Abstract
ObjectiveThe aim of this exploratory study was to compare the performance of carotid artery stenting (CAS) best practices between Intersocietal Accreditation Commission (IAC) accredited facilities and non-accredited facilities certified by the Centers for Medicare and Medicaid Services (CMS).MethodsA random, anonymous survey was sent to CMS and IAC accredited facilities querying facility routine performance of 16 CAS procedure components found in published guidelines and utilised during clinical trials.ResultsThere were 28 responses (response rate=17%). Significant differences were found between the CMS and the IAC facilities for four of 16 procedure measures: determination of modified Rankin Scale score prior to stenting (p=0.012, 95% CI 20% to 80%), accurate measurement of per cent stenosis using electronic callipers (p=0.005, 95% CI 24% to 84%), confirmation of anticoagulation with activated clotting time greater than 250 s prior to crossing the lesion (p=0.03, 95% CI 7% to 69%), and comparison of facility outcomes to accepted benchmarks for stroke and death (p=0.03, 95% CI 7% to 69%). Overall, IAC facilities performed all 16 procedures more frequently (97%) than CMS facilities (66%) (p<0.001, 95% CI 24% to 36%).ConclusionsAlthough the sample size was small, the results demonstrated IAC accredited facilities are more likely to follow best practices, to use quantitative tools to select appropriate patients, and quantitively measure patient-centred clinical outcomes compared with CMS certified facilities. The findings raise the question as to the value of CMS certification versus IAC accreditation as a requirement for reimbursement.
Funder
Intersocietal Accreditation Commission
Subject
Public Health, Environmental and Occupational Health,Health Policy,Leadership and Management
Reference20 articles.
1. U.S. Centers for Medicare &Medicaid Services . Centers for Medicare and Medicaid services decision memorandum for carotid artery stenting (CAG-00085R). Available: http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=157 [Accessed 22 Jan 2018].
2. Clinical competence statement on carotid stenting: Training and credentialing for carotid stenting—multispecialty consensus recommendations
3. The IAC standards for carotid stenting accreditation. Available: http://www.intersocietal.org/carotid/standards/IACCarotidStentingStandards2014.pdf [Accessed 27 Jan 2018].
4. Carotid artery stenting facilities. Available: https://www.cms.gov/Medicare/Medicare-General-Information/MedicareApprovedFacilitie/Carotid-Artery-Stenting-Facilities.html [Accessed 22 Jan 2018].
5. Carotid artery stenting: review of technique and update of recent literature;Ahn;Semin Intervent Radiol,2013