- Email: [email protected]
Implications for cost-effectiveness
based outpatient cardiac rehabilitation programs? The exact reason for this remains unclear, but it was due in part to the billing codesused and the “newness” of TEM compared with the established outpatient program approach. It has been estimatedthat more than two thirds of the hospitals in the United Stateswith >500 beds currently offer or will soon offer outpatient cardiac rehabilitation. to However, further estimates indicate that only between 2.5% and 4% of people with active coronary artery diseaseactually enroll in cardiac rehabilitation.‘O Certainly one factor affecting enrollment is program proximity, which must be addressedif more patients are to enroll. One of the more encouraging developments toward this end is TEM; however, additional research is needed before the cost-effectivenessof these systemsis clearly elucidated. Based on the results of this survey, we conclude that simultaneous TEM technology is expanding and is an appropriate adjunct to hospital-based cardiac rehabilitation programs.
IMPLICATIONS
1. Fletcher GF, Chiaramida AJ, LeMay MR, Johnston BL, Yheil JE, Spratlin MC. Telephonically-monitored home exercise early after coro!ary artery bypass surgery. Chest 1984;86:198-202. 2. Miller NH, Haskell WL, Berra K, DeBusk RF. Home versus group exercise training for increasing functional capacity after myocardial infarction. Circulntion 1984,70:64&649. 3. DeBusk RF, Haskell WL, Miller NH, Berra K, Taylor CB. Medically directed at-home rehabilitation soon after clinically uncomplicated acute myocardial infarction: a new model for patient care. Am J Cardiol 1985;53:251-257, 4. Squires RW, Miller TD, Ham T, Micheels TA, Palma TB. Transtelephonic electrocardiographic monitoring of cardiac rehabilitation exercise sessions in coronary artery disease. Am J Cardiol 1991;67:962-964. 5. Shaw DK, Sparks KE, Hanigosky P. Exercise compliance and patient satisfaction: tramtelephonic exercise monitoring (abstr). J Cardiopulm Rehbil 1990;19:373. 6. Shaw DK. Transtelephonic exercise monitoring: medico-legal and other considerations. Exercise Standards and Malpractice Reporter 1991;5:81-86. 7. Landers CB, Allen RD. Dageforde DA, Goodin RR, Squires RW. Cardiac rehabilitation in rural Kentucky: transtelephonic ECG monitoring from a metropolitan center. J Cardiovasc Manage 1992;3:3&34. 8. Oldridge NB, Pashkow FJ. Compliance and motivation in cardiac rehabilitation. In: Pashkow FJ, DaFoe WA, eds. Clinical Cardiac Rehabilitation: A Cardiologist’s Guide. Baltimore, MD: Williams & Wilkins, 1993:338-339. 9. Meyer CC. Overview of insurance. In: Hall LK, Meyer CC, eds. Cardiac Rehabilitation: Exercise Testing and Prescription. vol. II. Champaign, IL: Human Kinetics, 1988:98-99. 10. Pasbkow FJ, Dafoe WA. Preface. In: Pashkow FJ, Dafoe WA, eds. Clinical Cardiac Rehabilitation: A Cardiologist’s Guide. Baltimore, MD: Williams & Wilkins, 1993:viii.
FOR COST-EFFECTIVENESS
The cost-effectivenessof most new technology post-datesthe technology’s introduction. Such is the case with transtelephonic exercise monitoring (TEM). Data to date indicate excellent third-party reimbursement,especially when TEM is offered in tandem with rural hospitals. Medicare coverage varies from state to state; however, home TEM is often not reimbursed while tandem-siteTEM is viewed as phaseII cardiac rehabilitation and is covered accordingly. When all insurance data from the present study were analyzed, average TEM reimbursement was 86% of the actual $66 charge. This reimbursementis slightly better than that for typical non-transtelephonic phase II cardiac rehabilitation programs (180%). Simply stated,it is systemconvenience that defines TEM’s cost-effectiveness.Patients can exercise at or near home and not have to travel great distances for monitored exercise therapy. Rural hospitals can use already existing spacein physical therapy areas; monitoring of equipment purchases and staff salary expensesis virtually eliminated. Metropolitan hospitals maintain their referral networks while providing service traditionally unavailable to rural patients. Although the future appearsbright for TEM, technology proliferation will undoubtedly be a function of reimbursement. Donald K. Shaw, PhD
BRIEF REPORTS
1071
IMPLICATIONS
1. Fletcher GF, Chiaramida AJ, LeMay MR, Johnston BL, Yheil JE, Spratlin MC. Telephonically-monitored home exercise early after coro!ary artery bypass surgery. Chest 1984;86:198-202. 2. Miller NH, Haskell WL, Berra K, DeBusk RF. Home versus group exercise training for increasing functional capacity after myocardial infarction. Circulntion 1984,70:64&649. 3. DeBusk RF, Haskell WL, Miller NH, Berra K, Taylor CB. Medically directed at-home rehabilitation soon after clinically uncomplicated acute myocardial infarction: a new model for patient care. Am J Cardiol 1985;53:251-257, 4. Squires RW, Miller TD, Ham T, Micheels TA, Palma TB. Transtelephonic electrocardiographic monitoring of cardiac rehabilitation exercise sessions in coronary artery disease. Am J Cardiol 1991;67:962-964. 5. Shaw DK, Sparks KE, Hanigosky P. Exercise compliance and patient satisfaction: tramtelephonic exercise monitoring (abstr). J Cardiopulm Rehbil 1990;19:373. 6. Shaw DK. Transtelephonic exercise monitoring: medico-legal and other considerations. Exercise Standards and Malpractice Reporter 1991;5:81-86. 7. Landers CB, Allen RD. Dageforde DA, Goodin RR, Squires RW. Cardiac rehabilitation in rural Kentucky: transtelephonic ECG monitoring from a metropolitan center. J Cardiovasc Manage 1992;3:3&34. 8. Oldridge NB, Pashkow FJ. Compliance and motivation in cardiac rehabilitation. In: Pashkow FJ, DaFoe WA, eds. Clinical Cardiac Rehabilitation: A Cardiologist’s Guide. Baltimore, MD: Williams & Wilkins, 1993:338-339. 9. Meyer CC. Overview of insurance. In: Hall LK, Meyer CC, eds. Cardiac Rehabilitation: Exercise Testing and Prescription. vol. II. Champaign, IL: Human Kinetics, 1988:98-99. 10. Pasbkow FJ, Dafoe WA. Preface. In: Pashkow FJ, Dafoe WA, eds. Clinical Cardiac Rehabilitation: A Cardiologist’s Guide. Baltimore, MD: Williams & Wilkins, 1993:viii.
FOR COST-EFFECTIVENESS
The cost-effectivenessof most new technology post-datesthe technology’s introduction. Such is the case with transtelephonic exercise monitoring (TEM). Data to date indicate excellent third-party reimbursement,especially when TEM is offered in tandem with rural hospitals. Medicare coverage varies from state to state; however, home TEM is often not reimbursed while tandem-siteTEM is viewed as phaseII cardiac rehabilitation and is covered accordingly. When all insurance data from the present study were analyzed, average TEM reimbursement was 86% of the actual $66 charge. This reimbursementis slightly better than that for typical non-transtelephonic phase II cardiac rehabilitation programs (180%). Simply stated,it is systemconvenience that defines TEM’s cost-effectiveness.Patients can exercise at or near home and not have to travel great distances for monitored exercise therapy. Rural hospitals can use already existing spacein physical therapy areas; monitoring of equipment purchases and staff salary expensesis virtually eliminated. Metropolitan hospitals maintain their referral networks while providing service traditionally unavailable to rural patients. Although the future appearsbright for TEM, technology proliferation will undoubtedly be a function of reimbursement. Donald K. Shaw, PhD
BRIEF REPORTS
1071