Patients are less likely to follow through with life changing cardiac rehab because of out-of-pocket costs

A recent Michigan Medicine study has determined that, despite the demonstrated success of cardiac rehabilitation, patients may refrain from participating as a result of high out-of-pocket costs. The full cardiac rehabilitation program can take as many as 36 physician-recommended sessions, but among patients with insurance coverage that involved sharing costs of the program, those with higher out-of-pocket costs attended fewer overall sessions—often falling short of 24 sessions.

“Cardiac rehabilitation is a proven method of improving outcomes for patients with recent cardiovascular events, and our results show that lower out-of-pocket costs are associated with increased participation,” Michael Thompson, PhD, co-author of the study and associate professor of cardiac surgery at the University of Michigan Medical School, said in a university release. “In order to ensure cardiac rehab is utilized more often by those who need it, the barrier of cost must be addressed.”

The study, which is published in the American Journal of Managed Care (AJMC), included 43,992 people with Medicare and commercial insurance who attended at least one cardiac rehabilitation session. Of those beneficiaries, 35,883 (81.6%) did not have to pay for their initial session. Out-of-pocket cost for the initial session proved to be the strongest predictor of lower attendance, as, for every additional $10 spent out-of-pocket, patients attended 0.41 fewer sessions, on average.

“Out-of-pocket costs are one of many factors associated with adherence to cardiac rehab, and we hope this research spurs further investigations and quality improvement initiatives to improve cardiac rehab by mitigating financial barriers,” said Devraj Sukul, MD, MSc, a cardiologist at University of Michigan Health at the time the research was conducted.

Notably, patients who paid up to $25 out-of-pocket for the initial session were more likely to attend future sessions than patients who paid nothing, which is evidence that cost is not the only barrier to patient participation. Researchers note that it’s possible that the group with no out-of-pocket costs may have been less healthy, using more health care services and meeting their deductibles prior to enrolling in the programs.

Nonetheless, researchers encourage insurance companies to consider policies intended to reduce patient-incurred out-of-pocket spending for those with cost sharing for cardiac rehabilitation programs.

“Health care systems must seek ways to offset expenses for cardiac rehab for those who are underinsured, which may improve participation for patients with less comprehensive health plans and reduce disparities in cardiovascular care,” said Alexandra I. Mansour, MD, resident physician and graduate of the University of Michigan Medical School. “Future payment reform policy should also focus on developing payment models that reduce patient costs for cost-effective interventions such as cardiac rehab.”