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Proposal prompts letters to HCFA
A cardiac rehab industry group has initiated a letter-writing campaign in response to proposed rules from HCFA that would increase the physician supervisory requirements of cardiac rehab programs.
Under a proposed new policy by HCFA, continuous telemetry monitoring by a physician would be required for any cardiac rehab program. In addition, physicians would be required to read and interpret each EKG rhythm strip generated by a cardiac rehab program, as well as review and revise exercise prescriptions generated by cardiac rehab staff members.
Because most centers are staffed by nurses or exercise physiologists, the additional physician supervision would be cost-prohibitive for many programs, as well as unnecessary, says a representative for the American Association of Cardiovascular and Pulmonary Rehabilitation (AACPR) based in Madison, WI. If the proposed requirements were passed, a center would have to pay physicians for their time spent supervising these activities, even though these physician activities would not be reimbursable under current Medicare regulations, says Pat Comoss, chairperson of AACPR’s health policy and reimbursement committee and owner of Nursing Enrichment Consulting in Harrisburg, PA.
The AACPR has scheduled a meeting with HCFA to discuss its concerns about the policies, Comoss says. The group’s main concern is that discussions take place before the regulations are passed without an opportunity for public comment. The group favors either a public comment period or at least the chance for cardiac rehab providers to discuss the issue with HCFA before a new policy is passed.
"One of the reasons that we’re concerned . . . is that cardiac rehab programs are staffed with well-trained professionals including cardiac nurses and exercise specialists who are there to do the job of watching patients and adjusting the exercises they’re performing. One group of physicians said in a letter to HCFA, Are you asking me to do my nurses’ job?’" Comoss says.
Comoss points out that the increased physician supervisory proposals are part of an overall review HCFA is doing of how cardiac rehab is reimbursed. Because the current reimbursement rules for this patient population were written in 1989, the AACPR agrees it is time for revised guidelines, Comoss says. The group previously has tried to convince HCFA to expand the patient diagnoses that are eligible for Medicare reimbursement for cardiac rehab, Comoss says. Currently, only three groups of patients can be reimbursed: post-myocardial infarctions (heart attack patients), post-coronary artery bypass surgery patients, and patients with stable angina.