In this exclusive MedPage Today video, , of the Mayo Clinic, discusses the importance of cardiac rehab and how the cardiac rehab payment model needs to change.
Following is a transcript of his remarks:
I think everyone knows that cardiac rehab works. It improves outcomes. It makes patients understand the importance of their medications. It is far more cost effective than PCSK9 inhibitors, but it's underutilized. The available data suggests that fewer than 1 in 3 patients who are eligible for cardiac rehab actually participate. That's the subject of considerable concern, and the Million Hearts Initiative announced a program last year [in 2017] to try to increase the uptake of cardiac rehab in the United States.
In 2016, Medicare announced that they were going to create an incentive program for hospitals to try to increase the use of cardiac rehab. That was delayed several times, and then in August [of that year] it was cancelled. Instead, CMS has rolled out a new bundled payment initiative that includes myocardial infarction, coronary artery bypass surgery, and PCI as inpatient episodes and PCI as an outpatient episode. All of these scenarios should ideally include cardiac rehab as part of the treatment of the patient. The quality measures that are included in this latest bundled payment initiative do not include cardiac rehab. They end 30 days after discharge with a readmissions measure. They don't measure any effect of cardiac rehab, but they measure costs out to 90 days and cardiac rehab is clearly a cost within that 90 days.
Hospitals will be reimbursed based on their ability to meet the quality metrics, which don't include rehab, and to reduce costs. Rehab will contribute to costs. It seems pretty clear that savvy hospital administrators who are concerned about increasing their reimbursement will cancel cardiac rehab programs that are already marginal from the standpoint of their reimbursement. I think the impact is for people to realize that they have to start alerting their hospital administrator now to the importance of cardiac rehab for their patients and to continue to encourage their patients to use cardiac rehab because of its many benefits. I think they need to help emphasize to their patients and their elected officials that cardiac rehab is beneficial.