SCAI advocates for fairer policies to protect children and adults living with congenital heart disease

WASHINGTON—Too many children and adults living with congenital heart disease (CHD) are being left behind by a system that doesn’t adequately value their care. That’s the message of a new policy statement from the Society for Cardiovascular Angiography & Interventions (SCAI) that highlights broken reimbursement models, undervalued procedures, and barriers to device innovation.  

The statement, “Economic Barriers to Interventional Cardiology Care for Adults and Children With Congenital Heart Disease and Potential Policy Solutions,” was published today in JSCAI. It calls for Medicaid payment parity, fairer valuation of CHD procedures, new compensation models, and faster pathways for pediatric device approval.  

“The practice of interventional cardiology for congenital heart disease requires advanced expertise, significant time, and highly specialized technology. Yet, too often, these realities are not reflected in reimbursement structures or policy decisions,” said Lyndon C. Box, MD, FSCAI, lead author of the statement. “By shining a light on these barriers, we hope to spur reforms that support the physicians providing this care and, most importantly, improve outcomes for the patients and families who rely on it.” 

Congenital heart disease affects about 40,000 newborns in the U.S. each year, with 1 in 4 requiring an invasive procedure in the first year of life. More than 2.4 million adults in the U.S. are living with CHD, creating a lifelong need for access to highly specialized care. 

The policy statement highlights how economic inequities are undermining care: 

• Medicaid pays pediatrics less. More than 50% of pediatric CHD surgeries and 40% of adult CHD hospital encounters are billed to Medicaid, yet Medicaid physician fees average just 72% of Medicare rates. 
• The RVU system undervalues pediatrics. Balloon atrial septostomy, a life-saving procedure for newborns, carried a CPT code for more than 25 years but had a 0 wRVU valuation until 2018. In the past three years, CMS has rejected the recommended wRVU values for 20 of 24 congenital catheterization codes. 
• Pediatric compensation lags that of adult counterparts. Pediatric interventional cardiologists may earn only 50–65% of what adult interventional cardiologists make. At the same time, they can perform just 2–3 procedures per day compared to 8–10 in adult cath labs, due to patient complexity and safety demands.  
• Devices for pediatrics are lacking. Because the market for pediatric medical devices is smaller than the adult market, 63% of CHD interventions rely on off-label devices. An FDA survey found 74% of unmet device needs pertain to children, leaving many young patients dependent on tools never designed for them.  

“The barriers outlined in this statement directly affect the ability of physicians to deliver care and the outcomes our patients experience,” said Frank F. Ing, MD, MSCAI, a member of SCAI’s Congenital Heart Disease Council, and coauthor of the statement. “Achieving meaningful change will require collaboration among clinicians, policymakers, industry, and patient advocates. SCAI is committed to leading that effort so that children and adults living with congenital heart disease are no longer disadvantaged by the very systems designed to support them.” 

About the Society for Cardiovascular Angiography & Interventions (SCAI) 

The Society for Cardiovascular Angiography & Interventions, established in 1978, stands as the primary nonprofit medical society dedicated to representing invasive and interventional cardiology. SCAI's mission is to guide the global interventional cardiovascular community by fostering education, advocacy, research, and upholding standards for quality patient care. For more than 40 years, SCAI has exemplified professional excellence and innovation worldwide, cultivating a reputable community of over 5,000 members committed to advancing medical science and providing life-saving care for individuals, both adults and children, affected by cardiovascular disease.  For more information, visit www.scai.org.