By AMERICAN HEART ASSOCIATION NEWS

congress

Supporters of legislation that would allow physician assistants, clinical nurse specialists and nurse practitioners to directly supervise cardiac rehabilitation programs under Medicare took their message to 30 congressional offices on Tuesday.

Cardiac rehab is a medically supervised program that includes exercise training, education on heart-healthy living and counseling to reduce stress. A 2011 study found that heart attack survivors who participate in cardiac rehab are 30 percent less likely to die from a cardiac event, and a 2014 study found that 31 percent are less likely to be readmitted to the hospital.

But, while cardiac rehab could help the roughly 965,000 Americans who suffer a coronary event each year — as well as patients diagnosed with heart failure — research has found that only 20 percent of all eligible Medicare beneficiaries participated in cardiac rehab programs in the past year.

One reason cardiac rehab is underutilized is a requirement by Medicare that a doctor be within 250 yards of a program when cardiac rehab services are being furnished in order for that program receive reimbursement. This is in addition to the medical director, who designed and directs the program.

Most “supervising” physicians do not actively participate in these programs and are merely fulling an outdated and unnecessary requirement, several cardiac rehab supervisors noted at the fly-in kickoff dinner.

They noted that this requirement can saddle cardiac rehab programs with an unnecessary expense and make it difficult for them to expand, particularly into rural areas where there is a scarcity of physicians.

Additionally, some volunteers said they were familiar with programs that have closed or been forced to restrict their hours of operation based on physician availability. That makes it difficult for employed patients to attend before or after work.

“Physician assistants and nurse practitioners already perform supervisory roles in coronary care and intensive care units and in emergency rooms where their patients are much more critically ill than our patients. So why can’t these individuals supervise cardiac rehab?,” asked Dr. Basil Margolis, medical director of the Center for Preventive Cardiology at Saint Joseph’s Hospital in Atlanta and You’re the Cure advocate attending the fly-in. “It would … open these programs to many, many more patients.”

Legislation under consideration in both the U.S. House and Senate would allow that to occur.

On Tuesday, You’re the Cure advocates – both patients and program directors – told legislators about their experiences with cardiac rehab and how the service – or lack thereof– impacted their personal recovery process or their ability to expand their programs to close the treatment gap.

Linda Couch, an advocate from Georgia, said her lack of access to a convenient cardiac rehab program significantly hampered her recovery.

“I didn’t have access [to cardiac rehab] because I was at home, a single mother and I couldn’t drive. I didn’t have any way of getting to the hospital or going anywhere.”

Couch and her fellow advocates called on their members of Congress to cosponsor the legislation so others could more easily access the service.

Margolis said that if more patients were enrolled the programs that “would reduce the incidence of repeat cardiac events across the country, reduce rehospitalizations, and lower healthcare costs.”

Volunteers who met with senators asked for the bill to be included in a bipartisan legislative package currently being developed by the Senate Finance Committee. That package would improve health outcomes for Medicare beneficiaries with chronic illnesses.

In the House, advocates asked that it be included in any Medicare bill under consideration, including the hospital bill currently being developed by the Ways & Means Committee.