Proposed CMS Rule Increases Pay for Cardiac Rehabilitation

A proposed payment rule from the Centers for Medicare and Medicaid Services would increase the number and duration of payments to hospitals for cardiac and pulmonary rehabilitation services.

The expanded cardiac benefit is “very exciting,” said Dr. Alfred Bove, president of the American College of Cardiology. “A lot of us have been advocating rehabilitation for a long time, and lots of patients say, 'I can't afford it.' This would be a tremendous program for a lot of people after a major heart event.”

Currently, Medicare patients who experience a heart attack or heart failure usually are covered for 8 weeks of cardiac rehabilitation with a maximum of three 1-hour sessions per week, Dr. Bove said. Under the proposed benefit, patients could receive up to 72 sessions—up to 6 sessions per day—of intensive cardiac rehabilitation over an 18-week period.

Being able to spread the sessions out would be quite valuable, Dr. Bove said. “So much of recovering is giving people confidence in what they can handle … Improvement of depression and other symptoms [also] is better if you can get them into a rehab program.”

Medicare's approval of the expanded sessions also would put pressure on private insurers to create the same kind of benefit, he noted.

Other outpatient payment changes proposed in the rule include:

▸ Physician supervision requirements. Nonphysician providers may directly supervise all hospital outpatient therapeutic services that they are personally able to perform within their state scope of practice and hospital-granted privileges. Current Medicare policy allows only for physicians to provide direct supervision of these services.

▸ Kidney disease education. Establish payment to rural providers under the Medicare Physician Fee Schedule for kidney disease education services furnished on or after Jan. 1, 2010, for beneficiaries diagnosed with stage IV chronic kidney disease.

▸ Validation of quality reporting. To ensure that hospitals are accurately reporting measures using chart-abstracted data, the CMS would take samples of actual patient records and compare the hospital reports with the requirements of the Hospital Outpatient Department Quality Reporting Program. Although the CMS will begin validating hospital-submitted data for purposes of the 2011 payment update, the validation results will not affect a hospital's outpatient payments until 2012, according to the proposal.

The CMS also plans to implement the third of four phases of its revised payment system for ambulatory surgery centers (ASCs). The revised payment rate for any given service is a percentage of the rate for the same service under the Outpatient Prospective Payment System. However, for new ASC services usually performed in physicians' offices, the ASC payment is capped at the amount the physician is paid under the Medicare fee schedule for practice expenses in the office.

The CMS will accept comments on the proposed rule until Aug. 31; the final rule will be issued by Nov. 1.

Information on the outpatient payment proposals is available online at www.cms.hhs.gov/HospitalOutpatientPPS

A proposed payment rule from the Centers for Medicare and Medicaid Services would increase the number and duration of payments to hospitals for cardiac and pulmonary rehabilitation services.

The expanded cardiac benefit is “very exciting,” said Dr. Alfred Bove, president of the American College of Cardiology. “A lot of us have been advocating rehabilitation for a long time, and lots of patients say, 'I can't afford it.' This would be a tremendous program for a lot of people after a major heart event.”

Currently, Medicare patients who experience a heart attack or heart failure usually are covered for 8 weeks of cardiac rehabilitation with a maximum of three 1-hour sessions per week, Dr. Bove said. Under the proposed benefit, patients could receive up to 72 sessions—up to 6 sessions per day—of intensive cardiac rehabilitation over an 18-week period.

Being able to spread the sessions out would be quite valuable, Dr. Bove said. “So much of recovering is giving people confidence in what they can handle … Improvement of depression and other symptoms [also] is better if you can get them into a rehab program.”

Medicare's approval of the expanded sessions also would put pressure on private insurers to create the same kind of benefit, he noted.

Other outpatient payment changes proposed in the rule include:

▸ Physician supervision requirements. Nonphysician providers may directly supervise all hospital outpatient therapeutic services that they are personally able to perform within their state scope of practice and hospital-granted privileges. Current Medicare policy allows only for physicians to provide direct supervision of these services.

▸ Kidney disease education. Establish payment to rural providers under the Medicare Physician Fee Schedule for kidney disease education services furnished on or after Jan. 1, 2010, for beneficiaries diagnosed with stage IV chronic kidney disease.

▸ Validation of quality reporting. To ensure that hospitals are accurately reporting measures using chart-abstracted data, the CMS would take samples of actual patient records and compare the hospital reports with the requirements of the Hospital Outpatient Department Quality Reporting Program. Although the CMS will begin validating hospital-submitted data for purposes of the 2011 payment update, the validation results will not affect a hospital's outpatient payments until 2012, according to the proposal.

The CMS also plans to implement the third of four phases of its revised payment system for ambulatory surgery centers (ASCs). The revised payment rate for any given service is a percentage of the rate for the same service under the Outpatient Prospective Payment System. However, for new ASC services usually performed in physicians' offices, the ASC payment is capped at the amount the physician is paid under the Medicare fee schedule for practice expenses in the office.

The CMS will accept comments on the proposed rule until Aug. 31; the final rule will be issued by Nov. 1.

Information on the outpatient payment proposals is available online at www.cms.hhs.gov/HospitalOutpatientPPS

A proposed payment rule from the Centers for Medicare and Medicaid Services would increase the number and duration of payments to hospitals for cardiac and pulmonary rehabilitation services.

The expanded cardiac benefit is “very exciting,” said Dr. Alfred Bove, president of the American College of Cardiology. “A lot of us have been advocating rehabilitation for a long time, and lots of patients say, 'I can't afford it.' This would be a tremendous program for a lot of people after a major heart event.”

Currently, Medicare patients who experience a heart attack or heart failure usually are covered for 8 weeks of cardiac rehabilitation with a maximum of three 1-hour sessions per week, Dr. Bove said. Under the proposed benefit, patients could receive up to 72 sessions—up to 6 sessions per day—of intensive cardiac rehabilitation over an 18-week period.

Being able to spread the sessions out would be quite valuable, Dr. Bove said. “So much of recovering is giving people confidence in what they can handle … Improvement of depression and other symptoms [also] is better if you can get them into a rehab program.”

Medicare's approval of the expanded sessions also would put pressure on private insurers to create the same kind of benefit, he noted.

Other outpatient payment changes proposed in the rule include:

▸ Physician supervision requirements. Nonphysician providers may directly supervise all hospital outpatient therapeutic services that they are personally able to perform within their state scope of practice and hospital-granted privileges. Current Medicare policy allows only for physicians to provide direct supervision of these services.

▸ Kidney disease education. Establish payment to rural providers under the Medicare Physician Fee Schedule for kidney disease education services furnished on or after Jan. 1, 2010, for beneficiaries diagnosed with stage IV chronic kidney disease.

▸ Validation of quality reporting. To ensure that hospitals are accurately reporting measures using chart-abstracted data, the CMS would take samples of actual patient records and compare the hospital reports with the requirements of the Hospital Outpatient Department Quality Reporting Program. Although the CMS will begin validating hospital-submitted data for purposes of the 2011 payment update, the validation results will not affect a hospital's outpatient payments until 2012, according to the proposal.

The CMS also plans to implement the third of four phases of its revised payment system for ambulatory surgery centers (ASCs). The revised payment rate for any given service is a percentage of the rate for the same service under the Outpatient Prospective Payment System. However, for new ASC services usually performed in physicians' offices, the ASC payment is capped at the amount the physician is paid under the Medicare fee schedule for practice expenses in the office.

The CMS will accept comments on the proposed rule until Aug. 31; the final rule will be issued by Nov. 1.

Information on the outpatient payment proposals is available online at www.cms.hhs.gov/HospitalOutpatientPPS