IN BRIEF

CMS Approves New Code for Adult Congenital Heart Disease Subspecialty

September 13, 2020

The official billing code will enable growth of the subspecialty and is expected to result in improved patient care.

In March, the Centers for Medicare and Medicaid Services (CMS) approved a unique code for subspecialists in adult congenital heart disease (ACHD). The code will allow board-certified ACHD specialists to bill as such, rather than as general cardiologists, for the care they provide to the more than 1.5 million U.S. adults with ACHD.

“More importantly, we’ll be able to track quality metrics and outcomes for patients followed by board-certified ACHD cardiologists,” says Curt Daniels, MD, director of the Adolescent and Adult Congenital Heart Disease Program at The Heart Center at Nationwide Children’s Hospital, and one of the leaders behind the American College of Cardiology’s CMS application for the new code. “It should also make it much easier for hospitals and academic centers to build formal ACHD programs due to the billing and financial implications, which can have a great impact on patient care.”

Adults with congenital heart disease currently make up two-thirds of the total congenital heart disease population in the United States. Yet there are more than 3,000 pediatric cardiology specialists and just about 450 board-certified ACHD clinicians. Dr. Daniels believes that the CMS code will make it more appealing for cardiologists to consider pursuing the ACHD credentials, since hospitals can now more easily hire and charge for these specialists appropriately.

Together with ACHD experts from Lucile Packard Children’s Hospital, the McGill Adult Unit for Congenital Heart Disease Excellence and the Adult Congenital Heart Association, Dr. Daniels published an in-depth analysis of the importance of board-certified ACHD cardiologists and specialty teams for clinical care—and the overall national lack of specialists. The study, published in August in Cardiology Clinics, includes a count of specialists per state; 14% of states (7) have no board-certified ACHD cardiologists, and another 24% (12) states have three or fewer. In some geographic regions, multiple bordering states have no specialists, accentuating the lack of access to adequately trained specialists that adults with congenital heart disease may have.

“People often don’t realize that pediatric cardiologists don’t train to take care of adults, and adult cardiologists don’t receive congenital heart disease training,” says Dr. Daniels. After pediatric cardiology was acknowledged as a subspecialty in the 1960s, clinicians gradually realized that the aging congenital heart disease population lacked transitional, lifelong care options. “Kids were increasingly surviving to adulthood, but then survival wasn’t good, partly because of the lack of specialized care. Disease-specific knowledge has a huge impact on patient outcomes.”

By 2012, the data on the need for specialists were clear, so Dr. Daniels and other cardiologists started petitioning to launch fellowship programs and a board certification for ACHD. The formal training for ACHD cardiologists is now the longest of any cardiology subspecialty, and the board granted its first batch of ACHD certifications in 2015. Now that several hundred clinicians are board-certified, the CMS designation—three years in the making—should further develop the field’s popularity. Subspecialists should be eligible to apply for the CMS code in September, and it is expected to become active in October 2020.

“We’re finally on track to see the product of all of our work to get a board certification and a CMS code,” says Dr. Daniels. “It will help us follow patients for outcomes and hospitalizations and see how the subspecialty board promotes quality care for patients. It will also help centers like ours at Nationwide Children’s grow to keep up with patient demand. Many places around the country are suffering from a shortage of appropriate ACHD providers, which of course ultimately emphasizes the importance of this change for patient care.”

 

 

Reference:

Fernandes SM, Marelli A, Hile DM, Daniels CJ. Access and delivery of adult congenital heart disease care in the United States: Quality-driven team-based careCardiology Clinics. 2020;38(3):295-304.

Image credit: Nationwide Children’s