People who have congestive heart failure are at strong risk of morbidity and mortality unless they take control of their disease and make important changes in their lives. Unfortunately, until recently, heart disease patients have not been covered for rehab under Medicare, making it more difficult for them to get the help they need. Recently, though, Medicare changed its laws regarding payments for CHF Rehab, and certain patients are now eligible for rehab covered under the Medicare system.
What defines CHF?
CHF, or congestive heart disease, is chronic and progressive. It refers to the building up of fluid around the heart and in other parts of the body when the heart pumps inefficiently.
In the early stages of the disease, it can be treated through lifestyle changes and sometimes medication. In the late stages, there is not much to do to treat it, and usually palliative care is recommended. Symptoms of later stage CHF include shortness of breath during physical activity, edema, and fatigue.
16% of Medicare beneficiaries have CHF, and 1 in 9 death certificates in the US refer to heart failure.
Cardiac rehab is recommended for people who have heart disease, although only a small percentage of people who need it actually get it. Overall it has been shown to increase positive outcomes for heart disease patients.
Medicare and CHF rehab
Up until now, Medicare only covered cardiac rehab for patients who experienced a one-time heart episode, such as a heart transplant, an acute myocardial infarction or coronary artery bypass surgery. If someone has a one-time occurrence, and not a chronic condition, it’s more likely that through a cardiac rehab program they’ll be able to make the necessary changes in their lives to ensure no further problems.
The new law looks a little more broadly and provides coverage for patients whose disease is chronic but stable, which means that they have not recently had an attack and are not scheduled for any procedures, “patients with left ventricular ejection fraction of 35% or less and New York Heart Association (NYHA) class II to IV symptoms despite being on optimal heart failure therapy for at least six weeks.” In this situation, treatment can still prove helpful in overcoming the disease.
New research brings about a change
A research team authorized by the Center for Medicaid and Medicare Services (CMS) recently set out to determine if cardiac rehab was beneficial for CHF patients and if it actually increases better outcomes for these patients. The researchers studied 19 trials that followed 3967 patients with CHF. They found that in patients whose disease was mild to moderate, CHF rehab showed positive outcomes. Exercise training was shown to reduce hospitalizations and improve overall quality of life. They recommended to cover CHF rehab and public comments confirmed that this is what people want. Medicare endorsed it enthusiastically and brought this law into effect.
At Sinai Post Acute Care, we offer CFF rehab programs for patients who have earlier stages of the disease and can benefit from education and awareness, now covered my Medicare.