The American Heart Association has submitted a formal request to the CMS to offer national Medicare coverage of supervised exercise therapy for the treatment of peripheral artery disease.
The cardiovascular disease occurs when plaque buildup narrows the arteries outside the heart. It affects 12% to 20% of Americans age 60 and older, and the incidence of the disease increases considerably with age.
It most commonly affects the lower extremities and can cause pain and discomfort in the legs during exercise making patients afflicted by the disease more sedentary.
Without exercise, those with peripheral artery disease could see their condition worsen to the point they lose functional independence.
Supervised exercise is a non-invasive treatment option and is indicated for these patients. It results in less pain in the legs during exercise and improves walking distance, according to the American Heart Association, which cited numerous studies in its request to the CMS (PDF).
The proposed exercise would consist of a series of sessions lasting 45 to 60 minutes and involve use of either a treadmill or a track. Each session is supervised by an exercise physiologist or a physical therapist or a nurse.
The proposal received support from various providers around the country.
“We struggle with incorporating exercise therapy for our patients as both data and our experience only see results with supervised therapy,” Dr. Gary Ansel, a cardiologist at OhioHealth, a Columbus-based health system, said in a letter to the CMS. “Thus many patients that could be less invasively served are not due to the lack of cost coverage.”
While there are plenty of studies that highlight the benefits of supervised exercise for these patients, a recent one questioned its benefit.
Last summer, a study in the American Heart Journal found that supervised exercise for these patients did not lead to a noticeable improvement in quality of life.
“Given the current lack of evidence that [supervised exercise] improves quality of life … further evidence may be needed before reimbursement policies for supervised exercise will be reconsidered," the study read.
The CMS is taking comment on the AHA request until Oct. 15 and plans to release a proposed decision memo by March 15, 2017.