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Interventional cardiologists can be identified as such by Medicare starting Jan. 5, which the Society for Cardiovascular Angiography and Interventions says will open up reimbursement opportunities and improve quality metric comparisons.
The designation takes only a one-time request to the local Medicare provider asking to be changed from general cardiology to the new C3 category, a relatively straightforward process that , according to SCAI.
The most immediate impact will be that interventional cardiologists will no longer have consultation claims denied for referrals from general cardiologists within the same physician group, SCAI secretary , told ľֱ.
"Our electrophysiology colleagues are already in that situation. We're doing the work, we're just not getting paid for it," said Duffy, of Reid Heart Center in Pinehurst, N.C.
Recognition as a separate specialty by Centers for Medicare and Medicaid Services could also prompt private third-party insurers to follow suite more uniformly, he suggested.
"Hopefully it will carry through to them as well and they'll be able to create their own separate designation and recognize the importance of separating us out from general cardiology, electrophysiology -- if they have not done that already, from heart failure specialists, and from noninvasive, non-interventional cardiology," he told ľֱ.
However, the organization's push was not to get consults covered but because comparisons with general cardiology on quality metrics are skewed, he said.
For instance, the ST-segment elevation myocardial infarction patients often cared for by interventionalists are a much different, and often more complex and service-intensive patient population than an atrial fibrillation population, he noted.
"We're caring for a different group of patients and we simply want to be compared to each other," he told ľֱ. "The key reason that's important is performance measures being what they are and pay-for-performance coming down the line."
As accountable care organizations evolve, the separate designation will be important as well, he said.
"Right now general cardiology would be considered to be an included physician in an ACO model," he noted. "If you admitted the patient to the hospital that patient would be attached to you. Even if they went to other hospitals and were out of your system, your ACO would still be responsible for any services that they received there. As interventionalists, we're more designated to be doing specific procedures for patients ... As excluded physicians from an ACO model, we would not be the designated primary care provider, which we shouldn't be under that circumstance."
Another effect will be that "we'll actually know how many interventional cardiologists there are," Duffy noted, which is not the case now.