A new payment rule from the Centers for Medicare and Medicaid Services will increase the number and duration of payments to hospitals for cardiac and pulmonary rehabilitation services.
The expanded cardiac benefit is “very exciting,” said Dr. Alfred Bove, president of the American College of Cardiology. “A lot of us have been advocating rehabilitation for a long time, and lots of patients say, 'I can't afford it.' This would be a tremendous program for a lot of people after a major heart event.”
Previously, Medicare patients who experienced a heart attack or heart failure usually were covered for 8 weeks of cardiac rehabilitation with a maximum of three 1-hour sessions per week, Dr. Bove said. Under the new benefit, patients can receive up to 72 sessions of intensive cardiac rehabilitation over an 18-week period.
Being able to spread the sessions out will be quite valuable, Dr. Bove said. “So much of recovering is giving people confidence in what they can handle. So many people have a heart attack and go home and stare out the window because they have no idea what they can do that is safe. Improvement of depression and other symptoms [also] is better if you can get them into a rehab program.”
In addition, Medicare's approval of the expanded sessions will put pressure on private insurers to create the same kind of benefit, Dr. Bove noted.
Other outpatient payment changes included in the rule are:
▸ Physician supervision requirements. Nonphysician providers—physician assistants, nurse practitioners, certified nurse specialists, and certified nurse-midwives—may directly supervise all hospital outpatient therapeutic services that they are personally able to perform within their state scope of practice and hospital-granted privileges. Previous Medicare policy allowed only for physicians to provide direct supervision of these services.
▸ Kidney disease education. The CMS will establish payment to rural providers under the Medicare Physician Fee Schedule for kidney disease education services furnished on or after Jan. 1, 2010, for beneficiaries diagnosed with stage IV chronic kidney disease.
▸ Validation of quality reporting. To make sure that hospitals are accurately reporting measures using chart-abstracted data, the CMS will take a sample of actual patient records, determine how the measures should have been reported according to the Hospital Outpatient Department Quality Reporting Program, and compare results with the measures reported by the hospital. Although the CMS will begin validating hospital-submitted data for purposes of the 2011 payment update, the validation results will not affect a hospital's outpatient payments until 2012, according to the new rule.
The CMS also is planning to implement the third of four phases of its revised payment system for ambulatory surgery centers (ASCs). In general, the revised ASC payment rate for any given service is a percentage of the payment rate for the same service under the Outpatient Prospective Payment System. However, for new ASC services that are usually performed in physicians' offices, the ASC payment is capped at the amount the physician is paid under the Medicare fee schedule for practice expenses when providing the same service in the office.
The final rule is scheduled to be published in the Nov. 20 issue of the Federal Register. The CMS will accept comments on the final rule through Dec. 29, and will respond to them in the 2011 final outpatient rule.
Information on the outpatient payment rule is available online at www.cms.hhs.gov/HospitalOutpatientPPS