Virtual PR Efforts: The PR Reimbursement Working Group has focused on understanding Virtual Pulmonary Rehabilitation (VPR) characteristics and impact. Please see Surya Bhatt et al’s publication Telehealth Pulmonary Rehabilitation: A Call for Minimum Standards | American Journal of Respiratory and Critical Care Medicine | Articles in Press (atsjournals.org)
This recent ATS poster summarizes a 2024 US survey findings of virtual PR characteristics.
Pulmonary Rehabilitation Reimbursement Resources
Breathe Easy | Pulmonary Rehabilitation US Reimbursement Update: 2024 Interview by Francois Abi Fadell and Chris Garvey. Breathe Easy | Pulmonary Rehabilitation US Reimbursement Update: 2024 (transistor.fm)
Pulmonary Rehabilitation US Reimbursement Update: January 2024 Chris Garvey FNP, MSN, MPA and Francois Abi Fadel M.D, and Mollie Corbett
https://acrobat.adobe.com/link/review?uri=urn:aaid:scds:US:7ae786b3-e870-3799-b13b-f24f0efd8d28
The PR Reimbursement Toolkit supports clinicians and staff PR billing and addresses inadequate payment. This webpage also includes links to two focused summaries:
- Key Elements of PR Billing and Payment (summary for PR providers)
- Key Medicare and Scientific Updates (summary for CFOs & billing leads)
US Virtual PR Proposed Legislation Needs Your Help!
We are asking all US clinicians, patients, and those that value PR to ask your senators and representatives to co-sponsor two bills essential to improving PR quality, access, and financial survival:
US House Resolution (HR) 1406 / S. 3021 ‘Sustainable Cardiopulmonary Rehabilitation Services in the Home Act’
This bill will allow Medicare beneficiaries to receive PR services via real-time, audio/visual communication at home. It would allow more patients to receive PR services including those in rural areas or lacking near-by PR, transportation, or ability to travel to a PR center.
HR 955 / S 1849 “The Sustaining Outpatient Services (SOS) Act” mandates that Medicare payment for hospital-based PR remains under the outpatient payment rate. It will exempt PR from the drastic payment reduction based on the location of the hospital outpatient service. The 60% payment reduction for off campus PR is not sustainable.
The 3rd annual PR Social Media Campaign in March 2024 amplified the recent ATS PR Clinical Practice Guidelines. Thanks Enya Daynes for your help!
HR 955/S. 1849 and HR 1406/S. 3021 are synergistic. These bills will improve PR access and increase demand for these beneficial treatments. Please support PR services and patients by signing these bills today. Thank you!
Want to help? Ask your representative to co-sponsor HR 955/S. 1849 and HR 1406/S. 3021. PR staff, physicians, and patients can advocate for PR services. Use the links below for customizable letters to contract your US House Representative and Senators to sign on to the above bills. Show your support for the profound benefits of PR and click on the buttons below to start your letter.
Update on Medicare Models and Future Impact by Michael Belman MD, MPH
Michael Belman MD, MPH, pulmonologist and former executive at a large US health insurance firm has generously provided a focused update on the evolution of Medicare models such as Medicare Advantage and Accountable Care Organizations. He has also provided information on COPD national demographics and characteristics as an important consideration for future PR access and payment. Note that this summary represents key elements of a very complex topic. The main message is that further progress in structuring improvement in PR payment must involve an expanded group of individuals from the clinical, health policy and business areas.
We thank the ATS PR Reimbursement Working Group members
| Chris Garvey - ATS, AACVPR | Carolyn (Carly) Rochester MD - ATS |
| Richard Casaburi - PhD, MD - ATS, COPDF | Surya Bhatt MD - ATS |
| Brian Carlin MD - ATS, AACVPR | Marilyn Moy MD - ATS |
| Katherine Menson MD - ATS, AACVPR | Chris Mosher MD, MHS - ATS |
| John Studdard MD – ATS, ACCP | Michael Belman MD, MPH - ATS |
| Mike Nelson MD – ATS, ACCP | Grace Anne Dorney Koppel MA, JD, ATS, COPDF |
| Rebecca Crouch PT – ATS, APTA, AACVPR | Connie Paladenech RRT – AACVPR |
| Aimee Kizziar MHAL, RRT – AACVPR | Judy Corn – ATS staff |
| Gary Ewart – ATS staff | Phil Porte |
| Miriam O’Day – AARC staff |
*The Working Group thanks Enya Daynes, Francois Abi Fadell and Mollie Corbett for their expert help
