[caption id="attachment_4100" align="alignleft" width="320"]Beantown's biggest and America's best EPs[/caption]
This year’s edition of the Heart Rhythm Society annual scientific sessions is in the can, and there were a number of interesting related developments inside and outside the confines of the Boston Convention and Exhibition Center. While the content was fascinating, there was also a lot about social media that was quite interesting as well.
Lead Twitterators have stethoscopes
Gatherings like HRS draw an interesting and varied crowd, but when you look at the event’s hashtag (#HRS2015), you have to wonder about the ratio of media tweets to those from other sources. It struck me that the event lacked the volume of media coverage that I seem to recall was there in the past. When I dial up the hashtag on my own feed (@MedDeviceMark), it seems that physicians were far and away the heaviest users of the hashtag. Even if you remove the pound sign, media sources account for very few tweets.
The problem – assuming you think this is a problem – is that the media were really not there for the event if the Twitter feed is any indication. There was, however, at least one potentially mitigating circumstance, which I’ll explain later.
Prior engagement over a tech assessment
Conspiracy theory is about as much fun as one can have without breaking the law, and the Centers for Medicare & Medicaid Services released a couple of technology evaluations dealing with cardiac electrophysiology just prior to the HRS festivities in Boston. Coincidence? Maybe, but it’s a lot more fun to think it was timed that way.
The technology evaluation for catheter ablation for treatment of atrial fibrillation is dated April 20, and it shows up at the CMS website 10 days later, so no big deal. However, the tech evaluation for cardiac resynchronization in the Medicare population is dated March 24, and it does not appear on the Medicare coverage center webpage until May 1.
I had tweeted about the ablation/afib document in the first week of May, and a lot of the same electrophysiologists who were active at HRS 2015 were also very active in discussing this document on Twitter. Many of those discussions revolved around patient selection, durability of effect, and which tissues to ablate, all relevant topics.
However, I advised the physicians that CMS has sent a pretty clear signal that it wants to know what it’s paying for, and that the agency will get those data by hook or by crook. David Wilber, the editor in chief of JACC Clinical Electrophysiology seemed to agree, remarking in the May 6 edition of Medical Device Daily that the agency may be trying to tell everyone it’s time for an ablation/afib registry.
As we all know, though, registries ain’t cheap. Medtronic, Boston Scientific and St. Jude Medical should be prepared to bring out the checkbook because hospitals are not going to foot the bill for this one alone, and the National Heart, Lung and Blood Institute doesn’t exactly have access to Fort Knox, either.
The critical question here as best as I can tell is whether CMS will be happy with just a registry, or whether it will start looking at coverage with evidence development for afib ablation in addition to a registry. After all, CMS did announce last year it intends to make more extensive use of CED.
Wireless limbo at BCEC
Anyone in the media who did attend HRS 2015 probably wanted to chew glass over the wireless service at the Boston Convention and Exhibition Center, but calling it “service” is something of a misnomer. It was a nightmare, and it’s difficult to do a lot of tweeting when you’re scrambling to get more basic things done, such as accessing the medical journal articles needed to provide context for our coverage. It wasn't much fun for anyone providing media relations service at HRS, either, and my hat is off to them for working around it.
A note to the head honchos at BCEC. Might wanna get that fixed if you like booking these big, media-friendly conventions.
[caption id="attachment_4083" align="alignleft" width="348"]The spirit of 1773; tea overboard, device overseas[/caption]
Taxes are everywhere, but device makers are still exercised over the 2.3% excise tax on their offerings. Corporate tax reform, too, looms as a policy issue in our nation's capitol, but what are the odds Congress will pass and the President will sign legislation dealing with either of them? A quick read of the tea leaves, as it were, suggests the odds are not very good.
Klobuchar; corporate tax reform on the rocks
Sen. Amy Klobuchar, no novice where the device tax is concerned, appeared at last week's meeting of the Medical Device Manufacturers Association, and she briefly discussed both these tax policy issues. On the point of corporate tax reform, Klobuchar indicated it won't happen this year, which means it won't happen at all in the 114th Congress because next year is an election year.
Klobuchar indicated an interest in finding a way to incent corporate America to repatriate overseas revenues as a means of funding infrastructure, but this is no novelty on her part. The Obama administration laid out just such an argument the day before Klobuchar spoke at MDMA, according to a recent story, so Klobuchar's line appears to be that of President Obama.
The story at Yahoo news indicates that the Obama administration feels it has done all it can toward a compromise framework for legislation, so clearly corporate tax reform won't happen before 2017, especially since the administration's OMB director Shaun Donovan made it clear that the administration is asking corporate America to take a significant financial loss out of "a sense of patriotism." As if shareholders are going to take a hit for patriotism in this economy.
Mr. President, may I clue you in on something? Any CEO who goes along with this at the expense of his or her shareholders won't have a job for long. But you already know that, don't you?
Paying for the pay-for
Democrats do not hold the majority in the Senate, but Republicans have to get to at least 60 votes to get any kind of device tax repeal legislation through, unless it's tacked onto something the White House sees as a must-pass. The problem here is that everyone in the Democratic Party who has talked about the device tax recently kept saying "offsets" and "pay-fors."
First, Sen. Debbie Stabenow repeatedly cited the need to continue offering coverage under health insurance exchanges, something the device tax is designed to subsidize. Stabenow repeatedly circled back to this, probably because she was the only Democrat who bothered to attend the April 23 Senate Finance Committee hearing on the device tax.
As much as Stabenow tried to make nice about the problems the device tax creates, she also resumed the discussion of a "fiscally responsible" approach to repeal. In case you didn't get the flyer, "fiscally responsible" means "offsets."
In her remarks to the crowd at MDMA, Klobuchar wasn't exactly arguing against a pay-for, either. She referred to the fact that the Affordable Care Act has cost less than anticipated, which she conceded is "not officially a pay-for," but she said it offers "a good argument for repeal."
One is well advised to avoid saying, "never," but the GOP has only 54 seats in the Senate, so a veto-proof majority of 67 might be asking a lot in the event of a stand-alone device tax repeal bill. Many members of the GOP will remark that about $140 billion of the 10-year doc fix projection was not paid for, so they'll ask why Congress should worry about an unpaid device tax repeal when it'll cost about one seventh of the unpaid portion of the SGR bill.
It's a fair question, but the answer is not forthcoming because underneath it all, the vast majority of Senate Democrats really don't want to repeal this tax.