Medicare will reimburse heart patients for two wellness programs that focus on wholesale changes. Supporters see the move as a shift toward proactive care.
By Hilary E. MacGregor
Times Staff Writer
June 12, 2006
LIFESTYLE changes can boost the health and well-being of heart patients, proponents of such programs have long said. Now Medicare has acknowledged that as well.
The federal insurance program will now pay for the intensive cardiac rehabilitation plans created by preventive health guru Dr. Dean Ornish and mind-body medicine pioneer Dr. Herbert Benson — the first time the federal government has agreed to reimburse consumers for specific lifestyle intervention programs.
"This exciting breakthrough could change the face of medical care," said Ornish in a statement.
He and Benson have been working for years to obtain Medicare reimbursement for their cardiac wellness programs because it's seen as a critical first step to making their programs more widely available — and getting other insurance providers to pay for them as well.
Both have conducted clinical research demonstrating that comprehensive lifestyle changes — including support groups; good nutrition and low-fat diets; exercise; and stress management, such as yoga, meditation or deep breathing — may begin to reverse even severe coronary heart disease without drugs or surgery.
Ornish's Program for Reversing Heart Disease is offered at eight sites in Pennsylvania and at five medical centers in West Virginia. At least one private insurer in each state already has agreed to cover the programs in those states.
Cardiac wellness programs by Benson, who more than 25 years ago wrote the groundbreaking "Relaxation Response," are offered in Indiana, Rhode Island, Tennessee, Washington and Virginia.
Considered by many to be the father of meditation in this country, Benson has shown that 10 minutes of meditative technique a day can increase concentration and counteract the harmful effects of stress, such as high blood pressure and strokes.
His Cardiac Wellness Program combines these stress reduction techniques with nutrition, cognitive restructuring and exercise to lower cholesterol and blood pressure. Patients report fewer symptoms of chest pain.
Medicare, however, will not cover enrollment in the programs for as long as both centers frequently recommend. Instead, it will guarantee coverage for 36 sessions within an 18-week period, with a possible extension to 72 sessions for 36 weeks. The final details of how much will be covered are still under negotiation, Ornish said.
Although Medicare already pays for some cardiac rehabilitation programs, officials hailed the inclusion of both programs as an important shift toward preventive rather than rehabilitative medicine.
As of March, the definition of who can take advantage of the cardiac rehab benefit under Medicare has been expanded from conditions such as acute myocardial infarction (heart attack) and coronary artery bypass graft to include patients with less severe heart conditions, such as valve replacement.
"The programs of Dr. Ornish and Dr. Benson focus on a prevention model," said a spokesperson with the Centers for Medicare and Medicaid Services. "Now we are going to take even individuals with mild cardiovascular disease and show them how to ameliorate it or reverse it to avoid more serious disease."
Although the details of coverage have not been finalized, doctors who run similar lifestyle intervention programs to treat and prevent heart disease supported the move.
"It is just phenomenal that Medicare has decided to cover these programs since Medicare sets the precedent for all of the other insurance companies," said Dr. Mimi Guarneri, a cardiologist who co-founded and runs the Scripps Center for Integrative Medicine in La Jolla.
"What's really important is this is truly shifting the paradigm of healthcare from focusing on chronic disease to focusing on prevention."
L.A. Times
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