June 2, 2017

Supervised exercised therapy gets a big boost from Medicare

Daily Briefing

    CMS last week announced that Medicare would begin covering supervised exercise therapy for patients with peripheral artery disease (PAD), citing research showing that such treatment eases leg pain and other symptoms of cardiovascular disease.

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    According to STAT News, insurers have long refused to cover such treatment for PAD patients. However, the CMS announcement could mark a change, as private insurers often follow CMS' lead in coverage decisions, STAT News reports.

    Background

    According to Modern Healthcare, PAD affects between 12 and 20 percent of Americans age 60 and older. The disease occurs when a buildup of plaque narrows the arteries outside the heart, which in turn restricts blood flow to the legs and the amount of oxygen reaching the leg muscles. As a result, people with PAD can experience pain in their legs.

    In fact, according to Modern Healthcare, lack of exercise could cause the disease to progress to the point where patients do not have functional independence.

    While there are several ways to treat the disease—including inserting stents or using a blood vessel from elsewhere in the body to create a bypass around the blockage—the simplest, least-invasive approach is exercise, STAT News reports. According to STAT News, cardiologists believe that exercise helps the muscles adapt to the amount of blood they're getting, which in turn spurs the vascular system to produce more blood-carrying tendrils.

    Coverage details

    In its announcement, CMS said Medicare would cover a series of supervised exercise sessions for PAD patients, with each session lasting between 30 to 60 minutes.

    The sessions will be overseen by an exercise physiologist, a physical therapist, or a nurse, and they will be covered for a 12-week time period, with the possibility of extensions as needed. According to STAT News, the therapy could be used in addition to other approaches, or as a first-line response before moving on to more invasive options.

    According to medical experts, that supervision is key to the program. The medical professionals help the patient determine just how much time they should be exercising, and how difficult those exercises should be. "They do need to be able to push past the discomfort to get the most benefit. It's hard to do that on your own. … It can be not only uncomfortable, but also frightening to experience symptoms and try to push themselves past it," said Naomi Hamburg, a cardiology and vascular medicine physician at Boston Medical Center. "Being in a monitored setting helps with that."

    A long-standing request for coverage

    Medical professionals have long called on CMS to cover the treatment, STAT News reports, and the agency's decision follows an official request that the American Heart Association submitted in September 2016.

    According to STAT News, research on the benefits of supervised exercise is largely positive. One 2015 study found that PAD patients who undertook supervised exercise did not report a noticeable improvement in quality of life compared with those who engaged in unsupervised exercise—but a separate study published the same year found patients who got the therapy reported just as much improvement in their walking ability as patients who received a stent. And another study, published in 2014, found that supervised exercise therapy typically cost $5,000 less than a stenting procedure.

    Herbert Aronow—director of interventional cardiology at the Lifespan Cardiovascular Institute, who chairs the American College of Cardiology's peripheral vascular disease council—praised the announcement when CMS first proposed it. "Physicians and other providers and their professional societies have been able to align to present a uniform message ... that coverage for supervised exercise was not only necessary because it would improve outcomes, but would also improve cost," he said.

    Aronow added, "It has been one of the greatest ironies—and almost, absurdities—in the field of PAD, that you could have a stent paid for, or a bypass surgery, but something as non-invasive or low-risk as exercise would not be covered" (Dickson, Modern Healthcare, 5/30; Boodman, STAT News, 3/20).

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