Promoting Cardiac Rehab: Benefits, Access Enhancement, Legislative Advocacy

1. Expanding Access to Cardiac Rehab Scott Leezer, Director of Government Affairs The Federal Group, Inc.

2. Expanding Access to Cardiac Rehab Welcome Where are people calling in from today? Type your first name and city and state into the chat box.

3. Expanding Access to Cardiac Rehab Welcome Did you enrolled in a cardiac rehabilitation program? Yes No

4. Expanding Access to Cardiac Rehab Welcome How far did you have to travel for your cardiac rehabilitation program? 5 miles or less 6-15 miles 16-25 miles More than 25 miles

5. Expanding Access to Cardiac Rehab Promote, Ensure Access to, and Expand the Use of Cardiac Rehabilitation • Cardiac rehabilitation is an exercise and education program that helps improve the health and well-being of people who have heart problems. • Cardiac rehab helps patients recover more quickly, return to an active lifestyle, and reduces the risk of a future cardiac event. • Recommended for patients following heart attack, angioplasty, open heart surgery, chronic chest pain, and heart failure.

6. Benefits of Cardiac Rehabilitation CMS’ “Direct Supervision” Requirement & S.488/HR 3355 Proposed Incentive Payments for Cardiac Rehabilitation Services Provided to Medicare Beneficiaries

7. Expanding Access to Cardiac Rehab The Benefits of Cardiac Rehabilitation • Reduced all-cause mortality • Improved adherence with preventive medications • Improved function and exercise capacity • Improved mood and quality of life

8. Expanding Access to Cardiac Rehab The Benefits of Cardiac Rehabilitation Reduced readmission rates to hospital by up to 25 percent Reduced cardiac mortality from by up to 31 percent Strong correlation between the number of cardiac rehabilitation sessions and improved long-term outcomes

9. Expanding Access to Cardiac Rehab The Benefits of Cardiac Rehabilitation What percentage of eligible patients enroll in a cardiac rehab program? 80% 60% 40% 20%

10. Expanding Access to Cardiac Rehab The Benefits of Cardiac Rehabilitation Despite the benefits of cardiac rehabilitation, patients often don’t enroll. It is estimated that among eligible patients, only one in five enroll in a cardiac rehab program.

11. Expanding Access to Cardiac Rehab The Benefits of Cardiac Rehabilitation • The barriers to cardiac rehabilitation include: • Lack of referral by cardiologists. • Scarcity of programs in rural and medically underserved areas. • Lack of coverage by insurance providers. • High out-of-pocket costs for patients.

12. Expanding Access to Cardiac Rehab The Benefits of Cardiac Rehabilitation Can you think of any additional barriers to enrolling in a cardiac rehabilitation program?

13. Expanding Access to Cardiac Rehab “Direct Supervision” Requirement • Current law requires “direct physician supervision”, which requires a physician to be immediately available for each session. • This creates a more stringent requirement for physician supervision in cardiac rehabilitation than they do on the staffing of emergency rooms. • The physician requirement makes it difficult to operate cardiac rehab programs in rural areas were physicians are scare. • It also imposes unnecessary costs on programs and patients.

14. Expanding Access to Cardiac Rehab The Legislative Fix (S. 488/H.R. 3355) • Under proposed legislation (S. 488/H.R. 3355), non-physician providers; such as physician assistants, nurse practitioners, and clinical nurse specialists, would be able to supervise cardiac rehabilitation programs. • Senators Chuck Schumer (D-NY) and Mike Crapo (R-ID) and Representatives Lynn Jenkins (R-KS) and John Lewis (D-GA) • There are 26 Senate Cosponsors and 63 House Cosponsors

15. Expanding Access to Cardiac Rehab Incentive Payments for Cardiac Rehabilitation • In July 2016, the Centers for Medicare and Medicaid (CMS) proposed incentive payments to encourage the use of cardiac rehabilitation for Medicare beneficiaries. • To encourage doctors to refer more patients to cardiac rehabilitation, Medicare would pay an additional $25 per session for the first 11 sessions and an additional $175 per session thereafter.

16. Expanding Access to Cardiac Rehab Incentive Payments for Cardiac Rehabilitation • But, does it go far enough? • The incentive payments would only apply to patients who have had a heart attack or coronary artery bypass surgery. • They would initially only be available in 90 geographic areas. • Is $25 sufficient for incentivizing referral?

17. Expanding Access to Cardiac Rehab Incentive Payments for Cardiac Rehabilitation • Last month, Mended Hearts Inc. submitted comments to the CMS in support of the Cardiac Rehabilitation Incentive Payment Model • The comments highlighted the importance of cardiac rehab to our members and cardiovascular patients. • They encouraged CMS to continue to promote the use of cardiac rehabilitation and reduce barriers of enrollment for beneficiaries. • The comments supported the incentive payments and called for their broad implementation.

18. What to Expect from Mended Hearts on the Cardiac Rehab Issue in the Future Partnership with American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) Active support for S.488/H.R. 3355 to allow non-physician providers to supervise cardiac rehab Continually monitoring the proposed incentive payment models for providers of cardiac rehabilitation & promote its broad implementation

19. Thank you! Any Questions?