The AtriCure Health Economics and Reimbursement team focuses on illustrating the economic value of its cardiac surgical and post-operative pain management therapies to allow increased market access on a global basis. This work includes building value messages from Health Economic models, analyzing administrative claims, developing hospital value analysis tool kits, and clinical study support. A large focus is also on reimbursement coverage strategies and advocacy efforts with private and public payors in both the United States and globally in markets in which the company does business.
In the United States, the appropriate use of coding allows hospitals and physicians to be paid for prescribing life improving therapies and for patients to receive impactful treatments for their medical condition. A list of potential Medicare coding and reimbursement rates for AtriCure related procedures are listed in the AtriCure coding and reimbursement guide available for download below. The coding guide is not a recommendation for specific procedures, but serves as an example for healthcare providers; and it is up the provider to treat and choose the appropriate codes for reimbursement of their procedures. For personal assistance and additional information, please speak with your sales professional or contact AtriCure’s Customer Service department here.
A study published in The Journal of Thoracic and Cardiovascular Surgery concluded that Surgical ablation (SA) in patients with atrial fibrillation undergoing coronary artery bypass grafting is not only cost-effective, but also associated with a 29% reduction in the risk-adjusted hazard of late mortality (90 days to 2 years) - without an increase in total risk-adjusted inpatient cost.
This study examined 2-year risk-adjusted mortality and total hospital costs in Medicare beneficiaries with Atrial Fibrillation requiring CABG with or without SA. In this population, CABG was performed in 3745 Medicare beneficiaries with AF in 2013, with concomitant SA in 17% (626 of 3745). Risk-adjusted mortality, morbidity, and cost during the first 2 postoperative years for patients with SA and those without SA were compared. A piecewise Cox proportional hazard model (0-90 days and 91-729 days) was used to risk-adjust mortality.
Patient Population:
- 3745 Medicare beneficiaries with prior AF who underwent CABG
- Concomitant SA ablation was performed in 626 patients (17%)
- Risk-adjusted mortality, morbidity, and cost during the first 2 postoperative years for patients with SA and those without SA were compared
Key Findings:
- SA was associated with a 29% lower risk-adjusted hazard ratio for late mortality in patients with AF requiring CABG.
- Index hospital costs were higher with SA, but total inpatient costs were not different in the 2 groups after 2 years.
- No significant difference existed in the adjusted risk of admission for stroke, heart failure, MI, bleeding, or revascularization
- The authors concluded that SA for AF was a cost-effective addition to enhance late 2-year survival in patients with AF undergoing CABG.
Limitations:
- This was a retrospective analysis of Medicare claims data. Future prospective clinical studies will be necessary to confirm the conclusions presented in this analysis.
Publication:
Rankin, J. S., Lerner, D. J., Braid-Forbes, M. J., McCrea, M. M., & Badhwar, V. Surgical ablation of atrial fibrillation concomitant to coronary-artery bypass grafting provides cost-effective mortality reduction. The Journal of Thoracic and Cardiovascular Surgery. 2020, 160(3), 675-686.
“Hybrid AF Therapy Reduces Healthcare Resource Use Longitudinally.”
--Dr. Anish Amin, EP
Healthcare Utilization and Costs in Patients with Atrial Fibrillation Before and After Hybrid Ablation
PM-US-2645A-0425-G
A recent publication in the Journal of Atrial Fibrillation and Electrophysiology (EP) demonstrated hybrid ablation performed either during same-stay or sequential visits for hard-to treat AF reduces healthcare resource use longitudinally at one- and two-years following intervention.
Patient Population:
- 472 hybrid ablation patients
- Compared post treatment resource use 2-years following ablation to 1-year prior to their treatment
Key Findings: 2 years post hybrid ablation compared to the year before treatment (in same patients):
Yearly per Patient Average:
- 84% reduction in cardioversions (p<0.0001)
- Catheter ablations reduced by 46% (p<0.0049)
- 79% reduction in AF-related admissions (p<0.0001)
- 50% reduction in all hospital admissions (p<0.0001)
Reference: Amin et. al; Billakanty et. al: Healthcare Utilization and Cost in patients with atrial fibrillation before and after hybrid ablation; Journal of Atrial Fibrillation and EP
A study published in The Journal of Cardiac Surgery concluded that concomitant LAA exclusion via an epicardial closure device (LAACE) is associated with reduced CABG mortality, thromboembolic events, and readmissions in patients with pre-existing atrial fibrillation.
This study examined mortality, length of stay, thromboembolism risk, and 30-day readmission rates in Medicare beneficiaries with pre-existing AF who underwent isolated CABG (i.e., without ablation) with (n=931) or without (n=3279) LAACE. In this population. Long term risks of thromboembolism and mortality were assessed using competing-risk regression and Cox proportional hazard models.
Patient Population:
- 4210 Medicare beneficiaries with pre-existing AF underwent isolated CABG (i.e., without ablation) with (n = 931) or without (n = 3279) LAACE.
Key Findings:
- Operative mortality, length of stay, and 30‐day readmission did not differ between groups.
- Thromboembolism risk was 26% lower for CABG + LAACE group compared with isolated CABG over a 2‐year time to event analysis (p<0.05).
- There were no differences in ischemic stroke rates.
- All‐cause mortality risk was 45% lower for CABG + LAACE during the late follow‐up period.
- There were lower readmission rates (31% vs. 43%, p < .001) and total inpatient days (4.0 days vs. 7.2 days, p < .01) for the CABG + LAACE during follow‐up.
- Total hospital in and out‐patient treatment costs were similar between groups through one year.
Limitations:
- This was a retrospective analysis of Medicare claims data. Future prospective clinical studies will be necessary to confirm the conclusions presented in this analysis.
Publication:
Soltesz EG, Dewan KC, Anderson LH, Ferguson MA, Gillinov AM. Improved outcomes in CABG patients with atrial fibrillation associated with surgical left atrial appendage exclusion. Journal Cardiac Surgery, 2021;1–8.
