Cardiologists push to restore virtual rehab as covered Medicare benefit

Washington — November 17, 2023 — Recora's Dr. Ed Wu and an expert in cardiology outcomes, Dr. Dhruv Kazi, were interviewed for a recent Healio Cardiologytoday article on the need for access to cardiac rehabilitation. Excerpts of the article are below.

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Among the many changes brought by the COVID-19 pandemic was an abrupt switch from in-person to virtual cardiac rehabilitation.

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“When Medicare allowed for virtual cardiac and pulmonary rehab, that provided a lifeline, flexibility and access to hospitals to deliver this care,” Ed Wu, MD, co-founder and chief medical officer at Recora, a technology company providing virtual cardiac care services, told Healio. “This was a godsend to many recovering from a heart attack, a valve procedure, a bypass procedure. We had many patients tell us that without some other way to participate in cardiac rehab, they would have not done it.”

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In October 2023, the U.S. Senate introduced a bipartisan bill that aims to make the authorization for virtual cardiac and pulmonary rehab permanent for Medicare beneficiaries, after a similar bill was introduced in the House. The Sustainable Cardiopulmonary Rehabilitation Services in the Home Act would codify virtual cardiopulmonary rehab flexibilities that were established in response to COVID-19.

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Healio: What are some of the inherent advantages of virtual cardiac rehab?

Wu: Many patients do not have transportation. Some, to this day, fear being in congregate settings. Some patients are dependent on caregivers and there are people who may not speak English as their first language and fear going to a hospital. By doing cardiac rehab virtually, it is very easy, for example, for translation services to be patched in.

About 14% of the country is in a cardiac rehab desert and approximately 20% to 40% of people live in a cardiac rehab-challenged area. Studies have demonstrated that among patients who participated in cardiac rehab, there are decreased hospitalizations, decreased ED utilization and decreased mortality rates. Without cardiac rehab, patients may not get the exercise, training and education they need to turn their life around.

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Healio: How can clinicians support these efforts?

Kazi: Clinicians, physicians and nurses have always seen themselves as advocates for patients within the health systems. This is a unique opportunity to advocate for an entire population of patients with CVD. Write to your representative, saying you support these two bills. Most of our cardiac and pulmonary professional associations have put their weight behind these initiatives, showing their support. There is no reason to underestimate the amount of work it will take to convert these to law, given how our systems work. But this is the farthest we have ever come in making virtual cardiac rehab positive. We must continue the momentum to bring about a positive change in our patients lives. This would be a small investment from public payors that would create a sustainable improvement in access.

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Wu: There are three things. No. 1 is support this legislation by writing your representative. No. 2, part of this is an awareness issue. There is no major course on cardiac rehab in medical school. Create awareness for colleagues and when appropriate, order cardiac rehab for patients. No. 3, be prepared for patient questions on this topic. We are certainly seeing increased awareness among patients. With a shift to virtual, we really can’t put the toothpaste back into the tube. Now we are seeing many people trying to sort out the right things to do, virtually.

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References:

• ACC. COVID-19 public health emergency ending soon: what you need to know. Available at: https://www.acc.org/Latest-in-Cardiology/Articles/2023/05/03/10/50/COVID-19-PHE-Ending-Soon.
• Health Resources and Services Administration. Telehealth changes after the COVID-19 public health emergency. Available at: https://telehealth.hhs.gov/providers/telehealth-policy/policy-changes-after-the-covid-19-public-health-emergency.

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