Abstract 10999: Center for Medicare and Medicaid Services Reimbursement Criteria Concordant Primary Prevention ICD Implantation in the Outcomes Among Veterans with Implantable Defibrillators (OVID) Registry

Abstract

Introduction: Numerous trials have led to the establishment of evidence-based Centers for Medicare and Medicaid Services (CMS) reimbursement criteria for the implantation of cardioverter-defibrillators (ICDs) for the primary prevention of sudden cardiac death. A study from the NCDR ICD Registry reported that 77.5% of ICD implants met these reimbursement criteria. The rate of concordance with these criteria in the Veterans Affairs (VA) population has not been reported.

Methods: We examined all patients receiving primary prevention ICDs for standard indications in the Outcomes Among Veterans with Implantable Defibrillators OVID Registry from 2003-2009. Cardiac resynchronization therapy recipients were excluded. ICD implantation was considered to be non-concordant if any of the following criteria were met: 1. MI within 40 days, 2. CABG within 3 months, 3. NYHA class IV CHF, 4. Diagnosis of CHF within 3 months.

Results: Among 1,954 veterans meeting the study inclusion criteria, 88% met evidence-based CMS reimbursement criteria for ICD implantation. Table 1 describes the OVID cohort. Patients receiving non-concordant ICDs were marginally younger and slightly less likely to have a history of CHF. ICDs implanted within 3 months of diagnosis of CHF accounted for 43% of all non-concordant implants.

Conclusion: Despite the fact that CMS reimbursement criteria do not apply in the VA system, CMS-concordant ICD implantation is observed more commonly in the OVID Registry than in the NCDR ICD Registry. These findings suggest that there may be less overuse of ICDs in an integrated heath system, but whether underuse differs is unclear.