Public Health Impact of the Centers for Medicare and Medicaid Services Decision on Pass-Through Add-On Payments for Drug-Coated Balloons: A Call to Action.

On Wednesday, November 1, 2017, the Centers for Medicare and Medicaid Services (CMS) made a public decision to end the transitional pass-through add-on payment for drug-coated balloons beginning January 1, 2018, without creating a new ambulatory payment classification rate for these devices. In this Viewpoint, the authors highlight the disconnect between the CMS's decision not to create a new ambulatory payment classification category for drug-coated balloons despite demonstrated clinical superiority. The authors believe this decision is more in line with a rigid fee-for-service payment system than a value-based system that encourages quality over quantity, and disadvantages both the elderly and the poor. They call on all who advocate for patients with peripheral artery disease to action, encouraging their engagement on CMS decisions regarding payment.

Evolution of carotid stenting: regulatory issues.

Although carotid angioplasty and stenting have been performed for more than 20 years, the regulations surrounding its performance have remained a controversial issue. Intervention in the cerebral vascular bed is the only area in which regulations have limited the applicability of interventional techniques to vascular disease. Whether or not this is the correct approach remains to be seen, but knowledge of the regulations and requirements surrounding the performance of carotid stenting are of paramount importance for those performing these procedures. A review of the regulations affecting everything from the institutions to the physicians performing these procedures, as outlined in this article, will be helpful in clarifying for physicians and institutions what is mandated before performing carotid intervention.

Evolution of carotid stenting: payment issues.

Carotid stent placement received assignment of two Category I Current Procedural Terminology (CPT) codes in 2005, based on the collaborative efforts of 10 medical, surgical, and radiological specialty societies. One code is used to report stent placement with embolic protection, the other without embolic protection. The codes are unusual for interventional procedures because they include all associated catheterizations, diagnostic imaging, angioplasty, and radiologic supervision and interpretation. The Centers for Medicare and Medicaid Services (CMS) issued a coverage policy for carotid stenting in March 2005, imposing major limitations on eligibility. First, the Agency will only pay for carotid stents performed with embolic protection. In addition, each patient must meet three separate criteria to achieve Medicare coverage: (1) lateralizing transient ischemic attack, transient monocular blindness, or minor stroke with Rankin score <3; (2) an angiographically documented stenosis >or=70%, and (3) physiologic or anatomic criteria to indicate the patient is at high risk for carotid endarterectomy. No asymptomatic patients are covered under the current Medicare policy, but coverage criteria are currently under reconsideration. Finally, CMS restricts carotid stent coverage to facilities that meet its certification requirements.

[Patient information and informed consent in interventional radiology]. / Patientenaufklärung in der Interventionellen Radiologie.

Patient information and informed consent consultation before any invasive examination or treatment is meant to obtain the binding consent of the patient. It makes an important contribution to the physician-patient relationship and helps the orientation of the patient as well as the physician before the intervention. The aim of this article is to briefly explain the basic practical and legal principles of the patient information. Furthermore general risks of examinations and treatments in interventional radiology and specific risks of frequent interventional procedures are explained in more detail.