Bill Overview
Title: Sustainable Cardiopulmonary Rehabilitation Services in the Home Act
Description: This bill permanently allows services relating to cardiac rehabilitation programs, intensive cardiac rehabilitation programs, and pulmonary rehabilitation programs to be furnished via telehealth at a beneficiary's home under Medicare.
Sponsors: Rep. Joyce, John [R-PA-13]
Target Audience
Population: people requiring cardiac and pulmonary rehabilitation services
Estimated Size: 15000000
- The population impacted includes individuals with cardiac and pulmonary conditions who require rehabilitation services.
- Cardiac rehabilitation programs assist individuals recovering from heart-related health issues.
- Pulmonary rehabilitation programs are designed for individuals with chronic respiratory problems.
- The bill specifically targets the elderly or disabled who are Medicare beneficiaries.
- There is a global prevalence of heart and respiratory issues, thus a wide applicability worldwide.
Reasoning
- The policy primarily affects those with cardiac and pulmonary conditions who rely on rehabilitation services. This is a significant population, particularly among older adults reliant on Medicare.
- We expect a higher impact and duration of effect among individuals who face difficulties accessing traditional rehabilitation services due to mobility or geographic constraints.
- Telehealth availability broadens access and convenience, potentially improving quality of life and compliance with rehabilitation programs.
- Not everyone will be affected due to varying levels of tech-savviness, availability of devices, and internet access among the elderly.
- The budget constraints suggest reaching millions, but not covering the entire target population, which is sizable.
- Individuals with no access issues or who prefer in-person services may experience no impact.
Simulated Interviews
retired teacher (rural Texas)
Age: 71 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 3/20
Statement of Opinion:
- This policy could be a lifesaver for me as getting to the clinic is quite hard.
- Being able to do this from home would save me stress and money on transportation.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 8 | 4 |
| Year 3 | 8 | 4 |
| Year 5 | 9 | 3 |
| Year 10 | 8 | 2 |
| Year 20 | 7 | 2 |
retired accountant (urban New York)
Age: 68 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 4/20
Statement of Opinion:
- I find it difficult to fit clinic visits into my schedule; telehealth sessions at home would be more convenient.
- It might not completely replace in-person visits but having the option is fantastic.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 4 |
| Year 20 | 5 | 3 |
retired nurse (Florida)
Age: 74 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 3/20
Statement of Opinion:
- Having telehealth options would be great since going to the hospital is exhausting.
- It would be easier to get consistent care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 7 | 3 |
| Year 5 | 8 | 3 |
| Year 10 | 7 | 3 |
| Year 20 | 6 | 2 |
retired engineer (California)
Age: 82 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 4/20
Statement of Opinion:
- I'm not very tech-savvy, so I'd still likely go to the hospital.
- Maybe younger folks would benefit more.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 5 | 5 |
| Year 5 | 5 | 5 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 3 |
artist (Illinois)
Age: 67 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 2/20
Statement of Opinion:
- I am comfortable with technology, so telehealth is no problem.
- This should improve my adherence to rehabilitation.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 6 |
| Year 2 | 8 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 4 |
| Year 20 | 5 | 3 |
retired farmer (rural Kansas)
Age: 70 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 3.0 years
Commonness: 3/20
Statement of Opinion:
- Telehealth sounds good in theory, but my internet is unreliable.
- I still rely on driving to the clinic.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 4 | 4 |
| Year 5 | 4 | 4 |
| Year 10 | 4 | 3 |
| Year 20 | 3 | 2 |
retired (urban Atlanta)
Age: 60 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 5/20
Statement of Opinion:
- This won't affect me immediately, but knowing telehealth is a viable option eases future concerns.
- Hopefully, these programs will continue.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
retired librarian (New Jersey)
Age: 65 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 2.0 years
Commonness: 5/20
Statement of Opinion:
- I enjoy visiting the hospital for my treatments; I don't think I'd use telehealth much.
- More for emergencies, perhaps.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 6 | 6 |
| Year 20 | 6 | 6 |
retired police officer (Arizona)
Age: 78 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 7.0 years
Commonness: 4/20
Statement of Opinion:
- I can see myself using this service, especially during extreme weather when it's hard to travel.
- A good backup option for me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 4 |
retired homemaker (Washington)
Age: 73 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 3/20
Statement of Opinion:
- Telehealth would ease a lot of my transportation issues.
- It sounds like it would be less stressful overall for me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 4 |
| Year 5 | 8 | 4 |
| Year 10 | 7 | 3 |
| Year 20 | 6 | 3 |
Cost Estimates
Year 1: $500000000 (Low: $400000000, High: $650000000)
Year 2: $525000000 (Low: $420000000, High: $680000000)
Year 3: $551250000 (Low: $441000000, High: $714000000)
Year 5: $605000000 (Low: $484000000, High: $783000000)
Year 10: $725000000 (Low: $580000000, High: $940000000)
Year 100: $1400000000 (Low: $1120000000, High: $1820000000)
Key Considerations
- The policy benefits from existing telehealth infrastructure, but any infrastructural deficiencies could increase upfront costs.
- Current and future rates of telehealth adoption will influence cost-effectiveness.
- The demographic focus on older adults aligns closely with Medicare's existing beneficiary base.
- Compliance with HIPAA and other privacy standards in telehealth need to be ensured.