Abstract 14656: Virtual Cardiac Rehabilitation is Rarely Used but May Augment Overall Attendance

Abstract

Introduction: The COVID-19 public health emergency temporarily expanded Medicare reimbursement of cardiac rehabilitation (CR) to cover virtual CR. The purpose of this study was to evaluate the frequency of virtual CR use in Medicare and describe this emerging population of virtual CR patients, as there is currently limited data on the rates and patterns of virtual CR utilization. Methods: The study sample included 100% of Medicare beneficiaries undergoing surgical/percutaneous coronary revascularization or aortic valve replacement between July 2019 and December 2021 in the Medicare Virtual Research Data Center. Professional claims were used to identify CR use within one year of discharge using CPT codes (93797, 93798), and the disaster-related modifiers (“CR” or “DR”) were used to categorize CR visits as synchronized virtual sessions. Descriptive analysis compared patient characteristics and number of CR sessions attended between patients using virtual and facility-based CR. Results: Overall CR use was 32.5% in the entire sample (167066/513735). Any CR use was more prevalent among patients who were male, White, or 65-85 years old, and similar between coronary revascularization vs. aortic valve procedures. Only 14 states reported any virtual CR visits (CA, FL, GA, IL, IN, MI, MN, MO, NY, OR, PA, TN, TX, WI). Within these states, only 1% (886) of all CR users had at least one virtual CR session. The characteristics of patients who utilized virtual CR were largely similar to those who attended facility-based only CR. The median number of virtual sessions was 21 (IQR 26). Of patients who utilized virtual CR, 17.7% (157) also attended at least one facility-based CR session. Notably, combined virtual and facility-based CR utilizers attended a median of 33 (IQR 14) total CR sessions, compared to 25 (IQR 23) CR sessions for patients who attended only facility-based CR. Conclusion: Virtual CR was not widely available or used despite expanded Medicare reimbursement, yet our data suggests that the combined use of virtual and facility-based CR may be associated with a greater number of sessions attended (vs. facility-based only CR). Further research is needed to inform long-term policy decisions, particularly as it pertains to continued Medicare coverage of virtual CR.