Medicare Memo: Niche for Multidisciplinary Care in Cardiac Rehab

Cardiac rehab programs such as those developed by Dean Ornish, MD, and Eileen Stuart, RN, PhD, for the Mind Body Medical Institute (MBMI) at Harvard University, appear to be getting a boost from Medicare via a “proposed decision memorandum” from the Centers for Medicare and Medicaid Services (CMS) late December.

Just in today March 28: Medicare has approved the proposed desision memo for Cardiac Rehabilitation Programs-CAG 00089R.  

The agency has historically covered exercise programs. Now on the table, are other skills for healthy living. CMS proposed including the following language: “Phase II cardiac rehabilitation, as described by the U.S. Public Health Service is a comprehensive, long-term program including medical evaluation, prescribed exercise, cardiac risk factor modification [nutritional counseling is noted as an example], education and counseling.” (Bracket added.)

The recommendations for these 12-72 week programs apply to acute myocardial infarction (AMI), coronary artery bypass graft (CABG), stable angina pectoris, heart valve repair/replacement, percutaneous transluminal coronary angioplasty (PTCA), and heart or heart lung transplant, but not to congestive heart failure.

The decision directly references the Ornish program and that offered through the MBMI established by Herbert Benson, MD. Both have been under review by CMS, stating: “We believe these programs fall under the purview of this (National Coverage Decision). Completion of the demonstrations will allow further evaluation of the programs.” The decision memo follows a January 2005 meeting of the Medicare Coverage Advisory Committee entitled "Physician-supervised behavioral interventions for patients with symptomatic coronary artery disease."

Pamela Snider, ND, served on the CMS panel which explored these programs. She notes that one shift appears to be seeing that multiple disciplines are frequently useful in these programs. The panel voted to inform CMS that they viewed these services as “physician-supervised behavioral interventions that are comprehensive, intensive and multidisciplinary.”

For information: http://www.cms.hhs.gov/apps/mcd/viewdraftdecisionmemo.asp?id=164

Comment: The decision is a day late and a dollar short for the exciting joint venture Highmark Blue Cross Blue Shield developed with Ornish’s Preventive Medicine Research Institute back in 2001 under the direction of Highmark’s visionary Anna Silberman.  Their business plan assumed coverage was right around the corner. The exciting, and ultimately expensive collaboration eventually collapsed. The decision should be helpful to both Ornish and Benson programs, with a boost, also, to multidisciplinary team medicine. The Integrator Blog will be contacting Silberman to see if the joint venture may receive a new push.