BUSINESS CONSULT
KATY REED
Associate Principal, ECG Management Consultants
TESSA KERBY
Senior Manager, ECG Management Consultants
Should Your Organization
Add a TAVR Program?
W
hen the Centers for Medicare and
Medicaid Services (CMS) first approved coverage of transcatheter
aortic valve replacement (TAVR) in 2012, the
procedure was viewed as revolutionary. It offered
a minimally invasive, life-saving alternative to
open heart surgery for thousands of high-risk
patients. Four years and thousands of cases later,
it’s clear that the technology and technique have
lived up to their promise. A simple Google search
yields page after page of TAVR success stories,
from frail, elderly patients in their 80s and 90s to
diabetics and others previously deemed inoperable—and many of these patients walk out of the
hospital just days after the procedure.
Patients are starting to demand TAVR, and
CMS is expanding the criteria to allow more patients to qualify for it. TAVR remains a frequent
topic of conversation among cardiologists, cardiovascular surgeons, cardiac service line leaders,
and hospital administrators, and many cardiac
programs that didn’t immediately pursue the
TAVR program are beginning to ask themselves
if they should. Of course there are expected questions about cost. Still, the question we often hear
is how critical is a TAVR program to ensuring
that the organization’s structural heart, valve, and
cardiology service line is competitive and comprehensive? More simply, is this a nice-to-have or
need-to-have program?
Organizations that do not currently offer TAVR
should assess their current situation to determine
if they meet the requirements, and if adding TAVR
helps the organization meet its strategic goals. We
developed a pro-con list (see TABLE) to help cardiac
service line leaders make this decision:
Some organizations will find that they do not
yet have sufficient financial, staff, or infrastructure resources to pursue TAVR, while others simply will not feel ready to devote such significant
resources. Given the potential benefits of such
programs, however, these organizations should
leave the door open to a future offering. Here are
a few interim steps they can take to prepare:
• Partnership opportunities. Smaller organizations lacking the patient volume or expertise
28 CardioSource WorldNews
needed for a TAVR program can benefit from
collaborating with nearby organizations that
do offer TAVR, such as a local hospital. The
smaller program can screen and identify
patients to send to the established program
for the actual TAVR procedure. There is
some risk involved in pursuing these types of
partnerships, as patients deemed ineligible
for TAVR are sometimes not sent back to
the referring cardiologist. Consequently, the
agreement should establish clear protocols
to ensure proper care coordination among
the patient’s providers. Another option is to
work with similarly sized nearby hospitals
to develop a joint program, sharing costs and
revenue across the facilities.
• Complimentary cardiac service offerings. It
may be more straightforward to pursue other
cardiac offerings such as a valve clinic before
jumping into TAVR. A complimentary cardiac
service offering is usually less risky and can
help strengthen core areas (e.g., volume,
TABLE
staff, providers, facilities, and financials) in
preparation for developing a TAVR program
down the road.
• Referral relationships. Organizations should
evaluate how closely they work with cardiologists and primary care providers in the
community to identify relationships that can
be strengthened. Building on existing relationships and developing new ones will help
to increase case volume and better position
the hospital to launch a TAVR program.
An innovative medical advancement, TAVR has
become an important feature of leading cardiac
service lines over the past few years. Organizations that don’t yet have a TAVR program--especially those in communities without a competitor
program offering the procedure--should evaluate
its fit with their cardiovascular program and the
population they serve. Otherwise, they may very
well be missing out on a valuable opportunity to
differentiate their cardiac service line. ■
TAVR Programs: Pros and Cons
Pros
Cons
Considered a be a critical component of structural heart
programs
Expensive to offer, with limited reimbursement;
“break even” is typically the best case scenario
Satisfies increasing patient and provider demand for
minimally invasive procedures
Requires a volume threshold that can be difficult
to maintain in either rural areas or markets with
multiple competitors
Often creates a significant competitive edge in the
regional market
Demands the support of physician champions who
are willing to commit significant time to program
development
Drives facility improvements, which in turn improves
patient and staff satisfaction
Often requires significant capital investment (e.g.,
hybrid ORs, high-tech imaging equipment)
Helps recruitment efforts; many new interventional
graduates will not consider cardiac programs that don’t
include TAVR
Takes key physicians out of clinical practice to
receive appropriate training and facilitate program
development
Generates substantial ancillary revenue (i.e., cardiac
imaging and testing)
Necessitates substantial resources to coordinate
patient care and manage the TAVR registry.
Potentially offers a “halo effect” (e.g., traditional AVRs
and other procedures for patients deemed ineligible
for TAVR)
December 2016