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New law expands required cardiac rehab


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POSTED: Wednesday, November 12, 2008

A new federal law signed in July, the Pulmonary and Cardiac Rehab Act, mandates that patients with qualifying diagnoses receive cardiac rehabilitation effective Jan. 1, 2010.

"However, until mandated cardiac rehab coverage is in effect, or insurance coverage gives hospitals enough reimbursement, we may not see cardiac rehab return to our local hospitals," says Penney Sing, who operates the island's only cardiac rehab program in Arthur Senining's Honolulu Center for Physical Therapy.

Cardiologist William Dang said hospitals are cutting back on almost all outpatient programs, partly because of costs and reimbursements, which are "low to nonexistent."

He described three phases involved with cardiac patients: inpatient care; outpatient care right after discharge with monitoring as they increase activity; and phase three, six to eight weeks after a cardiac event, with a less-intense exercise program.

Medicare pays for phase two, but other insurers don't, he said. "Maybe about one-third (of patients) have some kind of coverage," he said.

Sing said only a doctor or physical therapist can bill for insurance and only patients who had open-heart surgery can be billed under physical therapy insurance.

She said she keeps her rates low as "a community service," charging $50 for two hours for a patient on one-on-one monitoring; $177 a month for those on maintenance twice a week; and $197 for three times a week. She has a small salary and no benefits, she said.

Cardiovascular disease - mostly heart disease and stroke - has been Hawaii's leading cause of death for several years, according to the state Department of Health. It was responsible for more than 2,900 deaths in 2005 and more than $604 million in related hospital charges.

Medical societies have endorsed these qualifying diagnoses for rehabilitation services under the new federal law: myocardial infarction, acute coronary syndrome, coronary artery bypass graft surgery, percutaneous coronary artery intervention, cardiac valve surgery, cardiac transplantation and chronic stable angina. Also, patients with chronic heart failure and peripheral arterial disease.

Dang said rehabilitation is very important after a heart procedure. "When I had patients who had a fresh heart attack or bypass surgery, it was always a little extra security blanket for me knowing when a patient goes home, there is follow-up with cardiac monitoring as they increase exercise," he said.

Doctors may tell patients to go to the YMCA or a gym for exercise, he said, "but a rehab program reinforces all the education for patients about diet, medications and exercise."