Clinical Decision Support for Heart Failure Referral—More Work, Better Outcomes?

Effective October 1^st 2017 the Centers for Medicare and Medicaid Services (CMS) will recognize a new physician specialty code for Advanced Heart Failure and Transplant Cardiology (code C7). This change, the culmination of a joint effort by the Heart Failure Society of America (HFSA) and the American College of Cardiology (ACC), will enable heart failure (HF) specialists to consult and bill for services and expertise additional to general cardiology services, recognizing their specialized contribution to health care. During this process CMS considered evidence that the practice pattern of the HF specialty was sufficiently different from general cardiology, required specialized training and certification, was recognized by the American Board of Internal Medicine, already held a unique Healthcare Provider Taxonomy Code under the National Uniform Claim Committee, and accepted a stated purpose for the change. The purpose for the change, as stated by the HFSA, was to enlighten patient choice of providers, improve performance and value comparisons between like providers, to appropriately select for and manage patients with highly specialized therapies including cardiac transplant and mechanical circulatory support devices, and to recognize the higher acuity of many encounters with HF patients. Not explicitly stated was the notion that encouraging HF specialty care could improve outcomes for patients.