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Press Release
Centers for Medicare & Medicaid Services Rule in Favor of Reimbursing Observation Services for Chest Pain
COLUMBUS, OH – November 29, 2001. The Centers for Medicare and Medicaid Services (CMS – formerly HCFA) announced it’s final ruling today in favor of creating a separate APC (Ambulatory Payer Category code for service) for reimbursement of observation services in the hospital emergency department for chest pain, asthma, and congestive heart failure.
With the creation of an APC for chest pain observation, CMS reverses its previous position of August 2000 of no separate funding for observation. Confronted with inadequate support, many observation units and chest pain centers have closed nationwide, reversing the trend of the previous ten years, when a third of hospitals had built chest pain centers to improve the quality of care of patients with acute coronary syndrome (ACS). With the new regulation, the present 1,300 chest pain centers is expected to double in the next 1-2 years.
“CMS is to be congratulated,“ said Louis Graff, MD and President of the Society of Chest Pain Centers, “on removing the roadblock to quality care of acute myocardial infarction.”
The Society for Chest Pain Centers played a leading role with its proactive efforts to bring together and build a consensus amongst the American College of Cardiology, the American Heart Association, the American College of Emergency Physicians, the American College of Nuclear Cardiologists, the American Society of Internal Medicine and the American College of Physicians. At an early stage, CMS administrators who wrote the previous regulation, were made aware of the medical advances which have taken place in the care of patients with acute coronary syndrome. This included a system for chest pain evaluation in the emergency department that includes an attack approach for patients with acute myocardial infarction (AMI), but also an observation approach for patients needing to be observed over a period of time before deciding the status of their problem (risk stratification). The risk stratification was included in the new ACC/AHA Guidelines1 for patients being evaluated with unstable angina and NST myocardial infarction. This approach has been evidenced to reduce the number of missed AMI patients being sent home as well as the number of inappropriate admissions to the hospital, thereby reducing health care costs.
As a result of the effort led by the SCPC, CMS officials were made aware that the chest pain center approach in the Emergency Department needed the proper reimbursement for hospital administrators to put such steps into place. The final regulation reflects the earnest effort of CMS to work with American medicine to improve the quality of care for patients with heart attacks while at the same time reducing healthcare costs.
"The Real Victory belongs to the American Public,” said Raymond D. Bahr, MD, FACP, FACC , President Emeritus of the Society of Chest Pain Centers, “who will benefit from better heart attack care through a shifting paradigm that places more emphasis on early care where more benefits can now take place… namely the strategy of Chest Pain Centers to provide prepared heart attack care at the community hospital level in the more than 5,000 hospitals in the United States. With the proper reimbursement now available for observational services, we expect to see a renewed interest in chest pain centers that will result in exponential growth in these centers throughout the United States."
About the Society of Chest Pain Centers
The Society of Chest Pain Centers (SCPC) is an international professional society focused on improving care for patients with acute coronary syndromes and related maladies. The Society is committed to improving the quality of patient care through protocol-based medicine and the adoption of process improvement science to healthcare. SCPC is headquartered in Columbus, Ohio. For more information, visit www.scpcp.org.
1 ACC/AHA Guidelines for the Management of Patients With Unstable Angina & Non-ST Segment Elevation Myocardial Infraction: Executive Summary and Recommendations. Circulation, Volume 102, No. 10, September 2000.
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