As a North Carolina resident I would appreciate your assistance with the following issue:
Supervision of Cardiac and Pulmonary Rehabilitation Services
The Issue
We need your support of legislation (S.488) that would amend the Social Security Act to allow physician
assistants, nurse practitioners and clinical nurse specialists to supervise cardiac and pulmonary rehabilitation
programs on a day-to-day basis. This change would not alter the requirement for medical direction of these
programs – it would simply re-define the requirement for a “physician” to be immediately available and
accessible at all times when services are being furnished under these programs. In 2010, authority regarding
direct physician supervision was extended to non-physician practitioners for other outpatient services by CMS;
however, authorizing language included in Public Law 110-275 (enacted in 2008) imposed an unintended
requirement for physician supervision that could not be reversed through regulation. As a result – cardiac and
pulmonary rehabilitation require a level of physician supervision that is not commensurate with patient risk;
creates access issues in rural and other areas with physician shortages, and creates unnecessary costs for these
low-revenue programs.
Background
Cardiac rehabilitation (CR) and pulmonary rehabilitation (PR) are medically directed and supervised programs
designed to improve a patient’s physical, psychological, and social functioning. Both programs utilize
supervised exercise, risk factor modification, education, counseling, behavioral intervention, psychosocial
assessment and outcomes assessment. A physician, who serves as Medical Director, is responsible for ensuring
that the program is safe, comprehensive, cost effective, and medically appropriate for individual patients.
Separate and distinct from medical direction is “direct physician supervision” which requires a physician to be
immediately available for each session. This individual is typically not the Medical Director and is mainly
responsible for responding if an emergency arises.
This change is supported by the American Heart Association, the American Association of Cardiovascular and
Pulmonary Rehabilitation, and NAMDRC.
The Legislative Correction
This provision (U.S. Senate bill to be introduced in the 114th Congress) would amend title XVIII (Medicare) of the
Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise
cardiac, intensive cardiac, and pulmonary rehabilitation programs. Because such physician supervision,
regardless of which professional performs the service, is an uncompensated service, there is no cost to the
Medicare programs if such a change is adopted.
In the last Congress, the legislation was co-introduced by Senators Chuck Schumer (D-NY) and Michael Crapo (RID). It had 13 bipartisan cosponsors including Senators Baldwin (D-WI), Blumenthal (D-CT) , Boxer (D-CA),
Crapo (R-ID), Durbin (D-IL), Franken (D-MN), Gillibrand (D-NY), Grassley (R-IA), Harkin (D-IA), Markey (D-MA),
Risch (R-ID), Thune (R-SD) and Warren (D-MA).
Thank you for your consideration of this important issue!
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