Medicare to Cover Rehab for Heart Failure

Without coverage, some with heart failure forgo rehab

man jogging

Medicare recently agreed to expand coverage for the cost of cardiac rehabilitation to more heart patients, including those with heart failure.

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Cardiac rehabilitation improves outcomes for heart patients, but getting that critical support has proved too costly for some patients with heart failure. Currently, Medicare doesn’t pay for their therapy. It only covers patients who have had a heart attack, bypass surgery or other major events in the past year.

History and appeals

In 2009, Centers for Medicare and Medicaid Services (CMS) decided to deny rehabilitation coverage for patients with heart failure (HF). The reason for the denial: that there was no health benefit associated with the therapy.

Taking issue with the decision, major health institutions, including the American College of Cardiology, the American Heart Association and the Heart Failure Society of America filed official appeals.

After considering those petitions and reviewing results from multiple studies that reaffirm that an organized cardiac rehabilitation program has a positive impact on health, CMS changed course.

What is cardiac rehab?

Cardiac rehabilitation is a general term for a program that takes place under medical supervision. It is designed to help patients with acute and chronic heart disease regain strength, manage symptoms, reduce risk and improve quality of life.

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It’s well known that exercise improves the quality of life and long-term outcomes for the vast majority of patients with cardiovascular disease.  And a multi-approach program that combines exercise, risk avoidance and education about healthy diet works particularly well.

Change welcomed, after wait

The delay in Medicare coverage has been frustrating for physicians on the front line of caring for patients with heart failure. 

Cardiologist Carlos Hubbard, MD, explains: “We have known for years that exercise is beneficial in improving cardiovascular outcomes in the majority of patients and the HF-ACTION trial published in 2009 confirmed that this benefit also applies to the heart failure population. Many heart failure patients are served by Medicare and, because of the cost associated with cardiac rehabilitation programs, this life-altering therapy was out of their reach.”

New proposal

CMS now proposes to offer cardiac rehab coverage to patients with heart failure. After a period for public comment, CMS will make a final decision.

Coverage for cardiac rehabilitation services will include at least six weeks of therapy, including:

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  • Programs about appropriate and beneficial exercise guided by physicians and other healthcare professionals
  • Information and counseling about lifestyle modification to reduce risk
  • Information about health and healthcare options
  • One-on-one counseling

The combined services add up to a holistic approach to patient care that looks at the entire picture rather than just individual symptoms.

Looking forward

Dr. Hubbard says the ruling is better late than never. “The CMS decision to cover cardiac rehabilitation is a welcome and overdue change in policy. Not only will this change improve the quality of life of many heart failure patients but it may also decrease hospitalization rates and risk of death associated with the disease.”

Dr. Hubbard says that benefits of expanded rehab coverage will spill over. “We as a society may benefit from decreased costs associated with costly hospital admissions for decompensated heart failure.”

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