Trends in Atrial Fibrillation Ablation Utilization Following 2022 CMS Reimbursement Reduction: A Nationwide Analysis.

Area of Science:

• Cardiology
• Health Policy
• Health Economics

Background:

• The Centers for Medicare & Medicaid Services (CMS) enacted a bundled payment policy in 2022, significantly decreasing reimbursement for atrial fibrillation (AF) ablation.
• This policy change raised concerns regarding its impact on the utilization and complexity of AF ablation procedures.

Purpose of the Study:

• To analyze national trends in AF ablation volumes, reimbursement rates, and procedural complexity after the 2022 CMS policy adjustment.
• Evaluate the impact of reduced reimbursement on the practice of AF ablation.

Main Methods:

• Utilized the Medicare Physician and Other Practitioners by Geography and Service Dataset (2016-2023).
• Identified pulmonary vein isolation (PVI) and additional ablation procedures using specific CPT codes.
• Adjusted reimbursement rates for inflation and employed joinpoint regression to analyze trends pre- and post-policy change.

Main Results:

• National AF ablation volume grew 11.7% annually from 2016-2023.
• Post-policy, inflation-adjusted reimbursement decreased by 27.7% in 2022 and 20% in 2023.
• Despite reimbursement cuts, total AF ablation volume increased by 24.3% (2021-2023), with procedures beyond PVI rising 42.4%.

Conclusions:

• Electrophysiologists maintained and increased AF ablation volumes, even with substantial reimbursement reductions from Medicare's 2022 policy.
• The trend of performing additional ablations beyond PVI also continued to rise, indicating no significant impact from the policy change on procedural trends.