HOLLYWOOD, Fla. — Foot-dragging by CMS and disagreements among professional societies are the most common reasons cited for why reimbursement for carotid stenting is limited in the United States, but there are more factors in play, a panel of experts said during a roundtable at the International Symposium on Endovascular Therapy.
Turf wars between vascular surgeons, neurologists and interventional cardiologists and radiologists have played a role in restricting reimbursement for carotid stenting in patients with carotid stenosis, according to Barry T. Katzen, MD, chief medical executive, Miami Cardiac and Vascular Institute, clinical professor of radiology and surgery at Florida International University Herbert Wertheim College of Medicine, Miami, and founder of ISET.
However, Katzen said, this may be changing.
Barry T. Katzen
“What drove a lot of the turf issues earlier was a question of shifting from vascular surgery to somebody else,” he said. “The most recent trials have been done in a space that’s multidisciplinary and everybody’s engaged to one extent or another. Has there been enough of a change in the culture to present a different face to CMS?”
Vascular surgeons have traditionally expressed concern that carotid stenting confers risk for stroke, but many have embraced newer technologies designed to address those concerns, particularly the transcarotid artery revascularization procedure (Enroute Transcarotid Stent and Enroute Transcarotid Neuroprotection System, Silk Road Medical), said Thomas G. Brott, MD, professor of neurology and director for research at the Mayo Clinic in Jacksonville, Florida.
“I think that’s changed the playing field,” Brott said.
Thomas G. Brott
However, he said, reimbursed carotid stenting procedures fell from 82,000 in 2003 to 48,000 in 2014, so CMS “may be sensing that we’ve got enough people taking care of the asymptomatic patients and we don’t need more people doing it.”