MedSolutions introduces ICD Surgery Management Program

Nov 19 2011

MedSolutions, a leading provider of quality-driven medical cost management services, today announced the launch of its Implantable Cardioverter Defibrillator (ICD) Surgery Management Program, which uses evidence-based guidelines to ensure the clinical appropriateness of ICD and CRT-D (cardiac resynchronization therapy defibrillator) implantation.

With the cost of each ICD/CRT-D procedure averaging $34,000 and 157,082 procedures being performed annually, the ICD/CRT-D market represents approximately $5.3 billion in cost per year in the United States. In addition, the estimated annual growth rate of ICD/CRT-D procedures is 11% to 14% respectively.

While clinical guidelines dictate waiting three months after diagnosis of heart failure and at least 40 days after a heart attack before ICD/CRT-D implantation, many physicians take a more aggressive approach to surgery. Earlier implantation has not been shown to benefit patients and, in some cases, the physicians or facilities providing the surgery may lack knowledge of evidence-based guidelines for ICD implants.

Studies have shown that as many as 22.5% of ICD/CRT-D surgeries fail to meet established clinical guidelines, putting patients at greater risk for serious complications, including cardiac perforation, infection, and even death. According to one recent study, patients who received an ICD despite failing to meet evidence-based guidelines had "significantly higher" risks of post-procedure complications and in-hospital death, as well as longer hospital stays, than individuals who met evidence-based criteria.

"ICD surgery is an effective and beneficial treatment for tens of thousands of patients, but it can be extremely harmful when performed outside of accepted guidelines," said Gregg Allen, M.D., chief medical officer of MedSolutions. "Not only do unnecessary ICD surgeries put patients at risk for a number of life-threatening issues, they also represent avoidable health care costs of up to $36,000 per procedure, not including co-pays or additional costs to treat adverse outcomes."

MedSolutions' Implantable Cardioverter Defibrillator Surgery Management program uses evidence-based clinical guidelines built upon the latest guidelines from the American College of Cardiology, American Heart Association, and Heart Rhythm Society and provides a dedicated cardiac queue, including cardiologists and nurses experienced with the complexities of cardiac care, to determine whether ICD implantations are clinically appropriate.

"By reducing unnecessary and inappropriate ICD/CRT-D surgeries, our program helps improve health outcomes while limiting unnecessary costs associated with the procedure," Dr. Allen said. "As a result, members experience improved outcomes and payors can reduce total claims costs related to cardiac implantables by 10% to 15%."