Evidence Leads to Medicare Policy Change

Posted by The Evidence Blog on June 6, 2014

At Hayes, Inc., we’re all about the evidence. That’s why there should be no surprise that we were pleased when the Centers for Medicare & Medicaid Services (CMS) reviewed new evidence and decided to begin covering cardiac rehabilitation programs for patients with stable, chronic heart failure. We reported this policy change in February in our News Service. However, since articles about this recently started popping up in the popular media, we thought the issue deserved to be revisited.

Until February 2014, CMS approved cardiac rehabilitation for patients with the following indications:

  • Acute myocardial infarction within the preceding 12 months
  • Coronary artery bypass surgery
  • Current stable angina pectoris
  • Heart valve repair or replacement
  • Percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting
  • Heart or heart-lung transplant

However, after reviewing the results of the HF-ACTION trial and newer trials, CMS determined that the evidence was sufficient to expand coverage to include cardiac rehabilitation for beneficiaries with stable, chronic heart failure. You can access the final coverage memorandum here.

The HF-ACTION trial examined the outcomes associated with cardiac rehabilitation in nearly 2300 patients. The results showed that patients who participated in exercise training had modest but significant reductions in all-cause mortality or hospitalization and cardiovascular mortality or heart failure hospitalization. Similar benefits were found in 2 smaller but longer-term studies.

This is a perfect example of how evidence can guide us to those healthcare services that offer a true health benefit and identify the patients for which they are most appropriate. We applaud CMS for evaluating the entire body of evidence and making the evidence-based decision to expand coverage for cardiac rehabilitation to patients with stable, chronic heart failure.

Topics: Hayes Blog

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