Home > Cardiology > Cardiac Rehab: CMS Increases Per-Patient Payment by $1,100

Cardiac Rehab: CMS Increases Per-Patient Payment by $1,100

May 5, 2011

We have great news for cardiology service lines: the 2011 payment level for outpatient cardiac rehabilitation will see an increase from $38 to $69 (APC 0095). This may not seem like it will make a significant impact, but considering that CMS covers up to 36 one-hour sessions per patient, this translates to over $1,100 in additional revenue (per patient) for hospitals and $200 for physicians.

Rehab programs are intended to limit patients’ chances of a new heart attack and to help them return to society as quickly as possible. Clinical trials show that attending all 36 sessions reimbursed by Medicare lowers the risk of death (47%) and heart attack (32%) when compared to attending fewer sessions or no rehab at all. Each year, approximately 4.7 million patients with congestive heart failure could benefit from a cardiac rehab program, but only 11% of these patients participate in a program. That’s a large untapped market with a lot of potential.

Cardiac rehabilitation falls under CPT codes 93797 and 93798. Now, under APC 0095, hospitals will see 45% increases. Physicians will see a 26% increase ($14 to $19) for CPT 93797 and 29% ($20 to $28) for 93798. What I find most interesting is that CMS makes a point to put incentives in place for programs that work.

I spoke with Dianne Feeney, MS, BSN, associate director of the Quality Initiatives at Maryland Health Services Cost Review Commission in Baltimore, MD, and an expert in quality improvement in high risk populations, about the impact of cardiac rehab. She said, “Aligning reimbursement to reduce avoidable hospital readmissions can be a challenge. But, incentivizing rehabilitation services is a step in the right direction.”

So just what does a 45% increase in reimbursement mean to the hospital’s bottom line? I ran the numbers through a MD Buyline value calculator (cardiac Rehab.xls) and found that most hospitals would break even at best with the 2010 payment level. But, the new 2011 reimbursement level would allow hospitals to generate almost $2 million in profits over a five-year period.

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