September 9, 2016

Why so few patients participate in cardiac rehab programs

Daily Briefing

    Despite evidence that cardiac rehabilitation programs improve health and lower costs, less than one-third of eligible patients participate, Julie Appleby writes for Kaiser Health News.

    Barriers to access

    Appleby says that several factors contribute to underutilization of the programs.

    Program costs can pose a major barrier to participation. Uninsured patients "simply can't afford" the costs of cardiac rehab, Appleby writes.

    Insured patients are more fortunate: Medicare and most private insurers typically cover cardiac rehab for patients who have had a heart attack, coronary bypass surgery, stents, heart failure, or one of several other conditions. They usually cover two or three hour-long visits per week, up to 36 sessions, according to KHN.

    Even so, per-visit copayments are the "No. 1 barrier" for those with insurance, according to Ellen Keeley, a cardiologist at the University of Virginia Medical Center (UVAMC). Copays generally are about $20 for Medicare beneficiaries and range from zero to $60 for individuals with employer-sponsored or Medicare Advantage coverage.

    Patients may also not participate because they don't have a referral, or because of time constraints or travel distance.

    In addition, patients may simply be reluctant to give the programs a try, particularly if they haven't previously been very physically active.

    How hospitals are responding

    To address these issues, some hospitals have started integrating automatic referrals into their discharge systems. Gary Balady, director of preventive cardiology at Boston Medical Center, said physicians are also stressing the importance of rehab to encourage reluctant patients to participate.

    Hospitals are also offering home-based rehab programs to make the treatment more convenient for patients.

    Mark Vitcenda, a senior clinical exercise physiologist at the University of Wisconsin Hospital and Clinics, said, "There are a whole plethora of different ways to provide cardiac rehab outside (of the) traditional center model." Under Vitcenda's program, patients start in a supervised setting for a few sessions before being offered the option to continue at home.

    "If we can lower the barriers of transportation and cost, patients are able to be more involved," he said.

    Advocates also say the Affordable Care Act could help boost participation because it incentivizes hospitals to reduce readmissions of patients who have suffered cardiac events.

    Further, CMS recently proposed a Cardiac Rehabilitation Incentive Payment Model, which would test the effect of an incentive payment for outpatient cardiac rehab to hospitals where beneficiaries are hospitalized for acute myocardial infarction or coronary artery bypass grafting in the 90-day care period following hospital discharge  (Appleby, Kaiser Health News, 8/31).

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