The ACC joined with the Society for Cardiovascular Angiography and Interventions (SCAI), Society of Thoracic Surgeons (STS) and American Association for Thoracic Surgery (AATS) to submit formal comments on the draft national coverage determination (NCD) regarding TAVR issued by the Centers for Medicare and Medicaid Services (CMS) last month.

The comments support changes proposed by CMS to eliminate a requirement for a second preprocedure consultation and the continued collection of data to answer outstanding questions.

However, they also reiterate the importance of a minimum volume standard as a surrogate to ensure high-quality outcomes, in line with the 2018 AATS/ACC/SCAI/STS Expert Consensus Document: Operator and Institutional Recommendations and Requirements for Transcatheter Aortic Valve Replacement and recently published data from the STS/ACC TVT Registry.

Should CMS not make changes to the volume section of the proposal, the societies recommend CMS require public reporting of outcome measures as a check on quality.

The societies also note a role for external certification in supporting any site's continuous quality improvement, but especially as a mechanism to support underperforming sites. CMS will issue its final NCD by June 24.

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Keywords: ACC Publications, Cardiology Magazine, Health Policy, Transcatheter Aortic Valve Replacement, Thoracic Surgery, Centers for Medicare and Medicaid Services, U.S., Quality Improvement, Medicaid, Medicare, Registries, Heart Valve Prosthesis, Referral and Consultation, Coronary Angiography, Outcome Assessment, Health Care, Surgeons, Certification

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