Time to Evaluate Revised Pulmonary Rehab Rule Impact
We're almost through the first quarter of 2010, and it's time to evaluate the impact of reimbursement and regulation changes in pulmonary rehabilitation programs.
Starting Jan. 1, the Center for Medicare and Medicaid Services (CMS) granted 12 weeks of pulmonary rehab for Medicare and Medicaid patients with moderate, severe, and very severe COPD.
Prior to the change, pulmonary rehab coverage had been provided on a piecemeal basis with some parts of the nation covering COPD and others not. For the first time, pulmonary rehab is covered nationally because of the new regulations.
How this will impact patient health remains an unknown, although the changes are expected to be significantly better. Those full-quarter sessions cover three one-hour sessions of rehab per week for 12 weeks.
Changes were a long-sought goal for numerous organizations including the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Association for Respiratory Care, the American College of Chest Physicians, the American Thoracic Society, and NAMDRC.
Certain criteria must be met in providing the care. Pulmonary rehab must be furnished in a physician's office or a hospital outpatient setting where a physician is immediately available for consultations and emergencies at all times the services are furnished.
Programs must include five components documented in the medical record:
- Physician-prescribed exercise, including some aerobic exercise, must be included in each session,
- Education and training, including information on respiratory management and smoking cessation, should be provided,
- A psychosocial assessment must be conducted,
- An outcomes assessment must be in place, and
- There should be a detailed plan showing how components are used for each patient.
While 36 rehab sessions are provided under the new law, an additional 36 sessions can be approved based on continued patient needs and a physician referral.
With a reimbursement rate of $50 per one-hour session, the new rules can mean the difference between rehab programs staying afloat or closing. In fact, the new rules may encourage facilities to add pulmonary rehab to their offerings if they are not already in place.
That critical first quarter is almost over, and it's time for rehab therapists to chime in with their experiences so far in 2010.