By Jonathan Springston, Editor, Relias Media

Despite availability and eligibility, the authors of a recent analysis reported only one in four Medicare recipients enroll in outpatient cardiac rehab programs, which are designed to improve the health of those who have experienced a heart attack or who have undergone heart surgery.

Investigators found 366,000 patients covered by Medicare who could have enrolled in outpatient cardiac rehab in 2016. Of this group, only about 25% took advantage. Among those who enrolled, researchers found only 27% completed the full course. Older adults, women, and minorities were those least likely to participate (10% of patients age 85 years and older; 19% of women vs. 29% of men; and 16% of Asians, 24% of African-Americans, and 13% of Hispanics).

"Cardiac rehabilitation has strong evidence demonstrating its lifesaving and life-enhancing benefits, and Medicare Part B provides coverage for the program. The low participation and completion rates observed translate to upwards of 7 million missed opportunities in this study,” Matthew D. Ritchey, lead study author and researcher at the CDC Division for Heart Disease and Stroke Prevention, said in a statement. "Improving awareness of the value of cardiac rehabilitation, increasing referral of eligible patients, and reducing system and patient barriers to participation are all critical steps in improving the referral, enrollment, and participation rates.”

In their report, Ritchey and colleagues referenced the Million Hearts Cardiac Rehabilitation Collaborative, a quality improvement initiative developed by the CDC and the American Association of Cardiovascular and Pulmonary Rehabilitation. The goal of the program is to raise participation rates in cardiac rehab programs to higher than 70% by 2022.

Using resources from this program, the Agency for Healthcare and Research Quality created the TAKEheart program, another tool to help hospitals and health systems raise cardiac rehab referrals, enrollment, and retention rates.

Hospitals and health systems always look for ways to help patients pay for healthcare services, even for cases in which patients may not be aware of their coverage. In the February issue of Hospital Access Management, author Stacey Kusterbeck reports on recent Medicaid expansion. More than 30 states and the District of Columbia have expanded Medicaid access, but there are plenty of patients who may not be aware they even qualify. Patient access staff at St. Luke’s Health System in Boise, ID, explain how they help eligible patients enroll.

In the same issue of Hospital Access Management, Kusterbeck also interviewed patient access staff who use detective skills to find “hidden” insurance coverage. For whatever reason, some patients may not be aware of what their health insurance covers or even if they are enrolled in a plan. Others may withhold full disclosure about their plan because of fears over deductibles. This article includes a closer look at several examples of when patients present as self-pay but may be covered more than they are aware or care to admit.