Cardiac rehab isn’t a new phenomenon. However, in recent years, CMS has expanded opportunities for this traditional program by approving reimbursement for three intensive cardiac rehab models.
Many factors set ICR apart from traditional cardiac rehab, including a focus on plant-based meatless diet and stress-reduction through daily meditation. ICR not only presents a compelling argument for integrative care within the traditional cardiac rehab program, but also suggests opportunities for strategic service line development. Medicare-reimbursed yoga, anyone?
In 2014, the indications for traditional cardiac rehab were expanded to include heart failure patients, who until then were largely excluded from rehab programs.Today, with more patients eligible for cardiac rehab than ever before and more programs choosing ICR over traditional cardiac rehab, there’s a renewed focus on this time-honored program.
If you’ve ever wondered what makes ICR different, and what it can mean for your CV service line, you’re not alone. Since several of our Cardiovascular Roundtable members have approached us with questions about ICR, we decided to take a closer look at its current status and potential.
What makes this cardiac rehab program ‘intensive’?
ICR programs differ from traditional cardiac rehab by providing more frequent and rigorous services. For CMS to grant approval, an ICR program must also illustrate within peer-reviewed, published research that it positively affects the progression of coronary heart disease, reduces the need for CABG, or reduces the need for PCI. The research must also demonstrate that the program achieved a significant reduction in one or more of the following six measures:
- Low density lipoprotein
- Body mass index
- Systolic blood pressure
- Diastolic blood pressure
- The need for cholesterol, blood pressure, and diabetes medications
How is ICR approved and reimbursed?
For Medicare reimbursement, ICR programs must be approved through the national coverage determination process. Three programs are currently approved.
A Becker Hospital Review article outlines the differences, summarized in a table below, between CR and ICR. One major difference between the two is that, while traditional CR is reimbursed higher when in a hospital setting than in a physician office setting, ICR is reimbursed at the higher hospital rate wherever it is located. Additionally, ICR programs are eligible for 72 hours of billable treatment, whereas traditional ICR is only eligible for 36 hours of billable treatment.
What activities are included in ICR?
As we mentioned earlier, there are currently only three ICR programs serving patients in the US. For a glimpse at one such program, the Pritikin ICR program includes the following types of education for its patients:
- Cook heart-healthy meals that are delicious and affordable
- Become smart grocery shoppers
- Order intelligently in restaurants
- Lose weight utilizing evidence-based skills
- Quit smoking
- Manage stress
- Improve personal and professional relationships
- Transform negative attitudes into positive ones
Ornish, another CMS-approved ICR program, describes its ICR program in this video.
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