The Centers for Medicare and Medicaid Services (CMS) update to the 2025 Physician Fee Schedule includes a measure that holds significant promise for advancing cardiovascular disease management. The initiative introduces G-codes for atherosclerotic cardiovascular disease (ASCVD) risk assessment and management. When implemented, the changes could greatly increase use of the ASCVD risk assessment in primary care, which has previously faced several barriers to adoption including insufficient time, difficulty accessing calculators, and not having the necessary information to input into a calculator.
The new G-codes stem from the CMS Innovation Center's Million Hearts Cardiovascular Disease Risk Reduction model. Running from 2017 to 2022, this model demonstrated that payments for cardiovascular risk assessment combined with cardiovascular care management could reduce death rates. Among high-risk participants who tested the model, ASCVD risk scores were reduced by 4%, and the incidence of first-time heart attacks and strokes decreased by 3-4%, depending on the outcome measure used.
Measure Supports Personalized Care Plans Based on Patient Assessments
Under the update, ASCVD risk assessments can be conducted during evaluation and management visits for patients with cardiovascular disease risk factors, such as family history, high blood pressure, or high cholesterol. However, assessments won't be separately billable for patients already diagnosed with cardiovascular disease or with a history of heart attack or stroke.
The assessment is a comprehensive evaluation that takes into account demographic information, controllable risk factors, potential risk amplifiers, and lab results. This includes factors such as age, sex, race, smoking status, weight, diet, activity level, and nutrition, as well as tests like lipid profiles and blood glucose levels. Healthcare providers gather this information through clinical questionnaires, physical examinations, and reviews of medical history and electronic health records. By combining these factors, providers can calculate an individual's 10-year ASCVD risk score and use it to guide targeted interventions that reduce cardiovascular risk.
Risk management involves using the assessment findings to create personalized care plans based on individual risk factors, medical history, and lifestyle. These plans are implemented through regular follow-ups, medication management, and lifestyle modification support. To encourage shared decision-making, healthcare providers work collaboratively with patients, utilizing tactics like the ABCs of cardiovascular risk reduction -- aspirin therapy, blood pressure control, cholesterol management, and smoking cessation. Patients also receive counseling on healthy dietary habits, physical activity, stress management, and adequate sleep. When combined, these strategies empower healthcare providers to help patients reduce their ASCVD risk and improve overall health outcomes.
Integrated Digital Health Tools Support Automated ASCVD Risk Calculation
Historically, primary care providers faced significant obstacles to implementing ASCVD risk scores, including manual calculations, fragmented Electronic Health Records (EHR) systems, and insufficient staff resources. Relying on lengthy processes and disparate tools meant assigning staff to tasks like identifying vulnerable patients, extracting relevant patient data from EHRs, and utilizing separate platforms to calculate scores. With clinicians already strained by demanding schedules and limited financial incentives, risk assessments were not a top priority, leading to missed opportunities for early interventions and optimal care quality. To bridge this gap and boost resource allocation, risk calculation tools should be integrated into clinical workflows with digital health solutions. These tools pull relevant data from EHRs into a single view and calculate ASCVD risk scores based on that data, allowing clinicians and care teams to prioritize high-need patients.
Meaningful reimbursement incentives will likely drive increased adoption of ASCVD risk assessments, prompting an adjustment period as providers look to incorporate new technologies into their practices to replace outdated processes and drive workflow efficiencies. By embedding ASCVD risk calculators within clinicians' day-to-day workflow, they can make informed decisions during appointments and optimize treatment plans.
Cardiovascular disease develops gradually, often over years, with well-established major risk factors. Timely interventions can significantly lower the chances of severe outcomes, like heart attacks and strokes. CMS' addition of ASCVD risk assessment and management G-codes is designed to motivate healthcare providers to prioritize cardiovascular disease prevention. Providers who integrate evidence-based tools and technology solutions into routine clinical workflows can enhance patient outcomes and support their own practices. This proactive strategy enables the timely identification and treatment of potential cardiovascular issues so concerns can be addressed before they escalate into life-threatening events.
About Lucienne Marie Ide, M.D., PH.D
Lucienne Marie Ide, M.D., PH.D., is the founder and Chief Executive Officer of Rimidi, a digital health company that supports healthcare providers in the delivery of remote patient monitoring and chronic disease management with EHR-integrated software, services, and connected devices. She brings her diverse experiences in medicine, science, venture capital, and technology to bear in leading Rimidi's strategy and vision. Motivated by the belief that we can do so much better as individuals, in industry and society, After completing her internship in Obstetrics and Gynecology at UPMC, Dr. Ide left clinical medicine to join the ranks of healthcare entrepreneurs who are trying to revolutionize an industry.