Pulmonary Rehabilitation Reimbursement Updates and Resources

16 Sep Pulmonary Rehabilitation Reimbursement Updates and Resources

by Christine Garvey, FNP, MSN, MPA, MAACVPR

Pulmonary rehabilitation (PR) is well established as a highly effective treatment for chronic lung disease, resulting in improved function, symptoms, mood, and quality of life.¹ However, inadequate payment, access, and awareness have negatively impacted the availability and utilization of pulmonary rehabilitation.¹ Despite its effectiveness, payment for PR is approximately 50% of the amount paid for cardiac rehabilitation. Inadequate access and poor awareness have resulted in fewer than 5% of those eligible undergoing pulmonary rehabilitation. ² This article describes the work of the American Thoracic Society (ATS) pulmonary rehabilitation assembly’s task force for pulmonary rehabilitation reimbursement and its efforts to address pulmonary rehabilitation coverage, access and awareness inequities.

The work group is composed of 18 pulmonary rehabilitation and policy experts as well as two patients with lung disease who oversee national foundations. Strategies to improve awareness include a recent national public relations and social media campaign with a key message of ‘Live Better and Live Longer’: This message is derived from pulmonary rehabilitation’s multiple patient-relevant benefits including improved survival after a COPD hospitalization based on a large study by Peter Lindenauer and colleagues.³

The campaign has targeted clinicians, patients and loved ones, health care organizations and insurers, and the National Heart Lung and Blood Institute of the National Institutes of Health. A social media blitz launched in April 2021 included a national Joint Sign-on Letter of support from 18 pulmonary societies and patient organizations, including PERF. To improve social media awareness and messaging, an infographic was used. Each organization has shared messaging and the pulmonary rehabilitation infographic below on their Twitter, Facebook, and/or Instagram pages. Twitter hashtags included:

• #PulmonaryRehabilitationMatters
• #PulmonaryRehabilitationWellnessDay
• #WorldHealthDay

The infographic provided is available for use in social media posts.

The campaign is listed in the NHLBI COPD National Action Plan: Community Action Tool.

Pulmonary rehabilitation resources include:

Live Better

• Pulmonary rehabilitation program directory
• What is pulmonary rehabilitation?
• What are pulmonary rehabilitation benefits?

American Association of Cardiovascular and Pulmonary Rehabilitation

• Pulmonary Rehabilitation Public Service Announcement Video for patients, providers, payers, and the community

ATS

• Pulmonary Rehabilitation Reimbursement Update

COPD Foundation

• Pulmonary Rehabilitation webpages

PERF

• Pulmonary Rehabilitation Overview
• Starting an Exercise Program
• Breathing Techniques
• A range of videos about the benefits of pulmonary rehabilitation

COPD SOS

• Public Service Announcement Campaign created by the Dorney-Koppel Foundation to raise awareness of COPD. The campaign targets:
  • Undiagnosed millions who are unaware that they have COPD and are at increased risk of serious outcomes from COVID
  • The need for appropriate screening and accurate diagnoses of persons at increased risk
  • Effective COPD treatment including Pulmonary Rehabilitation
  • Equitable funding for COPD research
  • Videos are available for use on social media and other platforms

Please Support This Vital Initiative

Send the copdsos.org link to members and contacts – ask for their support!

Share on your social media pages!

Legislative activities include proposed legislation to improve pulmonary rehabilitation payment and care sponsored by the American Association of Cardiovascular and Pulmonary Rehabilitation in collaboration with other societies.

• H.R. 3348: SOS: Sustaining Outpatient Services Act This bill would end the current 40% payment reduction if a program has relocated to a new or different off-campus location.
• H.R. 1956: Increasing Access to Quality Cardiac Rehabilitation Act of 2021 will allow non-physician practitioners to independently order and supervise pulmonary rehabilitation/cardiac rehabilitation/intensive cardiac rehabilitation services thereby increasing access for PR and CR, particularly in rural areas, effective 2022.

HELP MAKE THESE BILLS HAPPEN – TAKE ACTION HERE Click on Send a Letter and follow prompts

 The ATS task force group’s efforts have set the stage for improving pulmonary rehabilitation payment. Medicare recently published draft updated rules for payment for outpatient hospital-based pulmonary rehabilitation (including virtual pulmonary rehabilitation) as well as two new billing codes for pulmonary rehabilitation based in physician offices. National pulmonary societies will respond to the proposed rules including advocating for improved payment, support, and access. Final rules are expected to be published in November 2021. Equitable payment for pulmonary rehabilitation will be a long, complex process. The ATS and its pulmonary rehabilitation assembly are committed to further improving pulmonary rehabilitation payment, as well as access and awareness.

References 

1. Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013;188:e13–64.
2. Nishi SP, Zhang W, Kuo YF, Sharma G. Pulmonary rehabilitation utilization in older adults with chronic obstructive pulmonary disease, 2003 to 2012. J Cardiopulm Rehabil Prev2016;36:375–382.
3. Lindenauer PK, Stefan MS,  Pekow PS, et al. Association between Initiation of Pulmonary Rehabilitation after Hospitalization for COPD and 1-Year Survival among Medicare Beneficiaries. JAMA. 2020;323 (18):1813-1823.