Positive Margins While Saving Lives

There is great news for cardiology: the reimbursement level for Myeloperoxidase will more than double for FY 2011. Myeloperoxidase is a protein biomarker found in the blood and is more commonly referred to as MPO.  First studied in 2003, it is an early predictor for chest pain patients who are at risk of a heart attack.

Each year, over 5 million patients seek treatment for chest pain in an ER and encounter a long list of possible chest pain causes; some causes can be ruled out with basic tests.  EKGs have been an excellent test for heart problems, but in more recent years, MPO has proven very effective as an early indicator.  When discovered early, physicians can prescribe preventative treatment before damage can occur.  However, reimbursement, in most cases was below the cost of the test.

Because MPO is a known cause for multiple inflammatory conditions, it works well as a biomarker for reactions in the immune system.  The combination of high levels of MPO combined with chest pain indicates patients are at a significant risk of a heart attack.  Clinical trials reveal that MPO has a 95% success rate in predicting cardiac arrest over a 30-day to 6-month period.  In comparison, C-reactive protein, the most commonly used cardiac biomarker, has a 50% success rate as a heart attack indicator.

I asked Edward C. Jauch, MD, MS, FACEP, FAHA, associate professor in the Division of Emergency Medicine at the Medical University of South Carolina in Charleston, SC, and an expert in emergency stroke and heart attack treatment, about the advantages of biomarkers and he said, “If a patient is having a heart attack, it shows in the EKG tracing, but a tracing does not always present a clear indication.  You can also look at cardiac enzymes in the lab to determine a heart attack.   The quicker you treat the patient, the less damage and the better their chances of recovery.  With a heart attack, there is a 12-hour window for treatment, so time is critical in preventing long-term damage.”

In 2011, the laboratory test will be assigned to CPT 83880 (Natriuretic peptide) for reimbursement purposes.  This will allow for an average total payment level of $49, which is up from $19 when the MPO marker was assigned to CPT 83520 (Immunoassay, quantitative).  Considering MPO reagents alone costs $4 to $10 per test and labor is another $15 to $20 (blood draw, documentation, and sample processing), laboratories have been on the losing end when MPO was assigned to CPT 83520. Now, under CPT 83880, providers will be able to have the combination of practicing great medicine and maintaining their margins.

James Laskaris, EE, BME
James Laskaris, EE, BME, Clinical Analyst — Mr. James Laskaris is a senior emerging technology analyst at MD Buyline and has been with the company since 1994. With over 30 years of experience in the healthcare field, Mr. Laskaris is the primary analyst of high-end OR technology. He also covers issues related to the legislative and reimbursement effect on healthcare and authors a bimonthly “Issues that Matter” publication. Mr. Laskaris received his biomedical engineering degree from Southern Illinois University. His work has been published in hfm Magazine, Radiology Manager and Healthcare Purchasing News.