Medicare to cover simpler, less costly treatment for peripheral artery disease
By AMERICAN HEART ASSOCIATION NEWS
Medicare will now cover supervised exercise therapy for a vascular condition that affects about 8.5 million Americans, according to a decision issued Thursday by the Centers for Medicare and Medicaid Services.
The long-awaited decision means other insurers will likely follow suit.
Medicare will cover the therapy for patients experiencing symptoms of peripheral artery disease, or PAD, which is caused by a buildup of plaque in the blood vessels. It most commonly occurs in the legs, causing cramping and pain. PAD patients have a much higher risk of heart attack or stroke, and if left untreated, the disease can lead to gangrene and amputation.
Under the new policy, beneficiaries will be required to visit a doctor to receive a referral for supervised exercise therapy, as well as receive information about reducing risk factors, which may include education, counseling and behavioral interventions.
Then, Medicare will cover up to 36 sessions of 30 to 60 minutes each over a 12-week period, with the possibility of approval for an additional 36 sessions over time.
CMS’ ruling was triggered by a formal request last fall from the American Heart Association, and the benefit was designed using guidelines created by the AHA and the American College of Cardiology.
“Supervised exercise training is a safe and effective means to substantially improve walking distance,” said Mark Creager, M.D., director of the Heart and Vascular Center at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.
“Hopefully this will open up more opportunities for more patients with PAD to get this treatment,” said Creager, a former AHA president who focused on PAD awareness and treatment during his tenure.
In advocating for the change from CMS, the late Alan T. Hirsch, M.D., of the University of Minnesota Medical School, said earlier this year it would dramatically improve the quality of life for PAD patients.
Hirsch, a longtime AHA volunteer and pioneer in the field of vascular medicine who died last month, had said supervised exercise therapy is “the most clinically effective, safe and cost-effective” way to improve the painful cramps caused by artery obstruction and triggered by walking and exercise.
AHA Chief Executive Officer Nancy Brown said the exercise therapy is a “first-line, non-invasive” way to enhance clinical outcomes and improve the quality of life for PAD patients. About 12 percent to 20 percent of Americans age 60 and older have PAD.
“The Association has advocated for it since our first PAD guidelines were issued in 2005,” Brown said in a statement. “We couldn’t be more thrilled with [the] decision that will give more Americans the access they need to this important treatment option.”
A 2015 paper published in Journal of the American College of Cardiology showed supervised workouts worked just as well as more costly stents in helping patients improve the ability to walk.
Medicare covered the program of graduated exercise with the help of a specialist for some kinds of heart events, but until now it had not been covered for PAD.