Association Between Patient Cost Sharing and Cardiac Rehabilitation Adherence

Tracking Cardiac Rehabilitation Utilization in Medicare Beneficiaries

“…The CR-related out-of-pocket costs (ie, co-payment) paid by beneficiaries are known to influence program adherence. 60 The major strength of this study is that it assessed contemporary CR utilization data among Medicare FFS beneficiaries age ≥65 yr. As a result, we provide evidence that can be used to help guide health policy, clinical practice pathways, and research directions for a defined and large cohort of patients in whom coronary heart disease and HF are highly prevalent-a cohort associated with increased risk for mortality and multiple morbidities (eg, frequent hospitalizations, reduced exercise capacity and quality of life) and well positioned to benefit from CR. 12,13 However, these findings may not be generalizable to younger patients who likely have different CR use rates and/or are covered by other health insurance plans.…”

Cost-Sharing Deters Cardiac Rehabilitation Adherence

“…Although Farah et al 9 are the first to show a dose-response relationship between higher copays and lower CR attendance, there are limitations to their study worth mentioning so that future studies can fill knowledge gaps in this area. For instance, a majority (86%) of patients were non-Hispanic white, thereby limiting the generalizability by not being able to characterize the effect of cost-sharing practices on underserved populations within the United States.…”

“…However, costsharing on high-value services has placed a noticeable financial strain on patients across the United States, ultimately influencing their decision to not seek high-value services, as shown in the current study. 9 While insurance providers have made changes to eliminate cost-sharing practices for preventive services such as various cancer screenings, critics of this practice argue that such practice is not evidence-based, and can lead to increased false-positive diagnoses and unnecessary procedures, both of which may increase health-related expenditures. 10 In stark contrast, empirical evidence overwhelmingly supports the efficacy of CR programs, in not only improving highly prognostic clinical markers such as CRF, but also in significantly reducing health careerelated costs in patients who enroll in outpatient CR.…”

More Evidence of Comprehensive Cardiac Rehabilitation Benefits, Even for All-Cause Mortality: Need to Increase Use Worldwide

“…8,[21][22][23][24] As we have discussed in the past, many members of the health care team (eg, nurses, dietitians, pharmacists, physical and occupational therapists, exercise specialists, as well as general and CVD clinicians) should be involved with vigourously encouraging patients to enroll, attend, and complete CR. 1,6 In the United States, although there are numerous barriers to CR, 1,6 Farah and colleagues 25 recently demonstrated a negative dose-response relationship between cost sharing and CR sessions attended, and greater patient cost sharing was associated with fewer CR sessions attended. 26,27 Certainly, reducing shared costs of CR could increase the chance of successful CR attendance and completion in the United States, [25][26][27] and, indeed, providing financial incentives on an escalating schedule has recently been advocated to facilitate this.…”

“…1,6 In the United States, although there are numerous barriers to CR, 1,6 Farah and colleagues 25 recently demonstrated a negative dose-response relationship between cost sharing and CR sessions attended, and greater patient cost sharing was associated with fewer CR sessions attended. 26,27 Certainly, reducing shared costs of CR could increase the chance of successful CR attendance and completion in the United States, [25][26][27] and, indeed, providing financial incentives on an escalating schedule has recently been advocated to facilitate this. 27,28 In addition, the current CR model of centre-based CR is limited by long commutes, transportation, and employment issues; poor infrastructure and capacity; and other obstacles.…”