procedure offers a chance for treatment for these patients. Use of this procedure will be dictated by an experienced heart team composed of an interventional cardiologist, cardiac surgeon and others. The ACC and the Society of Thoracic Surgeons (STS) will also add a mitral module to the STS/ACC TVT Registry and begin reporting data in 2014.

Expanded Use of Novel Oral Anticoagulants in Patients with Atrial Fibrillation or Venous Thromboembolic Disease

These new medications began to get traction in the market in 2013, but still lagged behind warfarin, which was the only anticoagulant on the market for decades. Recent trial results have shown these new medications, which cost more per dose, improve outcomes compared to warfarin and do not require extensive monitoring or dietary/medication restrictions.

Results of the Dual Antiplatelet Therapy Study (DAPT)

Results of this phase IV study are expected to be released in 2014 and may impact the duration of such treatment following coronary stenting across a wide spectrum of patients. Researchers are evaluating 12 months vs. 30 months as the optimal duration of therapy in these patients.

Meaningful Use Implementation

Hospitals and health care providers who have received incentive payments for at least two years under Stage 1 of the Electronic Health Record (EHR) Incentive Program (also known as “meaningful use”) are required to move into Stage 2 in 2014. However, the Centers for Medicare and Medicaid Services (CMS) has delayed the start of the third and final phase of program until 2017 in order to extend the reporting timeline for Stage 2 through 2016. This delay will give hospitals and eligible professionals an extra year to meet meaningful use criteria.

Continued Growth of Cardio-oncology

This cardiology subspecialty is focused on the cardiovascular manifestations of cancer and complications of its treatment. It is offered at select hospitals across the country to help cancer patients maintain their heart health during and after treatment. Look for it to expand rapidly to more hospitals across the country.

Transition to ICD-10

On Oct. 1, 2014 all covered entities are required to have implemented the International Classification of Diseases 10th Edition Clinical Modification/Procedure Coding System (ICD-10), which replaces the current ICD-9 system. ICD-10 implementation will change the way coding is currently done, with the code-set growing from its current 14,315 diagnosis codes to more than 69,099 codes.

Keywords: Neoplasms, Cholesterol, LDL, Insurance Coverage, Mitral Valve Insufficiency, Receptors, LDL, Patient Protection and Affordable Care Act, Registries, International Classification of Diseases, United States Food and Drug Administration, Pharmaceutical Preparations, Atrial Fibrillation, United States, Cardiology Magazine, ACC Publications

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