WOW! Medicare is going to approve Dean Ornish's program!

[nomikins]

Let's hope this is the door opening!

http://www.sfgate.com/cgi-bin/article.c ... 1DQ2GA.DTL

[S B]

It's about time!

Thanks for sharing this!

[stirFry]

WOW! That's GREAT news. It's going to help so many people. Dean Ornish really does deserve the Nobel Peace Prize.

[Cathy]

That's awesome! I sent the article to my dad.

[ETeSelle]

That's great!! Now they need to approve Dr. McD's, too!

[lunaboyd]

Great article, but I wish I hadn't read the reader comments.

[pinkrose]

I am happy to know this and hope that this is only the beginning of the beginning of some big positive changes in health care!

[greentea]

Wow! That's great and surprising news!

[djunamod]

That's awesome! I sent the article to my dad.

Cathy, I'd love to forward the article to my dad too. My parents live abroad but they are American citizens who come visit the States a lot so they keep up their Medicare coverage. I would love to get him on a program like Ornish or McDougall, as he has the usual suspects when it comes to illnesses (high chol, unstable blood pressure, obesity, etc.) and some that are more serious and rarer (like mysthenia gravis). But he is a die-hard meat eater and jokes all the time about my veganism (though he respects my choices enough to worry about going out to eat so that I can find something to eat too).

Djuna

[JeffN]

I helped work on this when it was in its development stages while I worked for Pritikin, as they worked toggether in getting this crafted and passed.

The bill will cover "any" lifestyle related program that can meet the criteria set out below. The definition (which is the part I helped worked on) is defined as...

"An intensive cardiac rehabilitation program is defined as one that has been shown in peer-reviewed published research to (1) positively affect the progression of coronary heart disease, (2) reduce the need for coronary bypass surgery or (3) reduce the need for percutaneous coronary interventions and produce a statistically significant reduction in 5 or more specified measures (low density lipoprotein, triglycerides, body mass index, systolic blood pressure, diastolic blood pressure, and the need for cholesterol, blood pressure and diabetes medications)."

The bill will not cover the whole programs per see, but will pay for some of the educational sessions that occur during the program at typical medicare reimbursement rates (which is not great).


It is unfortunate that the fact, that it will cover "any" program that meets these criteria, is not better defined in the article as there are several good programs that would be eligible for this benefit.

In Health
Jeff

Here is the relevant portion of the bill, verbatim:

"H.R. 6331, MEDICARE IMPROVEMENTS FOR PATIENTS AND
PROVIDERS ACT OF 2008
AS PASSED BY THE HOUSE AND SENATE1

SUMMARY OF PROVISIONS

Title I—MEDICARE

Subtitle A—Beneficiary Improvements

Part I—Prevention, Mental Health, and Marketing ...

Subtitle C—Provisions Relating to Part B

Sec. 144. Payment and Coverage Improvements for Patients with Chronic Obstructive Pulmonary Disease and Other Conditions

Effective January 1, 2010, Medicare coverage would be explicitly provided for items and services furnished under a cardiac (or intensive cardiac) rehabilitation program or under a pulmonary rehabilitation program. These programs would have to be physician-directed (by a physician with expertise in the management of individuals with cardiac or respiratory pathophysiology), and a physician would have to be immediately available and accessible for medical consultation and medical emergencies at all times that items and services are being furnished under the programs (with such availability presumed when items and services are furnished in a hospital setting). Covered services would include physician prescribed exercise, psychosocial assessment, and outcomes assessment; for cardiac rehabilitation programs, they would also include cardiac risk factor modification, including education, counseling, and behavioral intervention, and for pulmonary rehabilitation programs, they would include education or training.

An intensive cardiac rehabilitation program is defined as one that has been shown in peer-reviewed published research to (1) positively affect the progression of coronary heart disease, (2) reduce the need for coronary bypass surgery or (3) reduce the need for percutaneous coronary interventions and produce a statistically significant reduction in 5 or more specified measures (low density lipoprotein, triglycerides, body mass index, systolic blood pressure, diastolic blood pressure, and the need for cholesterol, blood pressure and diabetes medications). To be eligible for an intensive cardiac rehabilitation program, a Medicare beneficiary would need to have: (a) had an acute myocardial infarction within the preceding 12 months, (b) had coronary bypass surgery, (c) stable angina pectoris, (d) had heart valve repair or replacement, (e) had percutaneous transluminal coronary angioplasty or coronary stenting, or (f) had a heart or heart-lung transplant. An intensive cardiac rehabilitation program could be provided in a series of 72 one-hour sessions, up to 6 sessions per day, over a period of up to 18 weeks. Medicare payment for intensive cardiac rehabilitation under the Medicare physician fee schedule would be equal to that determined under the hospital outpatient prospective payment system for HCPCS codes 93797 and 93798 (or any successor codes)."


Also, see here...

http://www.govtrack.us/congress/billtex ... Aenr%3A882


SEC. 144. PAYMENT AND COVERAGE IMPROVEMENTS FOR PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND OTHER CONDITIONS.

(a) Coverage of Pulmonary and Cardiac Rehabilitation-

(1) IN GENERAL- Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by section 101(a), is amended--

(A) in subsection (s)(2)--

(i) in subparagraph (AA), by striking ‘and’ at the end;

(ii) by adding at the end the following new subparagraphs:

‘(CC) items and services furnished under a cardiac rehabilitation program (as defined in subsection (eee)(1)) or under a pulmonary rehabilitation program (as defined in subsection (fff)(1)); and

‘(DD) items and services furnished under an intensive cardiac rehabilitation program (as defined in subsection (eee)(4));’; and

(B) by adding at the end the following new subsections:

‘Cardiac Rehabilitation Program; Intensive Cardiac Rehabilitation Program

‘(eee)(1) The term ‘cardiac rehabilitation program’ means a physician-supervised program (as described in paragraph (2)) that furnishes the items and services described in paragraph (3).

‘(2) A program described in this paragraph is a program under which--

‘(A) items and services under the program are delivered--

‘(i) in a physician’s office;

‘(ii) in a hospital on an outpatient basis; or

‘(iii) in other settings determined appropriate by the Secretary.

‘(B) a physician is immediately available and accessible for medical consultation and medical emergencies at all times items and services are being furnished under the program, except that, in the case of items and services furnished under such a program in a hospital, such availability shall be presumed; and

‘(C) individualized treatment is furnished under a written plan established, reviewed, and signed by a physician every 30 days that describes--

‘(i) the individual’s diagnosis;

‘(ii) the type, amount, frequency, and duration of the items and services furnished under the plan; and

‘(iii) the goals set for the individual under the plan.

‘(3) The items and services described in this paragraph are--

‘(A) physician-prescribed exercise;

‘(B) cardiac risk factor modification, including education, counseling, and behavioral intervention (to the extent such education, counseling, and behavioral intervention is closely related to the individual’s care and treatment and is tailored to the individual’s needs);

‘(C) psychosocial assessment;

‘(D) outcomes assessment; and

‘(E) such other items and services as the Secretary may determine, but only if such items and services are--

‘(i) reasonable and necessary for the diagnosis or active treatment of the individual’s condition;

‘(ii) reasonably expected to improve or maintain the individual’s condition and functional level; and

‘(iii) furnished under such guidelines relating to the frequency and duration of such items and services as the Secretary shall establish, taking into account accepted norms of medical practice and the reasonable expectation of improvement of the individual.

‘(4)(A) The term ‘intensive cardiac rehabilitation program’ means a physician-supervised program (as described in paragraph (2)) that furnishes the items and services described in paragraph (3) and has shown, in peer-reviewed published research, that it accomplished--

‘(i) one or more of the following:

‘(I) positively affected the progression of coronary heart disease; or

‘(II) reduced the need for coronary bypass surgery; or

‘(III) reduced the need for percutaneous coronary interventions; and

‘(ii) a statistically significant reduction in 5 or more of the following measures from their level before receipt of cardiac rehabilitation services to their level after receipt of such services:

‘(I) low density lipoprotein;

‘(II) triglycerides;

‘(III) body mass index;

‘(IV) systolic blood pressure;

‘(V) diastolic blood pressure; or

‘(VI) the need for cholesterol, blood pressure, and diabetes medications.

‘(B) To be eligible for an intensive cardiac rehabilitation program, an individual must have--

‘(i) had an acute myocardial infarction within the preceding 12 months;

‘(ii) had coronary bypass surgery;

‘(iii) stable angina pectoris;

‘(iv) had heart valve repair or replacement;

‘(v) had percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting; or

‘(vi) had a heart or heart-lung transplant.

‘(C) An intensive cardiac rehabilitation program may be provided in a series of 72 one-hour sessions (as defined in section 1848(b)(5)), up to 6 sessions per day, over a period of up to 18 weeks.

‘(5) The Secretary shall establish standards to ensure that a physician with expertise in the management of individuals with cardiac pathophysiology who is licensed to practice medicine in the State in which a cardiac rehabilitation program (or the intensive cardiac rehabilitation program, as the case may be) is offered--

‘(A) is responsible for such program; and

‘(B) in consultation with appropriate staff, is involved substantially in directing the progress of individual in the program.

[Anniriki]

What a blessing that Dr Ornish suffered from the depression that turned his life around as a young college studen, and that Dr McDougall suffered from a stroke at such an early age. Look what those unfortunate events led to and how many lives have been changed for the better because of what these men have accomplished!

[rijman]

This is great news, thanks for the link.

Thanks for all the info on this Jeff, as usual you go above and beyond with posts for our benefit.

I have been wondering for some time when the health insurance providers would get on board with promoting healthier lifestyles and preventitive health care. I know this is a very complex issue, but healthier Americans means less costly medical procedures, which save the health insurance companies money. This may not be the case with a Kaiser Permanente where they provide the health care and the insurance. Anyway, I am very happy to see some positive health care movement.

[MaryW]

"We are a conspiracy of love."

That is so beautiful. God bless Dean Ornish and all of the other doctors (including Dr. McD!) who endorse this low fat lifestyle. They truly care about people, wanting them to get better and be healthy, not just shutting people up with a prescription or lining their own pockets with expensive procedures. Thank you for fighting the good fight, guys!