Patients with higher out-of-pocket costs attended fewer cardiac rehabilitation sessions and were less likely to complete the program, a study finds.
Summary:
A Michigan Medicine study highlights the impact of out-of-pocket costs on cardiac rehab participation. While cardiac rehab is proven to reduce heart-related deaths and hospital readmissions, patients with higher out-of-pocket expenses attended fewer sessions and were less likely to complete the program. The study, which analyzed data from over 40,000 insured individuals, found that for every $10 increase in out-of-pocket costs, patients attended an average of 0.41 fewer sessions. Researchers stress the need for policies and initiatives to address cost barriers and promote equitable access to cardiac rehab.
Key Takeaways:
- Cost Impact on Participation: Patients with higher out-of-pocket costs for cardiac rehabilitation attended fewer sessions and had lower odds of completing the program.
- Proven Benefits of Cardiac Rehab: Cardiac rehab reduces the risk of death and hospital readmissions, but financial barriers prevent some patients from accessing its benefits.
- Policy Implications: Researchers recommend reducing cost-sharing for cardiac rehab services and implementing payment reforms to improve access and address disparities in cardiovascular care.
Despite the success cardiac rehabilitation has shown at reducing heart-related deaths and hospital readmissions, higher out-of-pocket costs may prevent patients from participating in the program, a Michigan Medicine study suggests.
In a national study of over 40,000 people with Medicare and commercial insurance, 81.6% of patients did not have to pay for their initial cardiac rehabilitation session. The medically supervised program lasts up to 36 sessions, which are often recommended for patients recovering from many conditions and procedures.
Among those with insurance coverage that involved sharing the costs of cardiac rehab, patients with higher out-of-pocket costs attended fewer sessions and had lower odds of completing more than 24 sessions.
Results are published in the American Journal of Managed Care.
Cardiac Rehab Linked to Improved Health Outcomes
“Cardiac rehabilitation is a proven method of improving outcomes for patients with recent cardiovascular events, and our results show that lower out-of-pocket costs are associated with increased participation,” says Michael Thompson, PhD, co-author of the study and associate professor of cardiac surgery at University of Michigan Medical School, in a release. “In order ensure cardiac rehab is utilized more often by those who need it, the barrier of cost must be addressed.”
Cardiac rehab is recommended as a standard of care for many cardiovascular conditions and procedures, including heart attack, heart bypass surgery, and minimally invasive coronary angioplasty and stenting.
A past U-M study found that people who participate in cardiac rehab have a decreased risk of death years after heart bypass, with those who attended more sessions achieving better outcomes. Another found that the program reduces the risk of hospital readmission by nearly 20%.
Cost Shown to Be a Barrier to Participation
In this study, cost for the initial cardiac rehab session was the strongest predictor of lower attendance. For every additional $10 spent out of pocket, patients attended .41 fewer sessions on average.
Researchers note that cost is not the only barrier to participation. While most cardiac rehab attendees had zero out-of-pocket costs for their first session, participants who paid up to $25 for the initial session—the lowest of those with cost-sharing—had higher rates of future attendance than patients who paid nothing.
The group with no out-of-pocket costs, however, may have been less healthy and utilized more health care services, meeting their deductible prior to enrolling in cardiac rehabilitation.
“Out-of-pocket costs are one of many factors associated with adherence to cardiac rehab, and we hope this research spurs further investigations and quality improvement initiatives to improve cardiac rehab by mitigating financial barriers,” says Devraj Sukul, MD, MSc, a cardiologist at U-M Health at the time the research was conducted, in a release.
Quality Improvement Initiatives Needed
The study results, researchers conclude, support quality improvement initiatives to limit cost-sharing hurdles for cardiac rehab services. Such efforts are promoted by the Million Hearts Cardiac Rehabilitation Change Package, a collaboration between the Centers for Disease Control and Prevention and the American Association of Cardiovascular and Pulmonary Rehabilitation.
“Health care systems must seek ways to offset expenses for cardiac rehab for those who are underinsured, which may improve participation for patients with less comprehensive health plans and reduce disparities in cardiovascular care,” says Alexandra I. Mansour, MD, resident physician and graduate of U-M Medical School, in a release. “Future payment reform policy should also focus on developing payment models that reduce patient costs for cost-effective interventions such as cardiac rehab.”