New technology add-on payment awarded for Gore Excluder iliac branch endoprosthesis

The US Centers for Medicare and Medicaid Services (CMS) has granted the Gore Excluder iliac branch endoprosthesis (IBE) new technology status. Beginning on 1 October, facilities using the IBE in conjunction with an Excluder abdominal aortic aneurysm device for endovascular aneurysm repair (EVAR) are eligible for a new technology add-on payment (NTAP) of up to US$5,250 per case, in addition to the applicable base payment for the Medicare Severity Diagnosis-Related Group (MS-DRG).

Recognition of new technology status is based on meeting three criteria; the technology must be a new device and/or application, demonstrate substantial clinical benefit to the patient, and have an associated cost not already represented in the current rate base. NTAP payments are made for no less than two and no more than three years, after which the DRG base rates are adjusted to reflect facility-reported costs and the utilisation rate of the new technology.

Gore was also successful in a previous petition to Medicare for the reclassification of EVAR, creating two new DRGs with increased hospital base reimbursement effective federal fiscal year 2016. This NTAP, along with the DRG base increase resulting from the 2016 DRG reclassification, “will greatly improve the alignment of hospital payment and average resource consumption, making sure hospitals are more appropriately compensated for using this new technology,” a Gore press release says.

Built on Gore’s technology platform and designed using their proven and durable expanded polytetrafluoroethylene (ePTFE) graft and nitinol stent materials, the IBE is used in conjunction with the Excluder abdominal aortic aneurysm device to preserve blood flow to the external iliac and internal iliac arteries.

“Prior to the IBE, there were limited options for maintaining blood flow to the internal iliac arteries during endovascular aneurysm repair, which is a consideration in about 25% of abdominal aortic aneurysm cases,” said Brian Peterson, vascular surgeon at St Anthony’s Medical Center in St Louis, USA. “The IBE provides physicians with an FDA-approved, off-the-shelf system to preserve blood flow to the internal iliac arteries and maintain patient quality of life.”