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    • br Reimbursement system The current reimbursement regulation

    2019-05-28


    Reimbursement system The current reimbursement regulations are in need of an update [26,27]. In 2008, the Centers for Medicare and Medicaid Services in the USA approved a revised set of codes developed in collaboration with HRS, the American College of Cardiology, and the American Medical Association that more accurately reflected the services and associated work involved in in-office and remote monitoring of CIEDs. Specifically, the RM codes recognize the critical role of the allied professional by assigning a separate code to cover the work of remote data acquisition, receipt and processing of the transmission, technical review and support, as well as distribution of the results. To prevent overutilization, the codes may be used only once every 90 days [28]. Health systems in Europe are significantly different, which affects their approach to reimbursement of RM and follow-up [29]. In the EHRA survey of 2010, 51 centers reported that reimbursement of remote follow-up was established per episode in 8.9% of cases, but in 82.1% no reimbursement structure was present [30]. A flat fee per patient per month or per year should be adopted for RM as part of integrated care or disease management contracts.
    Summary
    Conflict of interest
    Introduction Device therapy is a well-established treatment for preventing sudden cardiac death or managing drug-refractory congestive ezh2 inhibitor failure in adults [1–6]. However, device therapy is performed less commonly in pediatric populations, and the indications for implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy (CRT) device implantations are unclear in pediatric patients. This review aimed to examine the indications for ICD and CRT device implantations in pediatric and congenital heart disease (CHD) patients.
    Present situation of device therapy in Japan In a multicenter survey of device therapy performed before 2012 in Japanese children [7], the most frequent indications for device therapy included hypertrophic cardiomyopathy, long QT syndrome, and catecholaminergic polymorphic ventricular tachycardia for ICD patients and dilated cardiomyopathy (DCM), cardiac failure due to right ventricular pacing in congenital complete atrioventricular block, polysplenia, asplenia, tetralogy of Fallot, and atrioventricular septal defect for patients with CRT with a biventricular pacemaker (CRT-P) and those with CRT with a dual-chamber (DDD) pacemaker (CRT-DDD). DCM was the most common condition that required CRT with a defibrillator (CRT-D). Among 81 CRT-P and CRT-DDD patients, CRT-DDD was used in 41% of the patients at general hospitals vs. 89% at children’s hospitals (Fig. 1). Furthermore, CRT-DDD and CRT-P were effective in improving heart failure in 67 patients (83%). These results show that the number of CRT-P and CRT-D implantations needed in children may be higher than that believed previously. In contrast to general hospitals, children’s hospitals have no choice but to use DDD pacemakers for CRT, because CRT-P devices are not allowed to be used for biventricular CRT-P. In Japan, the institutional criteria for CRT implantation are as follows: The institutional criteria for ICD and CRT-D implantations are as follows: Of 64 ICD patients, 28 (44%) experienced appropriate shocks, and 19 (29%) experienced inappropriate shocks (Fig. 2). This may also suggest that the number of patients with an indication for ICD implantation may be higher than that reported in children. Lead implantation in children also differs from that in adults. The Japanese multicenter survey [7] showed that of 152 patients, epicardial leads were used in 94 (62%), transvenous leads were used in 53 (35%), and both leads were used in 5 (3%) patients. Epicardial leads were used in approximately two-thirds of the patients and in almost all of the patients aged <9 years. Moreover, epicardial leads were used for most of the CRT patients, regardless of their age or bodyweight. However, the use of transvenous leads for ICD implantations was higher in patients >8 years of age or with a bodyweight of >30kg. Epicardial lead implantation was performed in approximately one-third of the patients, and left subcutaneous lead implantation was performed in most of the patients.