National Coverage Analysis (NCA) View Public Comments

Cardiac Rehabilitation Programs

Public Comments

Commenter Comment Information
Ornish, MD, Dean Title: Founder and President,
Organization: Preventive Medicine Research Institute
Date: 01/22/2006
Comment:

My colleagues and I at the non-profit Preventive Medicine Research Institute are writing in response to the December 22, 2005, Proposed Decision Memo for Cardiac Rehabilitation Programs (CAG-00089R).

On September 14, 2004, I sent a letter to CMS Administrator Dr. Mark McClellan entitled, “Formal Request for a National Coverage Determination for an Intensive LifestyleModification Program for Reversing Coronary Heart Disease.” In this letter, I wrote, “We are

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Silberman, Anna Date: 01/22/2006
Comment:

Highmark is a health plan headquartered in Pittsburgh and Camp Hill, Pennsylvania, that serves more than 3.5 million members, with the mission of helping people live longer and healthier lives. The Dr. Dean Ornish Program for Reversing Heart Disease is one of the most effective ways the mission is experienced by Highmark members.

I recommend that the Dr. Dean Ornish Program for Reversing Heart Disease not be included in the National Coverage Decision for cardiac rehabilitation.

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Lambert, David Title: Vice President of Health Services
Organization: Mountain State Blue Cross Blue Shield
Date: 01/21/2006
Comment:

First, let me commend CMS for seeking to expand the availability of cardiac rehabilitation services to the Medicare population and also for seeking to provide coverage for intensive lifestyle/risk factor modification programs like the Dr. Dean Ornish Program for Reversing Heart Disease.

I am concerned, however, that putting intensive programs together with more traditionally limited services like cardiac rehab will not result in adequate coverage (in terms of intensity and

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Williams, Jan Date: 01/20/2006
Comment:

I am in favor of adding cardiac rehab coverage for patients with valves, PTCA or heart transplants. Helping PTCA patients modify their lifestyles should help to reduce additional cardiac problems (and costs). Valve and transplant patients can also benefit from cardiac rehab services. Thank you for considering these diagnosis for cardiac rehab coverage

Horner, Walter Title: Director/Program Director
Organization: Hamot Center for Healthy Living/Dr. Dean Ornish Program for Reversing Heart Disease
Date: 01/20/2006
Comment:

Having oversight responsibility for a traditional cardiac rehabilitation program and being director of the Hamot Medical Center's Dr. Dean Ornish Program for Reversing Heart Disease, I strongly urge CMS to reconsider the revision of the Cardiac Rehabilitation NCD that currently includes intensive Lifestyle Modification Programs as part of the NCD. AS currently written, the NCD does not include the Ornish Program as a treatment option. Moreover, the NCD does not provide the program duration,

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Jendro, Thomas Title: Senior Director, Finance
Organization: Illinois Hospital Association
Date: 01/20/2006
Comment:

On behalf of our approximately 200 member hospitals and health care systems, the Illinois Hospital Association (IHA) is taking this opportunity to formally comment on the proposed decision memo for Medicare coverage of outpatient cardiac rehabilitation programs. This has been a very important issue for Illinois hospitals over the past five years and IHA is pleased to work with the Centers for Medicare and Medicaid Services (CMS) to ensure continued beneficiary access to this important and

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conte, john Title: MD
Organization: Johns Hopkins University
Date: 01/20/2006
Comment:

I think rehabilitation costs shuld be covered for both transplant pts and pts who have a LVAD implanted. They are in great need of rehab and this will allow pts to be discharged from the hospital sooner and keep the overall costs down by reducing acute care hospital charges. Not making this move is penny wise and dollar folish because pts will be kept in the hospital longer. JVC

Hulscher, Heather Title: Director, Finance Policy
Organization: Iowa Hospital Association
Date: 01/20/2006
Comment:

On behalf of the Iowa Hospital Association’s (IHA) 116 member hospitals, we appreciate this opportunity to comment on the Centers for Medicare & Medicaid’s (CMS) proposed decision memo (PDM) for cardiac rehabilitation programs. The following are IHA’s comments.

Indications and Limitations of Coverage
The IHA supports the decision to expand the diagnoses covered under Medicare to include acute myocardial infarction, coronary artery bypass graft, stable

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patton, nancy Title: RN, Nurse Manager
Organization: Harrisburg Medical Center
Date: 01/20/2006
Comment:

I am impressed with the recommendations to add three new catagories to the coverage list. As aR.N. working in the health care field, I recognize the need for this expansion of benefits. The benefits for those patients will beessential for their recovery and their continuedgood health. The benefits will far outweigh theadded costs. Your recommendations are excellent.

Pearson, Jane Title: Medical Director Cardiac Rehab/Preventive Cardiolo
Organization: Dean Medical Center/ St. Mary's Hospital
Date: 01/20/2006
Comment:

I strongly support the expansion of covered diagnoses for cardiac rehab to include PTCA and valvular heart procedures. In my experience as a Medical Director for a hospital-based cardiac rehab program I see patients on a daily basis who have these diagnoses. I believe the opportunity to educate patients following an acute coronary intervention is extremely valuable and the cardiac rehab experience reinforces compliance regarding modifiable coronary risk factors. In addition, valvular

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Bahr, Bridget Title: Exercise Specialist
Organization: Phelps County Regional Medical Center
Date: 01/20/2006
Comment:

I am an Exercise Specialist at a Cardiac Rehab in Rolla, MO. I believe that stent patients and those with valve replacements would greatly benefit from Cardiac Rehab. We've been discussing different ways that we could try to help the people that we have to turn away due to them not being covered. Please consider accepting these two diagnoses for coverage for Cardiac Rehab services. Thank You. Bridget Bahr

Pollak, Eric Date: 01/20/2006
Comment:

First, I would like to thank you for your proposed expansion of coverage to also include patients who have undergone heart valve repair/replacement; have had percutaneous transluminal coronary angioplasty; or have had heart or heart lung transplant. This change, along with the others noted within the document support the provision of evidenced-based practice in the cardiac rehabilitation setting.

However, I would recommend a change related to the proposed language designating the

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Berman, MD, Joel Title: physician
Organization: Capital Region Health Care
Date: 01/20/2006
Comment:

First, I would like to thank you for your proposed expansion of coverage to also include patients who have undergone heart valve repair/replacement; have had percutaneous transluminal coronary angioplasty; or have had heart or heart lung transplant. This change, along with the others noted within the document support the provision of evidenced-based practice in the cardiac rehabilitation setting.

However, I would recommend a change related to the proposed language designating the

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Porte, Phillip Organization: American College of Cardiology and the American Association of Cardiovascular and Pulmonary Rehabilitation
Date: 01/20/2006
Comment:

The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) and the American College of Cardiology (ACC) welcome the opportunity to comment on the proposed decision memo outlining changes to the national coverage policy for cardiac rehabilitation. AACVPR is the leading professional health care association focusing on cardiac and pulmonary rehabilitation, and its members include physicians, nurses, respiratory therapists, physical therapists, exercise physiologists and

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Smith, MS, CES, Brian A. Title: Supervisor
Organization: St. Mary's Hospital
Date: 01/19/2006
Comment:

I wish to take this opportunity to applaud your decision to expand the diagnoses that will be covered by this new ruling. It will truly serve to benefit those patients who in the past would have been told that Cardiac Rehab was not an option for them. This in spite of the personal knowledge and experience of the rehab staff and referring physicians that such a program would have been an invaluable source of knowledge, social support, physical conditioning, and lifestyle modification so

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Kime, Kimberly Title: Nurse Case Manager
Organization: WVU Hospitals
Date: 01/19/2006
Comment:

I have been the Nurse Case Manager for the Dean Ornish Program for the past 3 1/2 years. Prior to that, I worked as a cardiac rehab nurse for 15 years. Cardic rehab's main focus is on increasing exercise tolerance and endurance. An attempt is made to educate patients regarding heart healthy diet and stress management. Patients come in 3 time a week for 36 session to exercise. Educational sessions are worked in if possible.The Ornish Program is much more intense. The Ornish Program not only

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Petto, Helen Date: 01/19/2006
Comment:

As a cardiac rehab nurse, I see so much improvement in those that come through our rehab program. Life-changing habits are encouraged and formed. This cannot help but lower costs down the road for those patients choosing to exercise/eat right/maintain tighter blood sugar control etc. PTCA's have documented heart disease, so prevention would certainly be more cost effective than treatment the second/third time around. Also valves would benefit so much from the opportunity of rehab! I hope

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Krider, Susan Date: 01/19/2006
Comment:

Heart Failure patients show a much improved quality of life, physical tolerance, energy level, and control of there disease/device when they have cardiac rehab. They and their family/signifcant-others are afraid of their disease and exacerbation of symptoms from exercise. Cardiac Rehab allows structure and monitor progression in ability to a high quality of life and functioning and should be covered for Heart Failure and VAD patients so they will get moving and decrease comorbidity from

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cunningham, mark Title: Cardiothoracic Surgeon
Organization: University of Southern California
Date: 01/19/2006
Comment:

I would like to encourage you to consider cardiac rehab for patients with ventricular assist devices. Currently the majority of my patients with a ventricular assist device are sent home to wait for their heart transplant. During this period, cardiac rehabilitation is paramount to improve their clinical condition prior to transplant. In addition, a number of patients now receive a ventricular assist device as destination therapy. They are also severely deconditioned because of their

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Andrisin, Sharon L Title: Clinical Manager, Cardiac Rehabilitation
Organization: Parma Community General Hospital
Date: 01/19/2006
Comment:

This is terrific! The expanded diagnosis is very appropriate and will allow us to reach out and offer a comprehensive cardiac rehabilitation program to more cardiac patients.

Jensen/Rundman, Dennis/Joan Title: Director of Cardiopulmonary
Organization: Portage Health System
Date: 01/19/2006
Comment:

1. In response to the Centers for Medicare and Medicaid Services (CMS) proposed coverage memo regarding cardiac rehabilitation services being covered by Medicare as an “incident to” physician service, Portage Health System (PHS) of Hancock, MI does not support this proposed coverage. Located in a rural setting, PHS and the community would be in jeopardy of losing their program since the majority(>95%) of our referrals are received from the Cardiologists at our regional

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Kehoe-Huck, Beth Title: Ventricular Assist Device Nurse Coordinator
Organization: Barnes Jewish Hospital
Date: 01/19/2006
Comment:

While I applaude the decision to include patients who have undergone valve/PTCA/heart/lung transplantation for cardiac rehabiliation coverage, I feel that those suffering from congestive heart failure should also be covered. This population would include those patients who due to the severity of their heart failure end up requiring a Ventricular Assist Device,whether it be as a bridge to cardiac transplantation or as a destination therapy. Patients that are post VAD implant especially

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Combs, Michelle Date: 01/19/2006
Comment:

The importance of Cardiac Rehab in our Left Ventricular Device patient population is vital to their recovery and in preparation for transplant. Our patients benefit tremendously from cardiac rehab, which enables them to regain their strength and better enable them to be a successful transplant candidate, improve quality of life, and reduce hospitalizations post-implant.

Chillcott, Suzanne Title: BSN, RN, Lead Mechanical Assist Device
Date: 01/19/2006
Comment:

Dear Sirs,
It would be a huge disservice to not include the post-VAD implant patients in the group of patients that are elegible for Cardiac Rehab. Cardiac Rehab is critical for anyone that has been through VAD implant.
Thank you,
Suzanne Chillcott BSN, RN
Mechanical Assist Device Lead
Sharp Memorial Hospital

Grimm, Janet Organization: Decatur Memorial Hospital
Date: 01/19/2006
Comment:

This is a positive step toward meetin the needs of these patients. Your efforts are very much appreciated! Good Job.

Yeager, Michael Title: RN
Organization: Cleveland Clinic
Date: 01/19/2006
Comment:

The application of continued cardiac rehabilitation after hospitalization warrents consideration by CMS for inclusion in the indications for reimbursable therapies. This patient population evolves from groups of patients who have the requisit etioloigies that qualify for reimbursement under the traditional and anticipated reimbursement schemes. Definitive empiric studies have not been performed as of yet that are directed soley toward the interrelationship between cardiac assist devices

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paul, cynthia Date: 01/19/2006
Comment:

I have been involved with cardiac transplant and now mechanical assist devices since early 80's. Pt who are S/P LVAD need cardiac rehabilitation as much as a patient who has had a cardiac transplant. Since mechanical assist devices are relatively new one can understand why it has been excluded from the list of pts who NEED cardiac rehab. The data that supports cardiac rehab for cardiac transplant pts is pertinent to this group as well as we know from experience that a pt who has enrolled

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Banks, Jon Title: Director Presbyterian Healthplex
Organization: Presbyterian Healthcare Services
Date: 01/19/2006
Comment:

We feel Cardiac Rehab reimbursement for patients with a diagnosis of congestive heart failure should be included.

Congestive heart failure is an ominous disease and the prognosis is poor. Data from the Framingham Heart Study show that 60% of men and 40% of women are dead within four years of the initial diagnosis of congestive heart failure. According to the American Heart Association 2005 update of heart disease and stroke statistics, of the 13,000,000 Americans with coronary

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Bernabei, MD, Alvise Title: Director of Thoracic Transplantation
Organization: Henry Ford Hospital
Date: 01/19/2006
Comment:

Heart failure patients who require a left ventricular assist device would greatly benefit from post operative cardiac rehabilitation. CMS should cover this type of care.

Campbell, Matthew Title: CARDIOPULMONARY MANAGER
Organization: ST ANDREWS HOSPITAL AND HEALTHCARE CENTER
Date: 01/19/2006
Comment:

ST ANDREWS HOSPITAL CARDIOPULMONARY DEPARTMENT SUPPORTS THE PROPOSAL MODIFICATIONS FOR CARDIAC REHABILITATION COVERAGE. THE EXPANDED COVERAGE IS GREATLY NEEDED FOR OUR PATIENT POPULATION WITH LIMITED HEALTHCARE ACCESS. WE BELIEVE THE NEW DIAGNOSTIC GROUPS COVERED WILL ENHANCE PROGRAM EFFECTIVENESS AS A WHOLE. EVERY OCCASION TO IMPROVE PAIENTS OVERALL CARE AND QUALITY OF LIFE IS AN OPPOPRTUNITY NOT TO BE MISSED. THANK-YOU~

Shelton, Kimberly Title: RN Coordinator (VAD patient population
Organization: Barnes-Jewish Hospital
Date: 01/19/2006
Comment:

In my experience as a Ventricular Assist Device (VAD) Coordinator at our facility, I have found cardiac rehabilitation to be an invaluable tool in the post operative outpatient treatment plan of a ventricular assist device recipient. As is often the case, this patient population often suffers the ill-effects of profound congestive heart failure for an extended duration of time. Resulting from poor heart pump performance, deficits include inadequate nutritional intake, inactivity and

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weggeland, susan Title: R.N.
Organization: Memorial Hosp. West
Date: 01/19/2006
Comment:

We applaud CMS’ recognition that Percutaneous Transluminary Coronary Angioplasty should be included as an indication for coverage, as it is a treatment and not a cure for Coronary Artery Disease, along with Valve Repairs and Replacement and Heart and Heart-Lung transplants. We applaud CMS’ recognition that secondary prevention programs, such as Cardiac Rehabilitation Programs have “improved the processes of care, enhanced quality of life/functional status, reduced

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Thomure, Helen Title: Respiratoy Therapist
Organization: Hospital Cardia Rehab outpatient
Date: 01/19/2006
Comment:

I am a respiratory therapist in a very cardia program.We are truly concerned for those patients that we cannot admit due to their diagnosis. These patients probably need our help just as much as those who have had cardiac surgery or an MI. The intent is to keep them healthy so they don't require major surgery. The exercise and education that comes from these programs are often a life changing intervention that can make a differnce in their well being and lives. Cardiac Rehab impacts

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Bowser, Stephen A. Title: Interventional Cardiologist
Organization: Century Cardiac Care-UPMC
Date: 01/19/2006
Comment:

based on medicare guidelines, I do not feel it is necessary for a physician to be present during cardiac rehabilitation given the rehabilitation staff is ACLS provider certified. In addition, our schedule does not allow a physician to be present at all times during cardiac rehabilitaion hours, as we do cover multiple hospitals in our practice including routine and emergency cardiac catheterizations.Thank you!
Stephen A. Bowser, M.D.

Chough, Simon H. Title: Interventional Cardiologist
Organization: Century Cardiac Care-UPMC
Date: 01/19/2006
Comment:

based on medicare guidelines I believe there is no need for a physician to be present during cardiac rehabilitation sessions due to the fact that the staff is ACLS trained. It is very difficult to be present continuously during cardiac rehabilitation due to hospital coverage duties that may interfere with time allotted for cardiac rehabilitation. Simon H. Chough, M.D., F.A.C.C.

Pertzborn, Michelle Title: Clinical Exercise Physiologist
Organization: St. Marys Hospital
Date: 01/19/2006
Comment:

PCI diagnosis is a very important diagnosis for early education and prevention of CAD. Additional diagnosis would be benefical for patients.

Bijou, R Organization: Columbia-University Medical Center
Date: 01/19/2006
Comment:

What about heart failure, congestive heart failure, systolic dysfunction, diastolic dysfunction, right heart failure? You know the AHA facts: 5 million patients, 50% mortality at 5 years; millions in hospital costs. Who needs rehab more: a patient with single vessel coronary disease and a normal EF or a patient with chf who is deconditioned and can walk only a block or two? Who stands to gain more from a cardiac rehab program? The decision to exclude heart failure is dumb and NOT cost

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Andrus, Shauna Title: Mechanical Assist Device Coordinator
Organization: University of Washington Medical Center
Date: 01/18/2006
Comment:

The post-VAD implant patient is not included in your list of rehab patient coverage. These patients are sorely in need for several reasons. First, may patients are deconditioned due to their heart failure and secondly they have just undergone major open heart surgery to have a ventricular assist device placed as bridge to transplant. If they were to be covered for this their outcome from transplant would be much improved; their recovery from a second open heart procedure could

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Naka, Yoshifumi Title: Assistant Professor of Surgery
Organization: Columbia University - Surgery
Date: 01/18/2006
Comment:

Those who receive ventricular assist devices for either bridge to transplant or destination therapy are generally critically sick and severely debilitated before the procedure, and often require extensive rehabilitation. The recent draft for "Cardiac Rehabilitation Programs" does not cover this most challenging patients who are mostly benefitted by post operative rehabilitation. The lack of coverage by CMS for these patients is unacceptable.

Kohmoto, Takushi Title: Director, Mechanical Assist Device Program
Organization: University of Wisconsin Hospital and Clinics
Date: 01/18/2006
Comment:

I take care of many patients who have left ventricular assist device for the treatment of end-stage heart failure. The need of devices are rapidly increasing and more patients are having such device. Because of the deconditioned status from preoperative heart failure, almost all such patients require cardiac rehabilitation. I believe the needs are more than routine cardiac surgery patients. Therefore, I would like to request cardiac rehabilitation is covered for patients who received

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Sample, Susan Date: 01/18/2006
Comment:

Please include congestive heart failure patients in your coverage especially those who are post-VAD implant. Cardiac rehab is essential for them to recover and stabilize after this surgery.

Paquin, Gregory Date: 01/18/2006
Comment:

Please recosider including Ventricular Assist Device (VAD) patients for riembursement for cardiac rehab. VAD patients undergo surgery as or more debilitating as valve replacement and Heart transplant. Especially with the inclusion of coverage for destination VADs, these patients will spend less time in hospital and quicker return to function with the assistance of a monitored rehab program.

Slaughter, Mark Title: Director Mechanical Assist Device program
Organization: Advocate Christ Medical Center
Date: 01/18/2006
Comment:

LVAD patients for destination therapy are as debilitated or more so than transplant candidates. Cardiac rehab is very important in the overall long term success for the patient with a permanent VAD. Not only do they want to be able to lie flat and breathe easier, but want to be able to go for walks and enjoy the benefits of their increased cardiac output. I believe that cardiac rehab should be covered for Destination Therapy as well.

Bonner, Susan Date: 01/18/2006
Comment:

I applaud the recognition for additional coverage for Cardiac Rehab. I would encourage consideration to extend coverage to those that have received VAD therapy. I firmly believe it would greatly benefit those in bridge to transplant as well as end destination therapy. These patients are deconditioned physically and emotionally with a great deal to gain from an exercise program, risk factor modification and psychosocial support. Thank you.

Grady, Kathleen Title: Administrative Director, Center for Heart Failure
Organization: Northwestern Memorial Hospital, Chicago, IL
Date: 01/18/2006
Comment:

Please consider covering post ventricular assist device (VAD) patients for cardiac rehabilitation as well. VAD patients are often in need of cardiac rehabilitation to assist them during the recovery process.
Kathleen L. Grady, PhD, RN

Loo, Alice Title: nurse practitioner
Organization: Jackson Memorial Hospital
Date: 01/18/2006
Comment:

Please consider the population of patients who have undergone artificial heart surgeries ( i.e left ventricular assist device) as a category for medical coverage.This population of patients are recieving assistive implant devices which support the cardiac function. In most cases, patients are discharged from the hospital and recieve mechanical support at home. Without cardiac rehabilitation and in rare cases,occupational therapy options, they maybe require expensive and extensive length

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Frey Carrier, Amy Organization: Inova Fairfax Hospital/Inova Ht and Vasc Institute
Date: 01/18/2006
Comment:

I agree with the expanded coverage in the DRAFT National Coverage Determination (NCD), however I believe there has been an oversight related to Heart Failure patients. I believe patients whoare post-VAD implant should also be covered for Cardiac Rehabilitation and respectfully request amendment to the NCD before finalizing this policy.

Rago, Karen Title: Administrative Director heart and Vascular Center
Organization: University of California San Francisco
Date: 01/18/2006
Comment:

I believe that Heart failure and Post Ventricular Assist Device Implant patients should be considered for Cardiac Rehab. These patients will benefit from the rehabilitation that should decrease hospital admissions and increase their quality of life.

Duvall, Daniel Title: CMD
Organization: Riverbend (Medicare FI)
Date: 01/18/2006
Comment:

Section:  C – Program Requirements

Proposed: Duration
Services provided in connection with a cardiac rehabilitation exercise program may be considered reasonable and necessary for up to 36 sessions without individual review by a contractor’s medical consultant. Patients generally receive 2 to 3 sessions per week for 12 to 18 weeks. Claims for cardiac rehabilitation services beyond 18 weeks should be reviewed by the contractors’ medical consultants to determine if coverage should

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Smith, Kenrick Title: Supervisor of cardiac Rehabilitation
Organization: Memorial Hospital
Date: 01/18/2006
Comment:

We applaud CMS’ recognition that Percutaneous Transluminary Coronary Angioplasty should be included as an indication for coverage, as it is a treatment and not a cure for Coronary Artery Disease, along with Valve Repairs and Replacement and Heart and Heart-Lung transplants. We applaud CMS’ recognition that secondary prevention programs, such as Cardiac Rehabilitation Programs have “improved the processes of care, enhanced quality of life/functional status, reduced

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Ballew, Carole Title: Heart Failure/Transplant Coordinator
Organization: University of Virginia Health System
Date: 01/18/2006
Comment:

Dear Madam and Sirs,I work with heart failure, heart transplant and ventricular assist device patients. There are resources available to this population on a very limited basis. Inpatient and in-home physical therapy are available but this isn't not enough. A patient's rehabilitation and reintigration into society is stunted by lack of financial coverage for outpatient rehab. I believe it is important for CMS to consider covering. I don't know why there is coverage for patients who are

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McMellon, RN, Tollea Title: Transplant Coordinator
Organization: Medical City Dallas Hospital
Date: 01/18/2006
Comment:

would like to see cardiac rehabilitation covered for patients who receive a left ventricular assist device, they have the same rehab needs as a cardiac bypass patient or valve patient

Chen, Leway Title: Director, Program in Heart Failure and Transplant
Organization: University of Rochester Medical Center
Date: 01/18/2006
Comment:

As a former director of our cardiac rehab, a heart failure cardiologist, and a site-PI for the HF-ACTION study, I am biased about cardiac rehab in HF, transplant, and VAD patients. I'm am very pleased that you are extending coverage to post-valve surgery, post-transplant, and post-PCI patients. I am hopeful that you will extend coverage to the HF population. I have personally seen great results from cardiac rehab in HF patients (patients covered by commercial insurers, those given

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Herzog, Tracy Title: Director of Health and Fitness
Organization: Memorial Regional Hospital
Date: 01/18/2006
Comment:

We applaud CMS’ recognition that Percutaneous Transluminary Coronary Angioplasty should be included as an indication for coverage, as it is a treatment and not a cure for Coronary Artery Disease, along with Valve Repairs and Replacement and Heart and Heart-Lung transplants. We applaud CMS’ recognition that secondary prevention programs, such as Cardiac Rehabilitation Programs have “improved the processes of care, enhanced quality of life/functional status, reduced

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Edwards, Susan Title: Program Manager
Organization: LifeStyle Center of Alamance Regional Medical Center
Date: 01/18/2006
Comment:

CMS is to be congratulated for the efforts to revamp the requirements and coverage regarding cardiac rehabilitation programs. These updates truly reflect the US Public Health Service definition of cardiac rehabiltation:

"comprehensive, long-term programs involving medical evaluation, prescribed exercise, cardiac risk factor modification, education and counseling." These programs are "designed to limit the physiological and psychological effects of cardiac illness, reduce the risk of

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Reep, Kathy Title: Vice President
Organization: Florida Hospital Association
Date: 01/18/2006
Comment:

The Florida Hospital Association appreciates the work that CMS has put into the development of this proposed coverage decision related to outpatient cardiac rehabilitation. We are concerned, however, with the clarification that the "incident to" physician is the ordering physician. The "incident to" regulations require a face-to-face encounter with the "incident to" physician during the course of the cardiac rehab treatment. This proposed clarification would limit this interaction with only

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Harshbarger, Dave Date: 01/18/2006
Comment:

As someone who has been involved in cardiac rehab type programs for years and also directing the Dr Dean Ornish Program, I find it irresponsible for Medicare to consider lumping the Ornish Program in with standard cardiac rehab and similar reimbursement.

Having seen first hand the incredible outcomes from patients in the Ornish Program and how much better they do than in typical cardiac rehab, it is like comparing apples to oranges. Cardiac rehab is a program for people who have

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Pluskis, Laura Title: Supervisor Cardiac and Pulmonary Rehab
Organization: Memorial Hospital West
Date: 01/18/2006
Comment:

We applaud CMS’ recognition that Percutaneous Transluminary Coronary Angioplasty should be included as an indication for coverage, as it is a treatment and not a cure for Coronary Artery Disease, along with Valve Repairs and Replacement and Heart and Heart-Lung transplants. We applaud CMS’ recognition that secondary prevention programs, such as Cardiac Rehabilitation Programs have “improved the processes of care, enhanced quality of life/functional status, reduced hospitalizations, reduced

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Loberg, Rachel Title: Director of Inpatient Care
Organization: The Wisconsin Heart Hospital
Date: 01/17/2006
Comment:

I have worked with cardiac patients for over 15 years in a variety of settings from inpatient hospital, private cardiac surgery and cardiology practices. It is my firm belief that Phase II Cardiac Rehab is not only beneficial to post-angioplasty/stent patients as well as patients recovering from valve repair/replacement surgery it is essential for a speedy and complete recovery. It also increases the long term compliance with risk factor reduction and healthy living. By participating in

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Green, Kerry Date: 01/17/2006
Comment:

It is with great enthusiasm that I welcome the long overdue expanded national coverage of cardiac rehabilitation for Medicare beneficiaries who have had heart valve repair or replacement, PTCA, and heart transplant. As director of a Cardiac Rehab Program over the past 25 years I have had many cardiac patients take advantage of the benefits of a regular, structured exercise program, as well as the thorough education sessions that accompany the program. Next add CHF.

Choitz, Amy Title: Cardiopulmonary Rehablitation Nurse
Organization: Hays Medical Center
Date: 01/17/2006
Comment:

Cardiac Rehabilitation has a unique oppurtunity in helping the persons that have been afflicted with CAD and Valvular disease learn to manage there health and help those patients make positive lifestyle changes thus reducing re-event and re-hospitalizations. The outcomes that we have seen with all these individuals have been very positive. I applaud the extension of coverage proposal, and look forward to its finalization.

Classick-Wallace RN, Maryann Title: Director of Non Invasive Cardiology
Organization: Our Lady of Lourdes Medical Center
Date: 01/17/2006
Comment:

Medicare reimbursement should reflect the best of science. It is only fair that we provide people with the exercise and monitoring they need to cope with their coronary artery disease and valve disease independent of their course of treatment. A bypass patient has a scar on their chest to remind them everyday that they need to modify thier risk factors. A person who has been to the cath lab for a stent may be left with the impression that they have been "fixed" in the lab and that they

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Arnold, R.N., Lisa Title: Director of Cardiac Rehab
Organization: Cardiovascular Associates, P.S.C.
Date: 01/17/2006
Comment:

As director of three cardiac rehab facilities and a cardiac nurse with 17 years of rehab experience, I am extremely pleased at the proposal of expanding the covered diagnoses and time frame for cardiac rehab. I have witnessed countless number of patients denied the clinically proven benefits of cardiac rehab due to lack of coverage based on their diagnosis. I would, however like to see clarification of direct supervision for rehab in a free standing facility or physician’s office.

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Koscielak, Karlene Title: Coodinator, Cardiac Rehabiliation
Organization: University Medical Center Measabi-Fairview
Date: 01/16/2006
Comment:

As program coordinator for cardiac rehab, I am extremely pleased that the CMS is considering expanding it's coverage to include PTCA, valve replacement, and transplants. CAD is enveloping a younger and younger population with devastating effects. The expanded coverage being proposed would allow us to reach a much broader population and help stress the importance of lifestyle modification. I have to agree with an earlier comment, it is very difficult to inform a patient that is desperate

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Christian RN, BSN, Cindy Title: Coordinator of Cardiac/Pulmonary Rehab
Organization: Phleps County Regional Medical Center
Date: 01/16/2006
Comment:

I sincerely hope the CMS will expand the Cardiac Rehab services as outlined. We serve a five county area here in Rolla, MO. As the Coordinator of the department it cuts me to the core when I have to tell individuals they are not covered by MC for our program. These individuals are seeking rehab to better their life styles and change behaviors. Expanding the coverage to a greater number of beneficiaries with cardiac illness is a win - win situation for all of us.

Houston, Vincent Title: Exercise Physiologist
Organization: Health Enhancement
Date: 01/14/2006
Comment:

Expanding the coverage criteria for cardiac patients to receive a service that does more for them than most medication is to be applauded. The duration of time for 36 sessions should also be mandated to all HMO's and insurance companies. It takes time for patients to make life changes. The staff at cardiac rehabilitation facilities are able to provide the knowledge and support that patients need to achieve the necessary changes. The requirement for direct physician presence on the

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Wollard, Robin Title: Cardiopulmonary Rehabilitation Staff RN
Organization: Bothwell Regional Health Center
Date: 01/13/2006
Comment:

I am very pleased to see the consideration of expanded diagnosis to provide Cardiac Rehab services. My experience as Critical Care Nurse for 18 years showed me the frequent offenders were not the clients who were well educated about heart disease through cardiac rehab. As a cardiac rehab nurse, I see first hand the benefits of education and exercise and we frequently turn down clients for cardiac rehab services who were prudent in getting checked out and stented prior to having a heart

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Roy, Brad Date: 01/13/2006
Comment:

I applaud the proposal to include heart valve repair/replacement, percutaneous transluminal coronary angioplasty and heart or heart lung transplant as eligible conditions for cardiac rehabilitation. I am also happy to see additional weeks being added in order to complete the 36 sessions as I feel the longer programs can keep in contact with patients the better the outcomes will be. Ideally I would like to see the time period to achieve the 36 sessions extended to 26 weeks.

Further

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Rich, Catherine Title: Cardiac Rehab Program Coordinator, RN, MSN
Organization: MidState Medical Center
Date: 01/13/2006
Comment:

I am commenting on behalf of our department and Medical Director. We strongly support the addition of diagnoses of heart valve replacement/repair, angioplasty and heart/heart-lung transplant. We have encountered many of these patients who would have benefited greatly from our services.

Miller, Allen Title: Administrator, Cardiovascular Service line
Organization: Provena St. Joseph Medical Center
Date: 01/13/2006
Comment:

I feel very positive that coverage for these programs. Most patients do not get referred or pursue rehab after angioplasty because it was not covered. This left many patients to truely go without good medical attention to reduce their risks and promote good health. Rehab programs have demonstrated that when properly done, the patients health and recovery is substantiall improved. I fully support this initiative.

Priggemeier, Mary Title: RN
Organization: Burdette Tomlin Memorial Hospital
Date: 01/13/2006
Comment:

I am a registered nurse currently working in the pulmonary rehab department in our hospital. I also work closely with the cardiac rehab team and have witnessed first hands it tremendous benefits both physically and mentally for our patients having under gone heart surgery. I strongly believe that adding addition covered diagnosis such as valve replacement, PTCA, and heart transplant is essential! The benefits of reducing hospitalizations and increased patient education and improved

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garant, walt Date: 01/13/2006
Comment:

HI, I AM A RESPIRATORY THERAPIST AND I RUN THE PULMONARY REHAB PROGRAM AT MY FACILITY. BASED ON THE RESULTS I HAVE SEEN I KNOW THE BENEFIT OF CARDIAC AND PULMONARY REHAB PROGRAMS. PLEASE APPROVE THIS PROPOSAL. PATIENTS WILL BENEFIT FROM ALL OF THIS. THANK YOU WALT

Smith, Katie Title: Cardiac rehab coordinator
Organization: Harrison County Community Hospital
Date: 01/12/2006
Comment:

In regards to "incident to": I am the coordinator for a rural cardiac rehab program. It would create a burden for the rural facilities and cardiologist if our program would have to rely on the ordering physician as the one referred to as "incident to" Our cardiologist are 90-100 miles from us. It would also create a burden for them. Our referrals come from the cardilogists and then I contact their attending. From there, the patients are enrolled in our program. They are followed by

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Davis, Mary Title: President
Organization: Virginia Association of Cardiovascular and Pulmonary Rehabilitation
Date: 01/12/2006
Comment:

I appreciate the proposed expanded diagnoses that will capture more patients needing the benefit of cardiac rehabilitation. It is possible that a patient is cared for by more than one physician:ie, a patient with diabetes that had an MI and needed CABG could possibly be cared for by a CV surgeon, a cardiologist, as well as a primary care physican, and overseen in the Cardiac Rehab by the Medical Director. Incident to should be covered by the MD supervising the patient's progress to

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Kuhn, Barbara Title: Clinical Nurse Manager
Organization: Provena St. Joseph Hospital
Date: 01/12/2006
Comment:

As a cardiac rehab director, I am in agreement with the proposal for cardiac rehab programs to expand coverage,comprehensive services, and indications for coverage. I also agree with the duration of coverage proposal and definition. Thank you very much

Fleming, Pam Date: 01/12/2006
Comment:

I am glad to see the proposed changes to cardiac rehabilitation coverage. The expanded coverage will be beneficial to all Medicare patients and will aid in their quicker recovery.

Stricklen, Miguel Date: 01/12/2006
Comment:

I am glad to see the proposed changes to cardiac rehabilitation coverage. The expanded coverage will be beneficial to all Medicare patients and will aid in their quicker recovery.

Hamilton, Audra Date: 01/12/2006
Comment:

I am glad to see the proposed changes to cardiac rehabilitation coverage. The expanded coverage will be beneficial to all Medicare patients and will aid in their quicker recovery.

Hamilton, Mike Date: 01/12/2006
Comment:

I am glad to see the proposed changes to cardiac rehabilitation coverage. The expanded coverage will be beneficial to all Medicare patients and will aid in their quicker recovery.

Hamilton, Angela Date: 01/12/2006
Comment:

I am glad to see the proposed changes to cardiac rehabilitation coverage. The expanded coverage will be beneficial to all Medicare patients and will aid in their quicker recovery.

Green, Marjorie Date: 01/12/2006
Comment:

I am glad to see the proposed changes to cardiac rehabilitation coverage. I hope that you follow through with the expanded coverage. I believe it would be beneficial to all patients covered by Medicare and would aid in their recovery and future prevention.

Hoehn, Michael Title: Cardiopulmonary Rehab Director
Organization: Mary Rutan Hospital
Date: 01/12/2006
Comment:

As program director for a small rural facility, I am both encourage to see the progress in the proposed NCD for cardiac rehab, yet dismayed at some of the continuing language seen the memo. The added diagnoses, the expanded time frame for session visits and the clarification of direct supervision are very positive revisions. However, the decision to keep coverage of services as "incident to" only the ordering physician is too narrow in its scope.

In our experience, routine progress and

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behrendt,md, douglas Title: professor of surgery
Organization: u of iowa
Date: 01/12/2006
Comment:

I strongly support the proposal to include patients who have had heart transplant, valve surgery, coronary bypass and catheter intervention as eligible to receive Phase II Cardiac Rehabilitation.This clearly allows patients to return to full function earlier than if they co not receive these seervices.

Friedman, Jeff Title: Director, Clinical Services
Organization: Morton Plant Mease Health CAre
Date: 01/12/2006
Comment:

As Director of Clinical Services for a health system serving more than a hundred patients each week in our cardiac rehab program, I am pleased with CMS' recommendation to expand coverage for valve surgery, transplants, and PTCA. Cardiac rehab has demonstrated its benefits in providing meaningful clinical improvement for patients with CV disease and this expansion will further benefit that population.

I have to add, however, that direct physician supervision is problemmatic and

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O'Hanley, Stephanie Title: Coordinator Cardiopulmonary Rehab
Organization: Newport Hospital A Lifespan Partner
Date: 01/12/2006
Comment:

The future of cardiac rehab will be in jeopardy if the proposed "incident to" physician is the ordering physician. Hospital based programs have access to many physicians in addition a Medical Director, both RN's and MS exercise physiologist have ACLS certification. This requirement for a face-to-face encounter will strangle cardiac rehab programs moreover, cardiac rehab well documented benefits is NOT due to what is the physician service.

Boehm, Neissa Title: Cardiac Rehab Registered Nurse
Organization: University Medical Center Mesabi
Date: 01/11/2006
Comment:

I am a cardiac rehab nurse. The benefits of cardiac rehabilitation are so profound. It is amazing to see how quickly people are feeling even better than they were before their surgery. Many say they feel better than they have for years. These patients really improve not only their physical endurance and quality of life but they make lifestyle changes. They quit smoking, start eating healthier and learn not to be as stressed. It helps with the post surgical depression that is often seen by

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Yoder, Lamont Title: VP Patient Care Services
Organization: Morrow County Hospital
Date: 01/11/2006
Comment:

Requiring the "incident to" physician to be the ordering physician is extremely disconcerting as it narrows the facilities and geographic areas of the country where this is not feasible as it may be the primary care physician or medical director of the rehab program that is having face-to-face time with the patient during rehab. We need flexibility with this requirement.

Parikh, M.D., Ketan P Title: Attending Cardiologist
Date: 01/11/2006
Comment:

I applaud CMS decision to cover cardiac rehab to new categories. Majority if not all of my patients have stated they truly enjoyed rehab and felt better faster and felt stronger once rehab was completed. They also commented on the learning initiatives made in the class. It is so important to educate your patients about diet and exercise and what better place to have a second chance at life. I think it would be a tragedy if CMS does not expand the coverage.

Williams, Steve Title: NM, Cardiac Rehab
Organization: Tanner Medical Center
Date: 01/11/2006
Comment:

The suggested changes to the medicare guidelines in reference to cardiac rehab would be a major improvement. If approved, it would greatly benefit medicare recipients who are not able to afford this service. I do not agree with the thoughts of having constant physician supervision. Currently at my facility all staff are acls certified and we have physicians who are readily available. I believe if this concept were to be implemented it would place many programs in jeopardy of closing. A

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COOPER, RN, DARLENE Title: Cardiac Rehabilitation Program Coordinator
Organization: St. Joseph Medical Center
Date: 01/11/2006
Comment:

Working as a Cardiac Rehab RN, I have seen the need for expanded CR services firsthand. Many Medicare patients who have had valve surgeries have suffered through a long and inadequate recovery because they could not afford to pay for CR services. PTCA patients can also benefit through education and heart strenthening exercises thus helping to delay or prevent further cardiac complications. As for transplant patients, the need is obvios. Thank You.

Matteson, Betty Title: Program Director, Cardiac Rehabilitation
Organization: UNC Health Care
Date: 01/11/2006
Comment:

I strongly urge CMS to approve coverage for AVR, PCI, and heart/lung transplant in addition to the diagnoses presently reimbursed by Medicare. Making cardiac rehabilitation services available to patients in these diagnosis groups will improve patients' quality of life and may, in the long term, save health care dollars. It is both the right thing and the expedient thing to do.

williams, chad Title: MD
Organization: UIHC
Date: 01/11/2006
Comment:

I strongly support the proposal to include patients who have had heart transplant, valve surgery, and catheter intervention as elgible to receive phase II Cardiac Rehablitation.

Marichak, M.S., Amanda Title: Clinical Exercise Physiologist
Organization: Westchester Cardiac Rehabilitation
Date: 01/11/2006
Comment:

I am an exercise physiologist at a cardiac rehabilitation program in Scarsdale, NY. I just wanted to thank you for a job well done on proposing extended diagnosis from Medicare for cardiac rehab. I am happy our profession has such devoted, hard working individuals working on our patient's behalf at levels alot of us cannot go. I appreciate your efforts and keep up the great work.

Miller, Karen Title: Cardiac Rehab
Organization: Maury Regional Hospital
Date: 01/10/2006
Comment:

I work in a Cardiac Rehab Department. My patients are typically post CABG, post MI, or has stable angina. Why would a physician be needed in the gym area when these patients are stable and not needed in the ICU or CCU area. This makes not sense. All CR staff are ACLS trained and very capable to work with stable patients.

An in-house physician should all that is needed for supervision. Thank you

Princell, Catherine Title: Cardiac Rehab Director RN/MS
Organization: Blue Hill Memorial Hospital
Date: 01/10/2006
Comment:

I think clarification should be made for the "incident to"clause. Is it the Primary Care physician or the cardiologist that this order is "incident to" or can it be either?

I think physician supervision as long as it is in the same facility and is immediately available is more reasonable than a physician in the room or next door at the time the rehab sessions are being held. As long as an emergency reponse team that includes a physician is part of the process and a policy to that

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martins, james Date: 01/10/2006
Comment:

I strongly support the proposal to include patients who have had heart transplant, valve surgery, and catheter intervention as eligible to receive Phase II Cardiac Rehabilitation.

Hinton, Terry Title: MA, RCEP, Clinical Coordinator
Organization: Johnson City Medical Center
Date: 01/10/2006
Comment:

There are many proven benefits for individuals attending a cardiac rehab program. Regardless of age, we know that a structured program including education, exercise and behavioral management can be effective in decresing the cost and occurance of future intervention. There is much support for the efficacy and implementation of structured programs for PTCA, valve repair/ replacement, and heart/ lung transplantaion.

The measured outcomes for post-bypass surgery patients, stable

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Breiner, Timothy Title: Cardiac Rehabilitation Coordinator
Organization: Wooster Community Hospital
Date: 01/10/2006
Comment:

I am strongly in favor of the proposed CMS changes concerning coverage of cardiac rehabilitation. The expanded diagnoses will insure that patients who have a true need for these services will have access to them. The changes in requirements for physician supervision remove an undue burden from many cardiac rehab programs while at the same time insuring that patients receive high quality care in a safe environment.

Elliott, Kim Title: Senior Cardiopulmonary Rehabilitation Nurse
Organization: Burdette Tomlin Memorial Hospital
Date: 01/10/2006
Comment:

Thank you for considering expansion for patients with heart valve repair, PCI and heart transplant. Risk factor management is no less critical for these patients than those with Angina, CABG or MI. We have treated younger patients with valve/transplant/PCI covered by other insurances with outstanding outcomes. I have been working in a hosptial based rehabilitation for the past 13 years. Patients consistenty report their success stories to staff, administration, families, physicians as well

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Rossen, James Date: 01/10/2006
Comment:

I strongly support the proposal to include patients who have had heart transplant, valve surgery, and catheter intervention as eligible to receive Phase II Cardiac Rehabilitation.

welsh, kevin Title: exercise physiologist
Organization: St marys medical center
Date: 01/10/2006
Comment:

These programs serve as umbrella lifestyle modification programs and for years have demonstrared with great success what the entire realm of Disease Management is trying to accomplish today by looking at the economic toll of poorly managed chronic diseases of which cardiac disease is so manifest in the population as a whole.

Kobienia, Randy Title: Clinical Exercise Physiologist
Organization: Rice Memorial Hospital
Date: 01/10/2006
Comment:

I wish to voice my support for the proposed changes to covered diagnoses for Cardiac Rehabilitation programs. I have worked in cardiac rehab for the past 8 years and have seen first hand how the service of cardiac rehab has benefitted those patients who undertook the rehabilitation. One of the determining factors in participation is insurance coverage. By expanding coverage to those disease conditions stated, it would benefit a large number of individuals in our region. Please consider

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Haag, Joyce Date: 01/10/2006
Comment:

Cardiovascular disease remains our number 1 health problem. Congestive Heart Failure specifically accounts for more hospitalizations than any other diagnosis. Cardiac rehab focuses on longterm behavior changes that reduce morbidity and mortality. Studies are very clear about the incidence of depression following a cardiac event. Data clearly show a reduction in depression in those individuals participating in cardiac rehab programs. Telling a patient to "Just go out and walk." or "Follow

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Bockol, Faith Title: Registered Nurse, Exercise Physiologistq
Organization: Our Lady of Lourdes
Date: 01/10/2006
Comment:

By broadening the patient population, I believe that we will be able to help alot of patients and their families, that previously have been left out. Cardiac rehab is more than exercise and I believe anyone with a cardiac related diagnosis should be eligible to enter into a cardiac rehab program, as the education and positive re-inforcement of healthy lifestyle changes is valuable for all cardiac patients. Our goal in cardiac rehab is to help patients and their families modify their risk

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Callandrillo, Gail Title: VIce President, Planning and Market Research
Organization: The Valley Hospital
Date: 01/10/2006
Comment:

The Valley Health System, Ridgewood, New Jersey would like to go on record in support of the CMS proposed changes to Cardiac Rehabilitation Program coverage.

Cardiac Rehabilitation/Secondary Prevention programs are well established programs that are important, efficient venues to which exercise therapy, education and other rehabilitative services can be delivered to an individual by competent professionals in a safe and well monitored environment. The proposed decision to include the

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kerber, richard Title: MD
Date: 01/10/2006
Comment:

I strongly support the proposal to include patients who have had heart transplant, valve surgery, and catheter intervention as eligible to receive Phase II Cardiac Rehabilitation.

Proffitt, Sally Title: Cardiac Rehab Supervisor
Organization: Health Hearts Coliseum Medical Center
Date: 01/10/2006
Comment:

Agree "whole heartily" with expanded diagnoses coverage. I also feel CHF should still be considered. I have seen from personal experience the difference it can make in people's lives.The removal of some problematic language regarding direct supervision is also a very positive change. As a hospital based facility with a Medical Director I see the importance of including other physicians as direct supervision. Our director is always available to assist when a patient is having problems,

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Chase, John Title: Staff Physician
Organization: University of Iowa Hospitals and Clinics
Date: 01/10/2006
Comment:

I strongly support the proposal to include patients who have had heart transplant, valve surgery, and catheter intervention as eligible to receive Phase II Cardiac Rehabilitation.

Coons, Lois Title: Director Cardiovascular Services
Organization: Mary Rutan Hospital
Date: 01/10/2006
Comment:

I have supervised a hospital based Cardiopulmonary Rehab program for 23 years and have witnessed its benefits. I am totally opposed to the CMS proposal regarding the "incident to" physician language meaning the ordering physician. I manage a community hospital program and many of our patients are direct referals from an interventional center in a city 50 miles away. Those patients would never consider driving that far to participate in an outpatient program nor do they have a reason to be

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Richenbacher, Wayne Title: Professor
Organization: The University of Iowa
Date: 01/10/2006
Comment:

I strongly support the proposal to include patients who have had a heart transplant or valve surgery as eligible to receive Phase II Cardiac Rehabilitation.

mark, allyn Title: Professor of Medicine (Cardiology)
Organization: University of Iowa Hospitals and Clinics
Date: 01/09/2006
Comment:

I strongly support the proposal to include patients who have had heart transplant, valve surgery, and catheter intervention as eligible to receive Phase II Cardiac Rehabilitation.

GEMME, DONNA Title: Director: Cardiovascular Ambulatory Services
Organization: UMassMemorial Medical Center
Date: 01/09/2006
Comment:

Cardiac Rehab programs are vitally important to facilitate recovery and education toward maintaining health lifestyles following cardiac events. Adding PCTA and cardiac valve surgery and transplants will increase compliancein changing behaviors and through support may decrease reocclusion in CAD patients. I have been caring for Cardiovascular patients for over 25 years, cardiac events continue to occur in the ages between 30-50-and this population needs attention to educate and prevent

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Jagasia, Dinesh Title: Staff Physician
Date: 01/09/2006
Comment:

I strongly support the proposal to include patients who have had heart transplant, valve surgery, and catheter intervention as eligible to receive Phase II Cardiac Rehabilitation.

Brown, Donald Title: M.D., Director of EKG/Treadmill laboratory
Date: 01/09/2006
Comment:

I strongly support the proposal to include patients who have had heart transplant, valve surgery, and catheter intervention as eligible to receive Phase II Cardiac Rehabilitation.

Olshansky, Brian Title: Professor of Medicine
Organization: Univ. of Iowa
Date: 01/09/2006
Comment:

I strongly support the proposal to include patients who have had heart transplant, valve surgery, and catheter intervention as eligible to receive Phase II Cardiac Rehabilitation.

Robinson, MD, MPH, Jennifer Title: Assoc Prof & Director, Lipid Research Clinic
Organization: University of Iowa
Date: 01/09/2006
Comment:

After going to the expense of the performing the procedures on these patients Medicare should ceratinly cover the costs of cardiac rehabilitation to increase the probability that patietns will survive to enjoy the benefits.

Kienzle, Michael Title: Staff Cardiologist
Organization: University of Iowa Hospitals and Clinics
Date: 01/09/2006
Comment:

I strongly support the proposal to include patients who have had heart transplant, valve surgery, and catheter intervention as eligible to receive Phase II Cardiac Rehabilitation. There is strong evidence to support its use. I am anxious to be able to offer rehab to my patients in these categories.

Michael Kienzle, MD
Staff Cardiologist
University of Iowa Hospital
Brennan, Theresa Organization: University of Iowa Heart Care
Date: 01/09/2006
Comment:

I strongly support the proposal to include patients who have had heart transplant, valve surgery, and catheter intervention as eligible to receive Phase II Cardiac Rehabilitation. THis is a very important part of their medical care

Haynos, William Title: Assistant Professor, Medicins/Cardiology
Organization: University of Iowa Hospitals and Clinic
Date: 01/09/2006
Comment:

I strongly support the proposal to include patients who have had heart transplant, valve surgery, and catheter intervention as eligible to receive Phase II Cardiac Rehabilitation.

Thamm, Michelle Title: Exercise Specialist
Organization: SMDC Health System
Date: 01/09/2006
Comment:

I am quite excited to hear that you are reconsidering adding back the PTCA/Stent coverage by medicare. I am also just as delighted to know you are considering valve and heart/lung transplants. Each of these diagnoses would benefit from the Cardiac Rehabilitation programs and the comprehensive therapy sessions offered. Please keep me updated on any further actions that take place from here on out regarding the coverage of these diagnoses.
Thanks, Michelle Thamm, MA

Gaynor-Peterson, Deidre Title: Exercise Specialist
Organization: SMDC Health System
Date: 01/09/2006
Comment:

I am requesting that the CMS ammend coverage for Cardiac Rehabilitation porgrams as per the preposal. This would allow patients to receive necessary and beneficial care. Thank you, Deidre
Gaynor-Peterson, M.S.

Lillard, Marianne Title: RN, director Cardiac Rehab
Organization: Dartmouth Hitchcock Medical Center
Date: 01/09/2006
Comment:

It makes tremendous sense to finally include patients who have had coronary artery interventions in the coverage group for cardiac rehab services, as they obviously have significant coronary artery disease. The language for this coverage is vague, however.It would be more appropriate to state that coverage is extended to those who are s/p PCI ( percutaneous coronary intervention) which would include stents, not just PTCA procedures.

cheek, sheri Title: Clinical Coordinator, RN, BSN
Organization: RRMC
Date: 01/09/2006
Comment:

Request that the new policy for adding PTCA clarifies those patients who received stents which is our most common treatment for coronary blockages.

Hudgins, Tom Title: Administrator/CEO
Organization: Pinckneyville Community Hospital
Date: 01/09/2006
Comment:

I wish to applaud the proposed changes which will allow us to return to providing supervised cardiac rehabilitation for Medicare patients. Many of the patients returning to our area either did not actively exercise or used our fitness center ( where we have an AED but do not have ACLS trained nurses ). Allowing our ACLS trained nurses to oversee the aerobic exercise portion with physician availability, as provided for in the proposed NCD, will permit our patients the opportunity for optimal

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Ball MD, Charles Title: Medical Director
Organization: Maury Regional Hospital
Date: 01/09/2006
Comment:

I am the medical director at a mod-large regional rural hospital in Middle Tennessee. Our cardiac rehab program has been active for several years. I disagree with the requirement of the need for constant physician supervision. This has proven costly to the organization with no benefit in patient care, safety, or outcomes. The nursing and rehab personnel are highly trained and have easy access to the referring physician who knows the patient best. Also with the availability of the Emergency

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Recker RN, Debra Title: Cardiac Rehab Nurse Manager
Organization: Buchanan County Health Center
Date: 01/09/2006
Comment:

Thank you very much for the opportunity to comment. As a Cardiac Rehab RN 15+ years, I have seen my patients benefit significantly from Cardiac Rehab- whether they have had bypass surgery, stents, or MI. I have yet to witness any untoward events that needed a physician present. In fact, I had less supervision of MD in the Critical Care unit, where I administered IV drug infusions! I am so happy to see this problem of physician involement being addressed, as well as coverage of PTCA and

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Prentice, Kellie Date: 01/09/2006
Comment:

I have seen first hand the difference CR has made in the lives of those patients with valve repair/replacement, heart transplant and angioplasty. These patients recover faster, have better outcomes physically, emotionally, and are able to return to work faster. CR provides patients with the educational components to assist patients in making lifestyle changes to improve overall health and prevent further heart disease. I believe that the proposed changes to Medicare coverage would be of

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Griffin, Jennifer Title: Cardiac Rehab Program Manager
Organization: Southern Regional Medical Center
Date: 01/09/2006
Comment:

Following AMI and/or CABG surgery, many patients are "too sick and debilitated" to attend an outpatient cardiac rehab program. Instead, they receive physical therapy at home. They also practice the exercises prescribed by the physical therapist on their own. There is no physician present or even in the area when this occurs. The patient may receive therapy for weeks before they are actually strong enough to benefit from a more structured exercise program in an outpatient setting. Yet, when

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Denecke, Shari Date: 01/09/2006
Comment:

As an master's prepared exercise physiologist with 17 years of clinical experience with cardiac rehab patients, I have seen over and over again the benefits a monitored, well designed exercise program can provide to patients with any heart ailment... from CABG, MI, PTCA, Cardiomyopathy, CHF, transplant, etc. I would hope that CMS would be proactive and pay for Cardiac Rehab to a greater variety of diagnosis allowing their subscribers to participate in a monitored secondary prevention

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Carlson, Devra Title: Director of Patient Care Services
Date: 01/08/2006
Comment:

1. The physician should be available within 10 minutes of the area.
2. The code team should be as responsive as to any other area in the hospital.
3. Monitor strips should be a part of the monitoring for phase II.
4. All of the diagnosis seem very appropriate for cardiac rehab. Even though CMS does not see CHF as a Dx for cardiac rehab, it is one of the biggest admitting dx for our hospital and a reduction on the # of chf cases would be positive for everyone.

komansky, henry Title: chairman dept of pulmonary medicine
Organization: burdette tomlin mem hospital
Date: 01/08/2006
Comment:

a s a pulmonary physician i see the benefits of rehab as improved quality of life issues in patients on a daily basis. i belive that rehab is essential if not mandatory for QOL in all post op cardiac pts. better physical conditioning has been proven to reduce hospitalizations and length nof stay therefore saving money. i would strongly agree to the increase in the scope of care in this high risk group of patients.

Baron, Nicole Title: Exercise Physiologist
Organization: Good Samaritan Hospital/Cardiac Rehab
Date: 01/06/2006
Comment:

I think this is a wonderful proposal made by the CMS. The entire realm of coronary artery disease is finally included. It was very hard to tell a patient they could not have Phase II cardiac rehab just because they "only" had a valve surgery or PTCA. I think this will save Medicare millions of dollars due to patients being given the opportunity to exercise and develop a healthier lifestyle and in turn have less medical bills.

Ledyard, Jonathan Title: Director Cardiovascular Services
Organization: Excela Health
Date: 01/06/2006
Comment:

I have responsibility for cardiac rehabilitation programs in a three hospital health system and about 20 years of first hand experience in seeing the benefits of Cardiac Rehabilitation for patient of all kinds. I am so pleased with the expanded coverage being proposed and believe that both the research and the testimonials of patients around the world support it. I wanted to comment on the need for a "face to face" encounter with the "incident to" physician. The programs I manage have

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Woods, Theresa Title: COO
Organization: West Calcasieu Cameron Hospital
Date: 01/06/2006
Comment:

concur with adding the additional coverage. have to say that despite your evidence, Cardiac rehab has and is beneficial to many CHF patients. your should reconsider this based on the patients improvement and quality of life. thanks,

Sword, David Title: Assitant Professor - Physical Therapy Program
Organization: Medical University of South Carolina
Date: 01/06/2006
Comment:

I applaud and support the decision to include valve replacement, PTCA, heart transplant, and combined heart & lung transplant as covered diagnoses for cardiac rehablitation services. Having been involved in the delivery of cardiac rehabilitation services for over 18 years, I can attest to the significant impact this service has on the lives of participants. Cardiac rehab provides a safe and effective means by which individuals with a variety of cardiac conditions can improve their

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Loebig, Darlene Loebig Title: Clinical Manager, Cardiopulmonary Rehab
Organization: UPMC Passavant
Date: 01/06/2006
Comment:

It has been my experience in 18 years of Cardiac Rehab nursing dealing with both inpatients and outpatients, as well as 14 years of critical care nursing prior, that patients who have congestive heart failure are frequently non compliant with guidelines regarding self care. For reasons that range from fear to misunderstanding to complacency and depression, they often fail to follow guidelines regarding medication, diet, daily wt checks and activity even though they are educated

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Kozmor, Christina Title: RN, M.Ed. Director Cardiopulmonary Rehab
Organization: Shore Memorial Hospital
Date: 01/06/2006
Comment:

As Director for Cardiac Rehab for over 26 years, I questioned why PTCA and valve surgery was not included as diagnosis for cardiac rehab. Those patients have had cardiac events and they would benefit from this service. Another group of patients that would do extremely well and need medical supervision are the Heart Failure patients.My experience having worked with heart failure patients that they do much better with compliance to medication diet and exercise when directed by staff

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Neely, Patricia Title: Supervisor
Organization: Porter Cardiac Rehabilitation
Date: 01/06/2006
Comment:

I am very excited to hear about the proposed expanded coverage for Cardiac Rehabilitation! There are so many individuals who have not been able to benefit from this therapy due to financial/reimbursement issues. One of the hardest things to hear from a patient is that they cannot participate in cardiac rehab because of lack of insurance coverage.

By increasing the applicable patient population for Cardiac Rehab, ultimately you should see a decline in readmission rates for patients

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Harris, Marcia Title: CEO
Organization: Madison County Health Care System
Date: 01/06/2006
Comment:

I am the CEO of a small rural hospital in central Iowa. We have a small cardiac rehabilitation department which has been in operation for 12 years. In those 12 years, we have had to turn down several referrals for patients who did not qualify for cardiac rehabilitation due to diagnoses or procedure performed. We also see those patients who have long term complications and have for many years felt that we could have affected more positive outcomes post valve replacement.

Since

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Howard-May, Marci Title: Coordinator, Preventive Cardiology
Organization: University of Utah Health Care
Date: 01/06/2006
Comment:

In our Cardiac Rehabilitation program we are very excited about this proposal. We feel it is so important for this coverage to be available for the benefit of patients health and rehabilitation. We are very hopeful it will pass and go into effect as soon as possible.

Haker, Elizabeth Title: Cardiac Program Administrator
Organization: Landmark Medical Center
Date: 01/06/2006
Comment:

I am very pleased that this service will now be covered. Valve repair/replacement patients are often more in need of rehabilitation than by-pass patients due to their pre-operative exercise tolerance. This will surely improve their lives.

Chaknova, Helen Title: Director of Cardiovascular Rehab
Organization: Mills-Peninsula Health Services
Date: 01/05/2006
Comment:

Please expedite these proposed changes. It could save Medicare a bundle of money and improve the quality of life of so many folks.' Thanks.

Collins, Nancy Title: Manager, Cardiopulmonary Rehab
Organization: Blue Mountain Health System - Palmerton Campus
Date: 01/05/2006
Comment:

I wholeheartedly support your proposal to include the 3 added diagnoses for Cardiac Rehab. More and more people are having PTCA instead of CABG and are still in need of monitored cardiac rehab for their recovery and to prevent further cardiac events. Thank you for considering this.

Abbey, Darleen Title: Coordinator of Cardiac Rehab
Organization: Charles Cole Memeorial Hospital
Date: 01/05/2006
Comment:

The suggested changes to the Medicare regulations related to Cardiac Rehabilitation are a great improvement. If they are all approved, it would be a great benefit to Medicare recipients.

Manfre, Michael J. Title: Manager Cardiac Fitness & Rehabilitation Center
Organization: St. Francis Hospital - The Heart Center
Date: 01/04/2006
Comment:

Clinical Criteria and time frame for "Stable Angina" must be clearly delineated. Patients on antianginal/ischemic medications whether the patient is symptomatic or not, regardless of the presence or absence of ischemia on a stress test (exercise or pharmacological) within 12 months of program entry should be should be approved for CR. A patient in need of treatment for angina/ischemia justifies the need for physician supervised exercise and a physician directed CR Phase II program.

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Gordon, Richard Date: 12/30/2005
Comment:

As a long-standing professional in the area of Rehabilitation medicine, working in Cardiac Rehabilitation now for > 16 years, I applaud the proposed changes to the CMS 35-25 guidelines for CR Therapy.

I would agree with the allowance of the additional time to 18 weeks to give flexibility for patients completing their CR therapy. I also would agree that the compendium of research data does show the wealth of benefits for individuals after having Valve Surgery, PTCA's and OHT's. I would

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Deutsch, MD, Paul Title: Carrier Medical Director
Organization: Empire Medicare Services Part B (NY)
Date: 12/29/2005
Comment:

The proposed decision includes coronary artery bypass graft (CABG), heart valve repair/replacement, percutaneous transluminal coronary angioplasty (PTCA), and heart or heart lung transplant as conditions indicating medical necessity for cardiac rehabilitation. Although the description of the service in the proposed NCD states the service is typically provided 1-3 weeks after hospital discharge, it does not mandate a specific time period after each of these procedures during which the

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Ford, Sharon Title: Reimbursement Analyst
Organization: Twin Lakes Regional Medical Center
Date: 12/29/2005
Comment:

It appears this proposal resolves the long-standing interpretation issue of physician proximity when providing cardiac rehab services in an outpatient hospital department. By assigning the "ordering" physician as the "incident to" physician, patients will be able to continue to receive this very beneficial service. Thank you

POTTER, DOROTHY Title: Pulmonary Rehab Coordinator
Organization: Duke Health System
Date: 12/28/2005
Comment:

1. Studies show cardiac rehabilitation is an important component for the care of people with coronary artery disease. PREVENTION of disease progression is less costly than medical treatment of disease and likely will have greater benefit for quality of life and societal productivity. I would like to see CHF added to the list of covered diagnoses for cardiac rehab.

2. Patients are clinically assessed by their physicians as well as rehab personnel prior to entering rehabn and

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Lovell, Patricia Title: Manager, Wellness Institute
Organization: Durham Regional Hospital
Date: 12/28/2005
Comment:

I fully support all aspects of the proposed Decision Memo (CAG-0089R). Now Medicare patients have the same level of care available to them as those younger with commercial insurance. The expanded diagnosis is so important to make any headway in the treatment / prevention of CAD. The Decision Memo also clarifies regulatory grey areas that cardiac rehab programs have been battling for years to meet but without clear direction. Please put CAG-0089R into effect ASAP. Thank you.

Pollock, Todd Title: Unit Director
Organization: UPMC Presbyterian Shadyside
Date: 12/27/2005
Comment:

This would be a wonderful addition to the Medicare benefit. Those patients who have a PTCA are important people to target to limit progression of CAD and future cardiac events. Patients who have had valve surgery or heart transplant benefit from cardiac rehabilitation to improve their cardiovascular endurance safely. Thank you for proposing these changes in service.

Todd P. Pollock
Unit Director
UPMC Presbyterian/Shadyside
Cardiopulmonary Rehabilitation

Treister, Neil Organization: Temecula Valley Cardiology
Date: 12/22/2005
Comment:

I strongly agree with the plan to cover cardiac rehabilitation in patients following angioplasty procedures; these are patients who are usually after acute coronary syndromes where exercise status is uncertain and opportunity for risk reduction is great. The post intervention group has been missed historically. It is a great time to offer all the benefits of a supervised and comprehensive approach to lowering the risk of future cardiac events.