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Lakdawalla D, Tunis S, Neumann P, Whicher D, Zeitler E, Liden B. A Roadmap for Improving Medicare's Application of Coverage With Evidence Development. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:1191-1195. [PMID: 38795958 DOI: 10.1016/j.jval.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/16/2024] [Accepted: 05/08/2024] [Indexed: 05/28/2024]
Abstract
The Centers for Medicare and Medicaid Services' coverage with evidence development (CED) policy allows the agency to provide coverage for an item or service through a National Coverage Determination (NCD), conditional upon an agreement to collect evidence designed to address specific questions or uncertainties. The goals of this policy are to expedite beneficiary access to new items and services and to generate additional evidence on the impact of these items or services for Medicare beneficiaries. However, these goals have not been fully realized because of several issues with the way the policy has been implemented, including (1) a lack of clear criteria for when CED will be applied, (2) examples of CED data collection activities placing unnecessary burdens on clinicians and the potential for undue inducement on beneficiaries, and (3) a lack of clarity around the process and timeline for reconsidering and ending CED requirements. Additionally, there are cases in which the application of CED has failed to improve access to services for certain Medicare beneficiaries because no data collection activity was implemented in response to the CED requirement or because the NCD only allows the technology to be provided and studied in certain centers of excellence. We describe a roadmap for addressing these issues, which includes, for example, developing a framework to guide the application of coverage constraints in NCDs with CED requirements. Once these issues are addressed, the Centers for Medicare and Medicaid Services could consider expanding the use of CED to technologies that are not subject to NCDs.
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Affiliation(s)
- Darius Lakdawalla
- USC Schaeffer Center, University of Southern California, Los Angeles, CA, USA
| | | | - Peter Neumann
- Center for the Evaluation of Value and Risk at the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | | | - Emily Zeitler
- Department of Medicine and the Dartmouth Institute, Dartmouth Geisel School of Medicine, Hanover, NH, USA
| | - Barry Liden
- USC Schaeffer Center, University of Southern California, Washington, DC, USA.
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Morrow DA, Jessup M, Abraham WT, Acker M, Aringo A, Batchelor W, Chikwe J, Costello S, Drakos SG, Farmer S, Gelijns A, Gillette N, Hochman JS, Isler M, Kapur NK, Kilic A, Kormos R, Lewis EF, Lindenfeld J, Lombardi P, Mancini D, Rao SV, Rutan C, Samsky M, Krucoff MW. American Heart Association Cardiogenic Shock Registry: Design and Implementation. Circ Cardiovasc Qual Outcomes 2024; 17:e010637. [PMID: 38887950 DOI: 10.1161/circoutcomes.123.010637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
BACKGROUND Cardiogenic shock is a morbid complication of heart disease that claims the lives of more than 1 in 3 patients presenting with this syndrome. Supporting a unique collaboration across clinical specialties, federal regulators, payors, and industry, the American Heart Association volunteers and staff have launched a quality improvement registry to better understand the clinical manifestations of shock phenotypes, and to benchmark the management patterns, and outcomes of patients presenting with cardiogenic shock to hospitals across the United States. METHODS Participating hospitals will enroll consecutive hospitalized patients with cardiogenic shock, regardless of etiology or severity. Data are collected through individual reviews of medical records of sequential adult patients with cardiogenic shock. The electronic case record form was collaboratively designed with a core minimum data structure and aligned with Shock Academic Research Consortium definitions. This registry will allow participating health systems to evaluate patient-level data including diagnostic approaches, therapeutics, use of advanced monitoring and circulatory support, processes of care, complications, and in-hospital survival. Participating sites can leverage these data for onsite monitoring of outcomes and benchmarking versus other institutions. The registry was concomitantly designed to provide a high-quality longitudinal research infrastructure for pragmatic randomized trials as well as translational, clinical, and implementation research. An aggregate deidentified data set will be made available to the research community on the American Heart Association's Precision Medicine Platform. On March 31, 2022, the American Heart Association Cardiogenic Shock Registry received its first clinical records. At the time of this submission, 100 centers are participating. CONCLUSIONS The American Heart Association Cardiogenic Shock Registry will serve as a resource using consistent data structure and definitions for the medical and research community to accelerate scientific advancement through shared learning and research resulting in improved quality of care and outcomes of shock patients.
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Affiliation(s)
- David A Morrow
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.A.M.)
| | - Mariell Jessup
- American Heart Association, Dallas, TX (M.J., A.A., S.C., M.I., C.R.)
| | - William T Abraham
- Division of Cardiovascular Medicine, Wexner Medical Center, The Ohio State University, Columbus (W.T.A.)
| | - Michael Acker
- Division of Cardiovascular Surgery, Penn Medicine Heart and Vascular Center, Philadelphia, PA (M.A.)
| | - Angeline Aringo
- American Heart Association, Dallas, TX (M.J., A.A., S.C., M.I., C.R.)
| | - Wayne Batchelor
- Inova Schar Heart and Vascular, Inova Health System, Fairfax, VA (W.B.)
| | - Joanna Chikwe
- Cardiac Surgery, Cedars Sinai, Los Angeles, CA (J.C.)
| | - Shaina Costello
- American Heart Association, Dallas, TX (M.J., A.A., S.C., M.I., C.R.)
| | - Stavros G Drakos
- Division of Cardiology, University of Utah Health and School of Medicine, Salt Lake City (S.D.)
| | - Steven Farmer
- Department of Health and Human Services, Centers for Medicare and Medicaid Services, Center for Clinical Standards and Quality, Baltimore, MD (S.F.)
| | - Annetine Gelijns
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York (A.G., D.M.)
| | - Nicole Gillette
- Office of Cardiovascular Devices, US Food & Drug Administration, Silver Spring, MD (N.G.)
| | - Judith S Hochman
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine (J.S.H., S.V.R.)
| | - Maria Isler
- American Heart Association, Dallas, TX (M.J., A.A., S.C., M.I., C.R.)
| | - Navin K Kapur
- Division of Cardiology, Tufts Medical Center, Boston, MA (N.K.)
| | - Arman Kilic
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston (A.K.)
| | | | - Eldrin F Lewis
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (E.F.L.)
| | - JoAnn Lindenfeld
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.)
| | | | - Donna Mancini
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York (A.G., D.M.)
| | - Sunil V Rao
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine (J.S.H., S.V.R.)
| | - Christine Rutan
- American Heart Association, Dallas, TX (M.J., A.A., S.C., M.I., C.R.)
| | - Marc Samsky
- Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (M.S.)
| | - Mitchell W Krucoff
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.W.K.)
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Smilowitz NR, Prasad M, Widmer RJ, Toleva O, Quesada O, Sutton NR, Lerman A, Reynolds HR, Kesarwani M, Savage MP, Sweeny JM, Janaszek KB, Barseghian El-Farra A, Holoshitz N, Park K, Albadri A, Blair JA, Jeremias A, Kearney KE, Kobayashi Y, Miner SES, Samuels BA, Shah SM, Taqueti VR, Wei J, Fearon WF, Moses JW, Henry TD, Tremmel JA. Comprehensive Management of ANOCA, Part 2-Program Development, Treatment, and Research Initiatives: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:1264-1279. [PMID: 37704316 DOI: 10.1016/j.jacc.2023.06.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/15/2023] [Indexed: 09/15/2023]
Abstract
Centers specializing in coronary function testing are critical to ensure a systematic approach to the diagnosis and treatment of angina with nonobstructive coronary arteries (ANOCA). Management leveraging lifestyle, pharmacology, and device-based therapeutic options for ANOCA can improve angina burden and quality of life in affected patients. Multidisciplinary care teams that can tailor and titrate therapies based on individual patient needs are critical to the success of comprehensive programs. As coronary function testing for ANOCA is more widely adopted, collaborative research initiatives will be fundamental to improve ANOCA care. These efforts will require standardized symptom assessments and data collection, which will propel future large-scale clinical trials.
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Affiliation(s)
- Nathaniel R Smilowitz
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA; Cardiology Section, Department of Medicine, VA New York Harbor Healthcare System, New York, New York, USA
| | - Megha Prasad
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York, USA
| | | | - Olga Toleva
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA
| | - Nadia R Sutton
- Department of Internal Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Harmony R Reynolds
- Sarah Ross Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Manoj Kesarwani
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Michael P Savage
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph M Sweeny
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Noa Holoshitz
- Ascension Columbia St Mary's, Milwaukee, Wisconsin, USA
| | - Ki Park
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Ahmed Albadri
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - John A Blair
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Allen Jeremias
- St Francis Hospital & Heart Center, Roslyn, New York, USA
| | - Kathleen E Kearney
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Yuhei Kobayashi
- New York Presbyterian Brooklyn Methodist Hospital/Weill Cornell Medical College, New York, New York, USA
| | - Steven E S Miner
- Southlake Regional Medical Centre, Newmarket, Ontario, Canada, School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bruce A Samuels
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Samit M Shah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut USA
| | - Viviany R Taqueti
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Janet Wei
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - William F Fearon
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Jeffery W Moses
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York, USA; St Francis Hospital & Heart Center, Roslyn, New York, USA
| | - Timothy D Henry
- Carl and Edyth Lindner Center for Research and Education, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA
| | - Jennifer A Tremmel
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.
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Vemulapalli S, Simonato M, Ben Yehuda O, Wu C, Feldman T, Popma JJ, Sundareswaren K, Krohn C, Hardy KM, Guibone K, Christensen B, Alu MC, Ng VG, Chau KH, Chen S, Shahim B, Vincent F, MacMahon J, James S, Mack M, Leon MB, Thourani VH, Carroll J, Krucoff MW. Minimum Core Data Elements for Transcatheter Mitral Therapies: Scientific Statement by PASSION CV, HVC, and TVTR. JACC Cardiovasc Interv 2023; 16:1437-1447. [PMID: 37380225 DOI: 10.1016/j.jcin.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 06/30/2023]
Abstract
Mitral regurgitation is the most common valvular disease and is estimated to affect over 5 million Americans. Real-world data collection contributes to safety and effectiveness evidence for the U.S. Food and Drug Administration, quality evaluation for the Centers for Medicare and Medicaid Services and hospitals, and clinical best practice research. We aimed to establish a minimum core data set in mitral interventions to promote efficient, reusable real-world data collection for all of these purposes. Two expert task forces separately evaluated and reconciled a list of candidate elements derived from: 1) 2 ongoing transcatheter mitral trials; and 2) a systemic literature review of high-impact mitral trials and U.S multicenter, multidevice registries. From 703 unique data elements considered, unanimous consensus agreement was achieved on 127 "core" data elements, with the most common reasons for exclusion from the minimum core data set being burden or difficulty in accurate assessment (41.2%), duplicative information (25.0%), and low likelihood of affecting outcomes (19.6%). After a systematic review and extensive discussions, a multilateral group of academicians, industry representatives, and regulators established and implemented into the national Society of Thoracic Surgery/American College of Cardiology Transcatheter Valve Therapies Registry 127 interoperable, reusable core data elements to support more efficient, consistent, and informative transcatheter mitral device evidence for regulatory submissions, safety surveillance, best practice development, and hospital quality assessments.
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Affiliation(s)
- Sreekanth Vemulapalli
- Duke University Health/Duke Clinical Research Institute, Durham, North Carolina, USA.
| | | | - Ori Ben Yehuda
- University of California San Diego, San Diego, California, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Changfu Wu
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Ted Feldman
- Edwards Lifesciences, Irvine, California, USA
| | | | | | - Carole Krohn
- Society of Thoracic Surgeons, Chicago, Illinois, USA
| | | | - Kimberly Guibone
- Beth Israel Deaconness Medical Center, Boston, Massachusetts, USA
| | | | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York, USA
| | - Vivian G Ng
- Columbia University Irving Medical Center, New York, New York, USA
| | - Katherine H Chau
- Columbia University Irving Medical Center, New York, New York, USA
| | - Shmuel Chen
- Cornell Weill Medical Center/New York-Presbyterian, New York, New York, USA
| | | | | | - John MacMahon
- Mitre Medical Corporation, Morgan Hill, California, USA
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala, Sweden
| | | | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - John Carroll
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Mitchell W Krucoff
- Duke University Health/Duke Clinical Research Institute, Durham, North Carolina, USA
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Improving the Patient Relevance and Generalizability of TAVR Core Data Elements. JACC Cardiovasc Interv 2022; 15:1386-1387. [DOI: 10.1016/j.jcin.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 11/20/2022]
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Simonato M, Vemulapalli S, Ben-Yehuda O, Krucoff M. Reply. JACC Cardiovasc Interv 2022; 15:1387-1388. [DOI: 10.1016/j.jcin.2022.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 10/17/2022]
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