This is great news. I worked for many years petitioning our Congress and Senate to urge CMS to cover Cardiac Rehabilitation services for Congestive Heart Failure patients. There is a large subset of patients who can be much better served and monitored through cardiac rehabilitation to prevent readmissions. Congratulations to the AACVPR for helping attain this coverage from CMS, that is a very big deal.
WASHINGTON — Medicare has proposed covering cardiac rehabilitation services for patients with chronic heart failure 4 years after saying there was little evidence to support doing so.
The proposed coverage decision would expand access to rehab for a wider range of heart patients. Medicare currently covers rehab only for patients who have had an acute MI in the preceding year, coronary artery bypass surgery, heart or heart-lung transplant, or other major events.
The Centers for Medicare and Medicaid Services (CMS) came to the determination after reviewing literature on the rehab service from 2006 to August 2013. It announced the decision online late last week.
“Since chronic heart failure often results from coronary artery disease and hypertension, evidence on behavioral interventions in the treatment of these conditions provide additional supportive evidence,” the agency wrote. “With the accumulated evidence that supports the benefits of the individual components of cardiac rehabilitation programs, the evidence is sufficient to determine that participation in these multi-component programs improves health outcomes for Medicare beneficiaries with chronic heart failure.”
The agency is seeking public comments on the proposed decision and will post a final determination later.
Under the proposal, the agency would pay for rehab services — exercise, behavioral risk factor reduction, health education, and personal counseling — for patients with left ventricular ejection fraction of 35% or less and New York Heart Association class II to IV symptoms with at least 6 weeks of heart failure therapy.
The American Heart Association praised the CMS announcement.
“We are gratified that the agency recognized the evidence that pointed to the need for this expansion, and look forward to the day when this coverage will enable millions of heart failure patients to reap the benefits of cardiac rehabilitation,” AHA President Mariell Jessup, MD, said in a statement.
The AHA, along with the American College of Cardiology, the American Association of Cardiovascular and Pulmonary Rehabilitation, and the Heart Failure Society of America had asked CMS to consider adding CHF for coverage of cardiac rehab.
The CMS decision follows a study of nearly 2,300 patients that showed that aerobic exercise is safe for heart failure patients and effectively improves clinical outcomes. The patient population CMS is including is effectively the same as that in the trial, Ileana Pina, MD, professor at Albert Einstein College of Medicine in the Bronx, N.Y., told MedPage Today in a phone interview.
“Even though we knew all the good things exercise can do, a lot of physicians were not recommending it because the patients would have to pay out of pocket to go to a cardiac rehab program,” Pina, vice chair of the clinical cardiology council at the AHA, said.
She said many patients without this rehab option end up going to skilled nursing facilities because of their condition.
Roughly 17% of those age 65 and older have heart failure, according to CMS.