UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM
CURRENT REPORT
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Item 8.01 |
Other Events. |
Centers for Medicare & Medicaid Services (CMS) Final Rule for the Inpatient Prospective Payment System (IPPS)
On May 11, 2020, the Centers for Medicare and Medicaid Services (CMS) released a draft of hospital payment levels proposed for patient discharges after October 1, 2020. The May 2020 Proposed Rule for the Inpatient Prospective Payment System (IPPS) update includes ICD-10 coding and confirms assignment of percutaneous Impella implantation to MS-DRG 215 for Other Heart Assist System Implant. The Proposed Rule also maintained bi-ventricular Impella (MS-DRG 1), ECPella (MS-DRG 3), and Impella hospital transfer / support (MS-DRG 268) for the receiving hospital. In addition, CMS proposed three options for MS-DRG 215 including (1) maintain FY2020 rate (hold harmless), (2) an average of the proposed rate and FY2020 rate or (3) adjust and audit reimbursement rate from FY2020 based on hospital charges, length of stay, patient transfer, patient comorbidities and hospital efficiencies over the prior year.
Proposed new payment levels for all hospital MS-DRGs, including those most relevant to Impella related procedures, are in Table A. The final rulemaking may differ substantially from this proposal and will take effect October 1, 2020. Hospitals that incorporate best practices often achieve better patient outcomes at a lower cost of care. For the sickest patients who utilize extensive resources, hospitals are eligible to receive additional outlier payments, which may collectively increase reimbursement in future years.
The American Hospital Association (AHA) and CMS have established a system of care around the utilization of percutaneous heart pumps. The history and creation of this dedicated payment system with Impella implant/explant, bi-ventricular, ECPella and transfer reimbursement allows some of the most critically ill patients in the system to have the potential to survive and improve/achieve native heart recovery.
The Proposed Rule for the Inpatient Prospective Payment System (IPPS) is available on the CMS website at cms.gov and is open for public comment until July 10, 2020.
Table A. Summary of common MS-DRGs from the Proposed Rule for illustration only.
Common Impella Procedures *
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MS-DRG |
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Current Rate (All Hospitals) |
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Proposed Rate (All Hospitals) |
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Current Rate (Sample 100 Impella sites) |
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Proposed Rate Oct 1, 2020 (Sample 100 Impella sites) |
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Uni-Ventricular Impella percutaneous insertion |
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215 |
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$ |
80,654 |
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$ |
61,127 |
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$ |
94,621 |
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$ |
71,712 |
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Biventricular Impella or open insertion with removal |
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1 |
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$ |
172,959 |
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$ |
185,819 |
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$ |
201,871 |
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$ |
216,881 |
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ECPella |
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3 |
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$ |
118,632 |
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$ |
121,684 |
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$ |
138,748 |
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$ |
142,318 |
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ICU care and removal of Impella, after transfer from outlying hospital |
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268 |
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$ |
42,452 |
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$ |
44,969 |
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$ |
50,235 |
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$ |
53,213 |
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* |
Actual MS-DRGs may vary based on procedure, estimated hospital relative weight. |
All Hospitals’ include ~3,200 Medicare hospitals, and only ~1,788 have cath labs or operating rooms.
(1) History of Percutaneous VAD (Impella) Reimbursement and Dedicated System of Care.
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Effective Dates (CMS Fiscal Years |
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MS-DRG |
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2015 Rate (All Hospitals) |
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2015 Rate (Sample 100 Impella sites |
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Current Rate (Sample 100 Impella sites) |
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Proposed Rate Oct 1, 2020 (Sample 100 Impella sites) |
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Impella assistance in catheterization lab only |
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2008-2016 |
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216-221 |
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~ $42,000 |
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~ $55,000 |
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N/A |
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N/A |
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Uni-Ventricular Impella percutaneous insertion |
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2017 |
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215 (Dedicated DRG PVAD) |
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N/A |
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N/A |
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$ |
94,621 |
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$ |
71,712 |
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Biventricular Impella or open insertion with removal |
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2016 |
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1 (Dedicated DRG BiVAD) |
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N/A |
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N/A |
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$ |
201,871 |
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$ |
216,881 |
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ICU care and removal of Impella, after transfer from outlying hospital |
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2016 |
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268 (Dedicated DRG Transfer) |
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N/A |
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N/A |
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$ |
50,235 |
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$ |
53,213 |
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SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.
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ABIOMED, Inc. |
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By: |
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/s/ Marc A. Began |
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Marc A. Began Vice President, General Counsel and Secretary
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Date: May 12, 2020 |
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