Medicare policy change could increase inequity in heart transplant access, study finds
A change to Medicare policy surrounding heart transplant may lead to increased inequities in access to transplant for patients with heart failure, a Michigan Medicine study finds.
In the United States, there are many health centers that implant LVADs but don’t perform transplants. Recognizing improved outcomes for patients with LVADs, the Centers for Medicare & Medicaid Services revised its national coverage decision in a manner expected to increase access to the life-altering devices. Starting in 2020, patients receiving an LVAD at a center not capable of transplant no longer needed permission from a Medicare-approved transplant center authorizing it if the patient was a transplant candidate.
While the relaxed requirements have the potential to increase access to LVADs for patients with heart failure, a study published in JAMA Network Open finds that patients receiving LVADs at transplant-capable centers had 79% higher odds to receive a bridge-to-transplant designation than patients treated at LVAD-only centers.
This Medicare policy change may have the unintended consequence of further increased inequities in access to heart transplant for patients who are treated at centers that don’t perform transplant, said senior author Thomas Cascino, M.D., a cardiologist at the University of Michigan Health Frankel Cardiovascular Center and a clinical instructor in the Division of Cardiovascular Disease at U-M Medical School.
Over two years, 25.6% of patients who received an LVAD at a transplant center eventually received a heart transplant, compared to just under 12% at LVAD-only centers.
An additional change impacting the disparity, Cascino notes, is a 2018 policy change made by the United Network for Organ Sharing that, while made with the goal prioritizing those at highest risk of death on the waiting ling, made it much less likely for patients receiving LVADs to receive a heart transplant unless urgent complications arose.
