Payers Should Cover Home-Based Cardiac Rehabilitation Programs, Researches Argue

Fierce Healthcare | By Frank Diamond

Insurers need to rethink their coverage policies regarding home-based cardiac rehabilitation programs, according to a study published yesterday in the Journal of the American Heart Association.

In a press release, the study’s senior author Mary A. Whooley, M.D. said that “our biggest challenge in the U.S. is that home-based cardiac rehabilitation is not covered by many health insurers. Currently, Medicare only pays for on-site or facility-based cardiac rehabilitation.”

While problems persist on the supply side for providing these programs, the study also found a lack of demand.

“The biggest surprise of our analysis was how few patients chose to participate in cardiac rehabilitation,” Whooley said, a primary care physician at the San Francisco Veterans Affairs Medical Center and professor of medicine at the University of California, San Francisco.

HBCR programs focus on lifestyle changes. “However, changing behaviors is difficult, and while care facilities may offer on-site cardiac rehabilitation, many patients don’t choose to take advantage of follow-up treatment,” Whooley said.

The study, which authors tout as the first to show that home-based cardiac rehabilitation can help people with heart disease live longer, involved examining data of 1,120 patients eligible for cardiac rehabilitation at the San Francisco Veterans Health Administration between 2013 and 2018.

Excluded from the study were veterans who choose to attend facility-based cardiac rehabilitation programs or those who died within 30 days of hospitalization. Researchers compared outcomes for 490 home-based care participants to 630 patients who did not participate in the program. The patients were monitored through June 30, 2021.

Those in the home-based program had a 36% lower risk of death compared to those who did not participate.  

“Although no observational study can eliminate the possibility that healthier patients were more likely to participate in HBCR, we rigorously adjusted for confounding using an inverse probability weighted Cox regression analysis with the goal of equalizing the samples across all variables other than exposure to HBCR,” the study found. “These results suggest that participation in HBCR contributed to lower mortality among patients referred to [cardiac rehabilitation].”

The home-based rehabilitation program lasted 12 weeks and included nine coaching calls, motivational interviews and a health journal to track diet, exercise and vital signs. Participants were also given a stationary bike and a blood pressure monitor.

Patients were given physical activity goals, after consultation with a nurse or exercise physiologist. Follow-up calls were made to patients at three and six months after the program, and they were monitored an average of 4.2 years after being hospitalized.

AARP: Paid Caregivers are Key to Relieving Family Caregiver Burden

McKnight’s Home Care | By Diane Eastabrook
 
AARP said Wednesday state and federal lawmakers must solve the home care worker crisis in order to take pressure off of an estimated 38 million family caregivers.
 
“We have to address that issue because it means family caregivers have no choice,” Susan Reinhard, director of the AARP Public Policy Institute said during a roundtable on family caregiving. “If there are no paid [caregivers], even more unpaid caregiving has to be done.”
 
Reinhard made the comments as AARP released Valuing the Invaluable 2023 Update: Strengthening Supports for Family Caregivers. The report estimated that unpaid family caregivers are providing an estimated 36 billion hours of care annually, worth approximately $600 billion. That is an increase of $60 billion from 2019 when AARP released its last family caregiver report. 
 
Attracting up to 6 million direct caregivers into the workforce by the end of the decade will require increasing caregiver wages, according to Nancy Leamond, AARP chief advocacy and engagement officer and executive vice president. She also suggested that finding ways for Medicare and private insurers to pay for home care might incentivize more workers to join the industry.
 
The family caregiver study painted a grim picture of stressed-out family members working what are essentially unpaid part-time jobs dressing wounds, managing medications, cooking, cleaning, bathing and providing other activities of daily living for loved ones. Many family caregivers are doing that work in addition to carrying on full-time jobs and taking care of children. 
 
AARP is advocating policy initiatives in Washington and state legislatures that would provide more resources, including training for family caregivers; tax credits and reimbursements to help families pay for direct care workers; workforce policies that provide flexible schedules and paid leave for family caregivers; and well-being programs that promote respite care. 
 
About a dozen states enacted paid family leave and sick leave that help family members care for ailing loved ones. Forty-five states now have Coronavirus Aid, Relief, and Economic Security (CARES) Act laws in place that support family caregivers when their relatives are hospitalized or return home.
 
Arizona, Colorado and New Hampshire now have laws in place that provide training for family caregivers.

Home Health Leads Senior Care Sector in Worker Demand, Report Finds

McKnight’s Home Care | By Diane Eastabrook 

The home health workforce is projected to grow a whopping 46% by 2040, representing the largest increase in the senior care sector. That’s according to a new report released Wednesday by Argentum, a trade association representing senior living facilities.
 
“The baby boomers are aging and will put a strain on our nation’s ability to provide senior care, supports and service,” Argentum researchers wrote in the report. “And, while our senior population grows, the American workforce is not keeping pace. We are facing a significant worker shortage across the economy generally but within senior care, in particular.”
 
The report said employment in the home health industry will reach 2.2 million by 2040, adding approximately 692,000 new jobs to the 1.5 million home health workers in 2021. Argentum also estimated home health will need to fill an additional 4.3 million positions as workers exit the industry or move to other occupations over the next two decades.
 
The report said demand will be strongest for home health and personal care aides, with 3.4 million workers needed for those jobs by 2040. Nursing assistants and registered nurses will also be in high demand filling 330,200 and 310,200 positions, respectively. The states that will see the strongest demand for home health workers by the end of this decade include Texas (415,800), New York (391,000) and California (156,000). 
 
The report reflects the changing demographics of an aging nation where 10,000 people are turning 65 each day. It also reflects the trend of seniors opting to age at home, rather than in a facility. Employment in senior living facilities is expected to grow just under 33% by 2040, while employment in skilled nursing is expected to decrease by 6.5%. 
 
Some of the states facing the most critical shortage of direct care workers are taking action. In January, New York took its first step in developing a master plan for aging which includes proposals for public-private partnerships to address long-term care initiatives. California, Texas, Colorado, Massachusetts and Minnesota have adopted similar plans.

DEA Issues Proposed Rule for Telemedicine Prescribing of Controlled Substances

A proposed rule was published in the Federal Register on March 1, 2023 focused on telemedicine prescribing of controlled substances when the practitioner and the patient have not had a prior in-person medical evaluation. This proposed rule applies only in limited circumstances when the prescribing practitioner wishes to prescribe controlled medications via the practice of telemedicine and has not otherwise conducted an in-person medical evaluation prior to the issuance of the prescription. With that in mind, NHPCO is working with legal counsel to determine the circumstances under which this proposed rule could apply to hospice or palliative care providers and will also provide talking points for those who want to submit a comment letter directly to the DEA. The DEA has posted two helpful resources for providers and prescribers.

Proposed Rules Summary

Proposed Rules Highlights for Medical Practitioners

To provide feedback for the NHPCO comment letter, email [email protected].