Expanded Coverage for Cardiac Rehabilitation Approved

April 28, 2006

hospital cardiologist plays critical role in advocating for new guidelines

The Centers for Medicare and Medicaid Services (CMS) recently announced expanded coverage for cardiac rehabilitation services to three additional groups of patients. Marjorie King, M.D., a board certified cardiologist who serves as Director of Cardiac Rehabilitation at Helen Hayes Hospital, as well as President of the American Association of Cardiovascular & Pulmonary Rehabilitation (AACVPR), strongly advocated for the new policy and played a pivotal role in affecting the change.

Coverage for outpatient cardiac rehabilitation will now be provided to Medicare beneficiaries who have had a heart valve repair or replacement; percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting; or heart or combined heart-lung transplant. Previously, Medicare only covered outpatient cardiac rehabilitation for patients with angina, heart attack or bypass surgery. In announcing the change, CMS stated that cardiac rehabilitation should be comprehensive and include medical evaluation, exercise, education and nutrition services. Patients will be covered for two to three sessions per week for 12 to 18 weeks, and potentially longer based on need.

“This is a tremendous advance for our cardiac patients,” states Dr. King. “ The CMS decision affirms what we have known for some time: that rehabilitation and appropriate treatment is fundamental to improving a cardiac patient’s quality of life. The previous guidelines had not been updated in over 20 years, so it was time for benefits to correspond to the advances we have made in medical care. Through evidence-based care, we know that outpatient cardiac rehab improves patient outcomes.”

In her role as President of AACVPR, Dr. King worked closely with a coalition of professionals to advocate for the change in cardiac rehabilitation benefits, developing Association position statements and traveling to Washington, DC to share information on the benefits of cardiac rehabilitation. “Ultimately, we need to ensure that cardiac patients have access to the care they need to get better,” explains Dr. King.

Along with its inpatient cardiac rehabilitation program, Helen Hayes Hospital provides comprehensive outpatient cardiac rehabilitation services at the physical rehabilitation hospital in West Haverstraw, as well as at it’s satellite site at Nyack Hospital. Rehabilitation programs are tailored to a patient’s needs and goals and include monitored exercise, education and risk factor modification focused on stress, diet, smoking and blood pressure and cholesterol control. Upon completion of the program, patients are reevaluated to measure their functional gains and to provide a prescription for ongoing exercise, which can be pursued in the HHH Wellness Center. Services are provided by a board certified cardiologist, exercise physiologist, nurses, physical therapists and registered dieticians.

In 2003 (the latest year for which full statistics are available), 910,000 individuals died due to cardiac disorders, with 83% of deaths occurring in individuals over 65 years of age. In 2006, it is estimated that heart disease will cost $403 billion health care dollars.