CMS Expands Rehab Coverage …
An updated final national coverage decision from the Centers for Medicare and Medicaid Services has expanded the number of people potentially eligible for cardiac rehabilitation. It may allow, for the first time, coverage of some aspects of lifestyle modification programs such as Dr. Dean Ornish's Program for Reversing Heart Disease and the Cardiac Wellness Program of the Mind/Body Medical Institute, Chestnut Hill, Mass. In the past, CMS paid for rehab only for patients with myocardial infarction, coronary artery bypass graft, or stable angina. Now coverage will be available for patients receiving a heart valve, percutaneous transluminal coronary angioplasty or stenting, and heart or heart-lung transplant. Evidence was not sufficient to back payment for rehab for congestive heart failure, said CMS. Under the new policy, CMS will cover programs that include medical evaluation, prescribed exercise, education, cardiac risk factor modification (including nutritional counseling), and counseling for up to 36 sessions. Regional contractors can cover the services beyond 18 weeks, but can't exceed 72 sessions over 36 weeks. To be covered, a rehab program must be under the direct supervision of a physician. Of the 181 comments CMS received, 93 agreed with the agency's decision on expanding covered indications. The agency received 32 comments on the components of rehab programs; of those, 17 said programs like Dr. Ornish's shouldn't be covered because they're more intense and comprehensive than the other services covered and should be under a separate policy.
… But Maintains ECP Policy
In another policy update, CMS said it will not expand indications for external counterpulsation therapy. (Medicare identifies the therapy as “ECP,” but it is also known among providers as enhanced external counterpulsation, or EECP.) Currently, CMS covers ECP for disabling angina (class III or class IV, Canadian Cardiovascular Society Classification or equivalent) that is not amenable to surgical intervention. The agency had been asked to extend coverage to CCSC II angina, heart failure, cardiogenic shock, and acute myocardial infarction, but said that it will not at the current time. ECP, which uses cuffs to gently compress blood vessels, increases diastolic flow and causes systolic unloading. The Prospective Evaluation of EECP in Congestive Heart Failure (PEECH) trial, presented at the American College of Cardiology annual meeting in 2005 and sponsored by a maker of EECP systems, found that a 7-week course of the therapy increased exercise duration, raised quality of life, and improved New York Heart Association class in patients who were on optimal pharmacotherapy. EECP has also been found to be a potentially effective treatment for restless legs syndrome.
ICD Registry Is Official
The national ICD Registry is now the official database for Medicare patients. Launched in June 2005, the registry is a collaboration between the American College of Cardiology and the Heart Rhythm Society. When CMS decided to expand coverage for ICDs last year, the agency required hospitals to begin submitting data to a registry. Initially those submissions were to go to the CMS QNet registry, but now the facilities will be asked to report to the ICD Registry instead. According to the ACC, 1,300 hospitals have been contacted and are all starting to enroll in the registry. “The Medicare aggregate data from the ICD Registry will be made available to the public to better inform patients and physicians on the most appropriate ICD therapy,” said CMS Administrator Mark B. McClellan in a statement.
GAO Report Critical of HRSA
The Health Resources and Services Administration needs to do a better job of making health workforce projections, says a report from the Government Accountability Office. “HRSA has in the past decade published national supply and demand projections for the nurse and pharmacist workforces but no national projections for the physician and dentist workforces,” the GAO said. “We [recommend] HRSA develop a strategy and time frames to regularly update and publish national health professions workforce projections.” In its response, HRSA noted that the GAO focused its criticisms on publications from the agency's national office and did not take into account those from regional workforce centers that are funded by HRSA. The agency also noted it “believe[s] that the legislated goal of providing 'health workforce information and analysis … such as shortages of registered nurses, shortages of pharmacists, and the distribution of health care workers in underserved areas' is broader than what GAO's exclusive focus on supply and demand projections for physicians, nurses, and dentists would allow.”