Association Between Increased Hospital Reimbursement for Cardiac Rehabilitation and Utilization of Cardiac Rehabilitation by Medicare Beneficiaries

2021 ◽  
Vol 14 (3) ◽  
Author(s):  
Dana R. Fletcher ◽  
Gary K. Grunwald ◽  
Catherine Battaglia ◽  
P. Michael Ho ◽  
Richard C. Lindrooth ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Time Window ◽  
Artery Bypass ◽  
Cost Effective ◽  
Coronary Intervention ◽  
Guideline Recommendation ◽  
Annual Growth Rate ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Percentage Points

Background: Although cardiac rehabilitation (CR) is a Class I Guideline recommendation, and has been shown to be a cost-effective intervention after a cardiac event, it has been reimbursed at levels insufficient to cover hospital operating costs. In January 2011, Medicare increased payment for CR in hospital outpatient settings by ≈180%. We evaluated the association between this payment increase and participation in CR of eligible Medicare beneficiaries to better understand the relationship between reimbursement policy and CR utilization. Methods: From a 5% Medicare claims sample, we identified patients with acute myocardial infarction, coronary artery bypass surgery, percutaneous coronary intervention, or cardiac valve surgery between January 1, 2009 and September 30, 2012, alive 30 days after their event, with continuous enrollment in Medicare fee-for-service, Part A/B for 4 months. Trends and changes in CR participation were estimated using an interrupted time series approach with a hierarchical logistic model, hospital random intercepts, adjusted for patient, hospital, market, and seasonality factors. Estimates were expressed using average marginal effects on a percent scale. Results: Among 76 695 eligible patients, average annual CR participation was 19.5% overall. In the period before payment increase, adjusted annual participation grew by 1.1 percentage points (95% CI, 0.48–2.4). No immediate change occurred in CR participation when the new payment was implemented. In the period after payment increase, on average, 20% of patients participated in CR annually. The annual growth rate in CR participation slowed in the post-period by 1.3 percentage points (95% CI, −2.4 to −0.12) compared with the prior period. Results were somewhat sensitive to time window variations. Conclusions: The 2011 increase in Medicare reimbursement for CR was not associated with an increase in participation. Future studies should evaluate whether payment did not reach a threshold to incentivize hospitals or if hospitals were not sensitive to reimbursement changes.

Abstract 134: Implementation of Home-Based Cardiac Rehabilitation in the VA

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
David W Schopfer ◽  
Nirupama Krishnamurthi ◽  
Hui Shen ◽  
Mary A Whooley
Keyword(s):  
Cardiac Rehabilitation ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
The United States ◽  
Medical Centers ◽  
The United Kingdom ◽  
Home Based ◽  
Percutaneous Coronary ◽  
The Us ◽  
Va Hospitals

Objective: Referral to cardiac rehabilitation (CR) is one of nine performance measures for patients with ischemic heart disease (IHD), but fewer than 20% of eligible patients participate in the United States. Home-based CR programs (available in the United Kingdom, Australia, and Canada) have similar effects on morbidity and mortality as traditional (facility-based) CR, but they are not currently available or reimbursed in the US. We sought to determine whether implementing home-based programs could increase CR participation among patients with IHD. Methods: Using electronic health records from 134 VA medical centers, we identified 106,277 veterans hospitalized for acute myocardial infarction, percutaneous coronary intervention or coronary artery bypass grafting between 2010 and 2015. We compared the proportion of eligible patients who participated in CR at 13 VA hospitals that offered referral to either home-based CR or facility-based CR vs. 121 VA hospitals that offered referral to only facility-based CR (usual care). Results: The number of VA medical centers offering home-based CR increased from 2 in 2010 to 13 in 2015. Among the 20,949 eligible patients hospitalized at VA medical centers that implemented home-based CR between 2010 and 2015, CR participation increased from 11% to 26% (Figure). Among the 85,328 eligible patients hospitalized at VA medical centers that did not offer home-based CR, CR participation increased from only 8% to 11%. Conclusion: Among eligible patients with IHD, participation in CR more than doubled at VA medical centers that implemented home-based CR programs between 2010 and 2015, whereas participation increased by only 3% at VA medical centers that did not implement home-based CR programs. Home-based CR is an effective way of engaging patients who may otherwise decline to participate in CR.

scholarly journals Tracking Cardiac Rehabilitation Participation and Completion Among Medicare Beneficiaries to Inform the Efforts of a National Initiative

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Matthew D. Ritchey ◽  
Sha Maresh ◽  
Jessica McNeely ◽  
Thomas Shaffer ◽  
Sandra L. Jackson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Rehabilitation ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Prevalence Ratio ◽  
Medicare Beneficiaries ◽  
Event Type ◽  
Timely Initiation ◽  
South Central

Background: Despite cardiac rehabilitation (CR) being shown to improve health outcomes among patients with heart disease, its use has been suboptimal. In response, the Million Hearts Cardiac Rehabilitation Collaborative developed a road map to improve CR use, including increasing participation rates to ≥70% by 2022. This observational study provides current estimates to measure progress and identifies the populations and regions most at risk for CR service underutilization. Methods and Results: We identified Medicare fee-for-service beneficiaries who were CR eligible in 2016, and assessed CR participation (≥1 CR session attended), timely initiation (participation within 21 days of event), and completion (≥36 sessions attended) through 2017. Measures were assessed overall, by beneficiary characteristics and geography, and by primary CR-qualifying event type (acute myocardial infarction hospitalization; coronary artery bypass surgery; heart valve repair/replacement; percutaneous coronary intervention; or heart/heart-lung transplant). Among 366 103 CR-eligible beneficiaries, 89 327 (24.4%) participated in CR, of whom 24.3% initiated within 21 days and 26.9% completed CR. Eligibility was highest in the East South Central Census Division (14.8 per 1000). Participation decreased with increasing age, was lower among women (18.9%) compared with men (28.6%; adjusted prevalence ratio: 0.91 [95% CI, 0.90–0.93]) was lower among Hispanics (13.2%) and non-Hispanic blacks (13.6%) compared with non-Hispanic whites (25.8%; adjusted prevalence ratio: 0.63 [0.61–0.66] and 0.70 [0.67–0.72], respectively), and varied by hospital referral region and Census Division (range: 18.6% [East South Central] to 39.1% [West North Central]) and by qualifying event type (range: 7.1% [acute myocardial infarction without procedure] to 55.3% [coronary artery bypass surgery only]). Timely initiation varied by geography and qualifying event type; completion varied by geography. Conclusions: Only 1 in 4 CR-eligible Medicare beneficiaries participated in CR and marked disparities were observed. Reinforcement of current effective strategies and development of new strategies will be critical to address the noted disparities and achieve the 70% participation goal.

scholarly journals Face-to-Face Nursing Promotion of Cardiac Rehabilitation

2021 ◽  
Author(s):  
◽  
Maria Whitaker
Keyword(s):  
Cardiac Rehabilitation ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Cost Effective ◽  
Healthcare Team ◽  
Enrollment Rate ◽  
Face To Face ◽  
Effective Strategies ◽  
Practice Problem ◽  
Clinically Significant

Practice Problem: The burden of cardiovascular disease is rising at global and national levels, and cardiac rehabilitation is recognized as one of the most beneficial and cost-effective strategies to manage it. One significant problem globally, nationally, and locally is the low numbers of eligible patients who enroll in cardiac rehabilitation. PICOT: In patients with isolated coronary artery bypass graft (CABG) (P), how does face-to-face nursing promotion of cardiac rehabilitation (I) compared to the patients who do not have face-to-face nursing promotion (C), affect the percentage of patients enrolling in cardiac rehabilitation after discharge (O) within 8 weeks (T)? Evidence: The evidence used to guide this project included the need for a healthcare organization to have a systematic process for cardiac rehabilitation enrollment, face-to-face nursing promotion, improvement of the healthcare team’s knowledge about cardiac rehabilitation, and identification of patient barriers that hinder cardiac rehabilitation enrollment. Intervention: A systematic approach for cardiac rehabilitation was developed using the interprofessional team. After the healthcare team received standardized education, nurses in various roles provided face-to-face promotion, the ARNPs endorsed cardiac rehabilitation, and the care managers addressed barriers. Outcome: The cardiac rehabilitation enrollment rate increased by 16% among all patients admitted with an isolated CABG on the pilot unit. Conclusion: Implementation of face-to-face nursing promotion, ARNP endorsement, and reducing barriers were clinically significant in increasing the cardiac rehabilitation enrollment rate.

Return to work: does cardiac rehabilitation make a difference? Danish nationwide register-based study

2021 ◽  
pp. 140349482110626
Author(s):  
Sasja Maria Pedersen ◽  
Marie Kruse ◽  
Ann Dorthe O. Zwisler ◽  
Charlotte Helmark ◽  
Susanne S. Pedersen ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Artery Bypass ◽  
Emergency Admission ◽  
Coronary Intervention ◽  
Lower Probability ◽  
Main Diagnosis ◽  
Exact Matching ◽  
Logistic Regression Models ◽  
Icd 10 ◽  
Returning To Work

Aim: to assess whether participation in cardiac rehabilitation affects the probability of returning to work after ischaemic heart disease. Methods: the study population consisted of 24,509 patients (18–70 years of age) discharged from an inpatient admission at a Danish hospital during 2014–2018 and who were working before their admission. Only patients with a percutaneous coronary intervention or coronary artery bypass grafting surgery procedure and ICD-10 codes I20–I25 as their main diagnosis or ICD-10 codes I21, I240, I248 or I249 as secondary diagnosis during an emergency admission were included. Exposure was defined as participation in cardiac rehabilitation ( N = 15,742), and binary indicator of being at work in the last week of a given month were used as primary outcomes. Coarsened exact matching (CEM) of exposed and unexposed patients was used to reduce selection bias. Logistic regression models were applied on the matched population ( N = 15,762). Results: Less deprived and less comorbid patients were more likely to receive cardiac rehabilitation. CEM succeeded in arriving at a population where this selection was reduced and in this population we found that patients who received cardiac rehabilitation had a lower probability of returning to work after 3 months (OR 0.81, 95%CI: 0.77–0.84), a higher but insignificant probability after 6 (OR 1.02, 95%CI: 0.97–1.08), and a higher probability after 9 (OR 1.08, 95%CI: 1.02–1.15) and 12 months (OR 1.20, 95%CI: 1.13–1.28). Conclusions: Deprived and comorbid patients have lower use of cardiac rehabilitation. In a matched population where this bias is reduced, cardiac rehabilitation will increase the probability of returning to work.

Abstract P323: Cardiac Rehabilitation is Associated With Decreased Mortality in HIV Patients With Cardiovascular Disease

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Justin M Bachmann ◽  
Suman Kundu ◽  
Kaku So-Armah ◽  
Amy Justice ◽  
Jason Sico ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cardiac Rehabilitation ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Hiv Status ◽  
Hiv Patients ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Cox Proportional Hazard Models ◽  
One Year

Background: Human immunodeficiency virus (HIV+) patients are at high risk for cardiovascular disease (CVD). While cardiac rehabilitation (CR) reduces mortality in uninfected (HIV-) patients with CVD, there are no specific data on CR use in CVD patients with HIV. Methods: We analyzed data on 7650 veterans (28.4% HIV+) eligible for CR from the Veterans Aging Cohort Study, an observational cohort of HIV+ and HIV- veterans. CR eligibility was defined as a hospitalization for acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, or cardiac valve surgery from 2003-2012, identified using ICD9 and CPT codes. CR use was ascertained from VA and non-VA facilities within one year of discharge from the index CVD hospitalization using CPT codes. We evaluated the association between CR and mortality after adjusting for age, eligibility diagnosis, race, sex, and comorbidities using Cox proportional hazard models. Results: CR use was low in HIV+ and HIV- veterans (9.1% vs. 9.6%, respectively, p=0.06). Among the 7650 CR eligible veterans, there were 2211 deaths over 25,715 person-years of follow-up. Mortality rates were higher among those who did not receive CR, regardless of HIV status (Figure). In adjusted models stratified by HIV status, CR was associated with a significant reduction in mortality for HIV+ (hazard ratio [HR] 0.39, 95% confidence interval [CI] 0.26-0.59) and HIV- veterans (HR 0.52, 95% CI 0.42-0.65). Among those receiving CR, HIV was not associated with an increased risk of mortality (Figure) even after adjusting for confounders (HR 1.01, 95% CI 0.63-1.61). Conclusions: CR utilization in both HIV+ and HIV- veterans is low. Participation in CR programs is associated with a significant reduction in mortality, regardless of HIV status. When CR is utilized, however, the risk of mortality is the same for HIV+ and HIV- veterans. CR may be particularly important for reducing mortality in HIV+ patients with CVD.

scholarly journals Differences in High‐ and Low‐Value Cardiovascular Testing by Health Insurance Provider

2021 ◽  
Vol 10 (3) ◽  
Author(s):  
Vinay Kini ◽  
Bridget Mosley ◽  
Sridharan Raghavan ◽  
Prateeti Khazanie ◽  
Steven M. Bradley ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Fee For Service ◽  
Medicare Advantage ◽  
Commercial Insurance ◽  
Cardiovascular Testing ◽  
To Receive

Background Quality of care incentives and reimbursements for cardiovascular testing differ between insurance providers. We hypothesized that there are differences in the use of guideline‐concordant testing between Medicaid versus commercial insurance patients <65 years, and between Medicare Advantage versus Medicare fee‐for‐service patients ≥65 years. Methods and Results Using data from the Colorado All‐Payer Claims Database from 2015 to 2018, we identified patients eligible to receive a high‐value test recommended by guidelines: assessment of left ventricular function among patients hospitalized with acute myocardial infarction or incident heart failure, or a low‐value test that provides minimal patient benefit: stress testing prior to low‐risk surgery or routine stress testing within 2 years of percutaneous coronary intervention or coronary artery bypass graft surgery. Among 145 616 eligible patients, 37% had fee‐for‐service Medicare, 18% Medicare Advantage, 22% Medicaid, and 23% commercial insurance. Using multilevel logistic regression models adjusted for patient characteristics, Medicaid patients were less likely to receive high‐value testing for acute myocardial infarction (odds ratio [OR], 0.84 [0.73–0.98]; P =0.03) and heart failure (OR, 0.59 [0.51–0.70]; P <0.01) compared with commercially insured patients. Medicare Advantage patients were more likely to receive high‐value testing for acute myocardial infarction (OR, 1.35 [1.15–1.59]; P <0.01) and less likely to receive low‐value testing after percutaneous coronary intervention/ coronary artery bypass graft (OR, 0.63 [0.55–0.72]; P <0.01) compared with Medicare fee‐for‐service patients. Conclusions Guideline‐concordant testing was less likely to occur among patients with Medicaid compared with commercial insurance, and more likely to occur among patients with Medicare Advantage compared with fee‐for‐service Medicare. Insurance plan features may provide valuable targets to improve guideline‐concordant testing.

scholarly journals A nationwide survey on participation in cardiac rehabilitation among patients with coronary heart disease using health claims data in Japan

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shosuke Ohtera ◽  
Genta Kato ◽  
Hiroaki Ueshima ◽  
Yukiko Mori ◽  
Yuka Nakatani ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiac Rehabilitation ◽  
Artery Bypass ◽  
Nationwide Survey ◽  
Coronary Intervention ◽  
Health Claims ◽  
National Database ◽  
Nutritional Education ◽  
Health Claims Data

AbstractPoor implementation and variable quality of cardiac rehabilitation (CR) for coronary heart disease (CHD) have been a global concern. This nationwide study aimed to clarify the implementation of and participation in CR among CHD patients and associated factors in Japan. We conducted a retrospective cohort study using data extracted from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patients who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in 2017–2018 were included. Aspects of CR were assessed in terms of (1) participation in exercise-based CR, (2) pharmacological education, and (3) nutritional education. Of 87,829 eligible patients, 32% had participated in exercise-based CR, with a mean program length of 40 ± 71 days. CABG was associated with higher CR participation compared to PCI (OR 10.2, 95% CI 9.6–10.8). Patients living in the Kyushu region were more likely to participate in CR (OR 2.59, 95% CI 2.39–2.81). Among patients who participated in CR, 92% received pharmacological education, whereas only 67% received nutritional education. In Japan, the implementation of CR for CHD is insufficient and involved varying personal, therapeutic, and geographical factors. CR implementation needs to be promoted in the future.

Abstract 310: Neighborhood Socioeconomic Context Predicts Cardiac Rehabilitation Participation Above and Beyond Individual Socioeconomic Status

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Justin M Bachmann ◽  
Loren Lipworth ◽  
Thomas J Wang ◽  
Michael T Mumma ◽  
Mary A Whooley ◽  
...  
Keyword(s):  
United States ◽  
Socioeconomic Status ◽  
Cohort Study ◽  
Cardiac Rehabilitation ◽  
Cox Regression ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
The United States ◽  
Socioeconomic Context ◽  
Percutaneous Coronary

Background: Cardiac rehabilitation (CR) is underutilized in the United States, with less than 20% of eligible patients participating in CR programs. Individual socioeconomic status is associated with CR utilization, but the effect of neighborhood socioeconomic context on CR use has not been described. We investigated the association of CR participation with neighborhood socioeconomic context in the Southern Community Cohort Study (SCCS). Methods: The SCCS is a prospective cohort study of 84,569 largely poor adults in the southeastern United States, of which 52,117 participants have Medicare or Medicaid claims. Using these claims data, we identified SCCS participants with hospitalizations for myocardial infarction, percutaneous coronary intervention, coronary artery bypass surgery or cardiac valve surgery and ascertained their CR utilization. Neighborhood socioeconomic context was assessed using a previously validated neighborhood deprivation index. This index was derived using 11 census-tract level variables including median household value and percentage of households with public assistance income. We used multivariable-adjusted logistic and Cox regression to evaluate the association of CR participation with neighborhood socioeconomic context and mortality. Results: A total of 4456 SCCS participants (56% female, 59% Black) were eligible for CR at a mean age of 60.5 + 9.1 years and an average of 4.0 + 2.5 years after study enrollment. CR utilization was low as expected, with 308 subjects (6.9%) participating in CR programs. CR participation is inversely associated with all-cause mortality (hazard ratio [HR] 0.52, 95% confidence interval [CI] 0.39-0.70, p=<0.0001) and cardiovascular disease (CVD) mortality (HR 0.38, 95% CI 0.22-0.65, p=<0.001) after multivariable adjustment. Neighborhood socioeconomic context is strongly associated with CR participation after adjustment for individual socioeconomic status (educational level and household income) as well as rural status (Table). Conclusions: Neighborhood socioeconomic context predicts CR participation in addition to individual socioeconomic status. These data invite research on interventions to increase CR access in deprived communities.

Abstract 19209: Utilization of Inpatient Cardiac Rehabilitation During a Hospitalization for a Cardiac Condition: A National Sample

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Quinn R Pack ◽  
Aruna Priya ◽  
Tara Lagu ◽  
Penny Pekow ◽  
Robert Berry ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Rural Areas ◽  
Urban Areas ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
National Sample ◽  
Utilization Rate ◽  
Or Practice ◽  
Cardiac Condition ◽  
Current Utilization

Introduction: Inpatient cardiac rehabilitation (ICR) programs provide important services to patients, including daily ambulation, risk factor education, and coordinated referral to outpatient cardiac rehabilitation. However, little is known about national current utilization or practice patterns. Methods: Utilizing a geographically and structurally diverse sample of US hospitals (PREMIER data warehouse, Inc.) we examined the use of ICR using detailed administrative data from January 2007 to June 2011. Patients with an ICD-9 principal diagnosis of myocardial infarction (MI) or heart failure (HF), or with a procedure code for coronary artery bypass surgery (CABG), valve (V) surgery, or percutaneous coronary intervention (PCI) were included. Any patient with ≥ 1 service code for ICR was considered to have received ICR. Results: We evaluated 1,343,537 qualifying admissions from 458 hospitals. The overall ICR utilization rate was 20.8%. ICR utilization was highest in patients with surgical procedures with 45.5%, 37.0%, 40.7% for CABG, V, CABG+V, with rates of 23.7%, 31.3%, 23.7%, 15.6%, and 10.6% for elective PCI, urgent PCI, MI + PCI, MI alone, and HF respectively. Of 458 hospitals, 223 (49%) hospitals provided any ICR, with a median (10-90%) hospital ICR rate of 18.8% (0.06% - 74.1%). Hospitals in urban areas had significantly higher rates of ICR compared to hospitals in rural areas (30.1% vs. 18.6%) as did hospitals with presence of interventional services (surgical services: 31.5% vs. 20.2%, p = 0.006; PCI services: 30.3% vs. 14.7%, p =0.003). Conclusions: There appears to be substantial variation in the delivery of ICR across US hospitals. Less than half of hospitals with cardiac patients provide ICR and only a minority of patients ever receives ICR. This substantial gap in the secondary prevention of heart disease appears to warrant further investigation and intervention.

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