RE: VAD evals

[Guest guest]

Hi Leah,

We find out from the insurance company what

the VAD benefits is and then we go over that information with the patient.

If you have any more questions, please

feel free to contact me directly. 

Thanks

Deanna Ridgeway

Specific Program Financial Specialist

Transplant and Disease

Management

IHVI/Inova Fairfax Hospital

Phone:

Fax:

From:

TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of justme1234

Sent: Wednesday, November 24, 2010

8:29 AM

To:

TxFinancialCoordinators

Subject:

VAD evals

Does anyone counsel patients on VAD benefits? If so,

what do you go over exactly? We have recently started performing more VADs and

our VAD team wants us to be part of the eval. We know what to go over if its

Bridge, but what would be discussed for DT?

Any info is greatly appreciated!

Leah Knowles

TFC

CMC

Charlotte NC

[Guest guest]

FDA approved VADs are considered implants. 

As long as your hospital is certified to provide destination/DT and bridge-to-transplant/BTT,

the surgery and implant are part of patient’s benefits just as an AICD, hip

replacement, cataract lens, or any other implant.  Just as with other types of

surgery, there are CMS medical necessity requirements (below). 

LVADs are high cost and part of the

cardiac team that also is involved in heart transplant.  A benefit check is

performed to evaluate if patient has enough $$ in the plan for 2 implants---since

it is not unheard of to need a replacement VAD in 2+years--- and whether they’ll

be able to maintain insurance.  It’s an implant and there isn’t

extensive post implant care or medicines outside of what a cardiac patient

would be used to (which may be due to our hospital being one of the most active

with VADs and therefore low complications).  No special patient counseling is

provided to DT which is consistent with how we interact with the general

inpatient population.  Only organ transplant (and BTT) candidates receive “upgraded”

counseling to explain initial and long term costs of procedure. 

Here is the recent final decision from CMS

on LVAD for DT.

<http://www.cms.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp & id=243 & >

Sheila Kantor

Manager, Patient Access Services Department

Sharp Metropolitan Medical Campus

(fax)

(pgr)

From:

TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of Ridgeway, Deanna

Sent: Wednesday, November 24, 2010

6:28 AM

To:

TxFinancialCoordinators

Subject: RE:

VAD evals

Hi Leah,

We find out from the insurance company what the VAD benefits is

and then we go over that information with the patient.

If you have any more questions, please feel free to contact me

directly.

Thanks

Deanna Ridgeway

Specific Program Financial Specialist

Transplant and Disease Management

IHVI/Inova Fairfax

Hospital

Phone:

Fax:

From: TxFinancialCoordinators

[mailto:TxFinancialCoordinators ] On Behalf Of justme1234

Sent: Wednesday, November 24, 2010

8:29 AM

To:

TxFinancialCoordinators

Subject:

VAD evals

Does

anyone counsel patients on VAD benefits? If so, what do you go over exactly? We

have recently started performing more VADs and our VAD team wants us to be part

of the eval. We know what to go over if its Bridge, but what would be discussed

for DT?

Any info is greatly appreciated!

Leah Knowles

TFC

CMC

Charlotte

NC

[Guest guest]

thanks for this info guys!

Subject: RE: VAD evalsTo: "'TxFinancialCoordinators '" <TxFinancialCoordinators >Date: Wednesday, November 24, 2010, 1:14 PM

FDA approved VADs are considered implants. As long as your hospital is certified to provide destination/DT and bridge-to-transplant/BTT, the surgery and implant are part of patient’s benefits just as an AICD, hip replacement, cataract lens, or any other implant. Just as with other types of surgery, there are CMS medical necessity requirements (below).

LVADs are high cost and part of the cardiac team that also is involved in heart transplant. A benefit check is performed to evaluate if patient has enough $$ in the plan for 2 implants---since it is not unheard of to need a replacement VAD in 2+years--- and whether they’ll be able to maintain insurance. It’s an implant and there isn’t extensive post implant care or medicines outside of what a cardiac patient would be used to (which may be due to our hospital being one of the most active with VADs and therefore low complications). No special patient counseling is provided to DT which is consistent with how we interact with the general inpatient population. Only organ transplant (and BTT) candidates receive “upgraded†counseling to explain initial and long term costs of procedure.

Here is the recent final decision from CMS on LVAD for DT.

<http://www.cms.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp & id=243 & >

Sheila Kantor

Manager, Patient Access Services Department

Sharp Metropolitan Medical Campus

(fax)

(pgr)

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Ridgeway, DeannaSent: Wednesday, November 24, 2010 6:28 AMTo: TxFinancialCoordinators Subject: RE: VAD evals

Hi Leah,

We find out from the insurance company what the VAD benefits is and then we go over that information with the patient.

If you have any more questions, please feel free to contact me directly.

Thanks

Deanna Ridgeway

Specific Program Financial Specialist

Transplant and Disease Management

IHVI/Inova Fairfax Hospital

Phone:

Fax:

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of justme1234Sent: Wednesday, November 24, 2010 8:29 AMTo: TxFinancialCoordinators Subject: VAD evals

Does anyone counsel patients on VAD benefits? If so, what do you go over exactly? We have recently started performing more VADs and our VAD team wants us to be part of the eval. We know what to go over if its Bridge, but what would be discussed for DT?Any info is greatly appreciated!Leah KnowlesTFCCMCCharlotte NC