Uptake and outcomes of supervised exercise therapy for peripheral artery disease: The importance of vascular medicine specialists at a large midwestern health care system during the first 5 years of CMS reimbursement

Background: Supervised exercise therapy (SET) is the cornerstone of medical therapy for symptomatic peripheral artery disease (PAD). Despite the efficacy of SET, initial reports following the 2017 Centers for Medicare and Medicaid Services (CMS) reimbursement decision indicate low SET uptake, referr...

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Bibliographic Details
Published in:	Vascular medicine (London, England) Vol. 29; no. 2; pp. 112 - 119
Main Authors:	Whipple, Mary O, Burt, Marsha A, Pergolski, Aaron L, McArthur, Paige, Treat-Jacobson, Diane, Salisbury, Dereck L
Format:	Journal Article
Language:	English
Published:	London, England SAGE Publications 01-04-2024 Sage Publications Ltd
Subjects:	Aged Centers for Medicare and Medicaid Services, U.S Delivery of Health Care Exercise Therapy Humans Intermittent Claudication Medicare Medicine Patients Peripheral Arterial Disease - diagnosis Peripheral Arterial Disease - therapy Quality of Life Reimbursement Retrospective Studies Statistical analysis Statistical tests Therapy United States Vascular diseases Vein & artery diseases Walking United States vascular medicine exercise therapy peripheral artery disease (PAD) physical function quality of life claudication physical activity
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Summary:	Background: Supervised exercise therapy (SET) is the cornerstone of medical therapy for symptomatic peripheral artery disease (PAD). Despite the efficacy of SET, initial reports following the 2017 Centers for Medicare and Medicaid Services (CMS) reimbursement decision indicate low SET uptake, referral, and completion. Vascular medicine specialists are key to the success of such programs. We examined rates of SET referral, completion, and outcomes in a health system with a robust SET program during the first 5 years of CMS reimbursement. Methods: A retrospective chart review of patients with PAD referred to SET between October 1, 2017 and December 31, 2022 was conducted. Patient demographic and medical characteristics, SET indication, referring provider specialty, SET participation (e.g., exercise modality, number of sessions, treadmill prescription), and outcomes were abstracted. Descriptive statistics, t-tests, and multiple linear regression were used to examine the sample, evaluate outcomes, and explore outcomes by relevant covariates (i.e., age, sex, referring provider specialty). Results: Of 5320 patients with PAD, N = 773 were referred to SET; N = 415 enrolled and were included in the present study. Vascular medicine and vascular surgery specialists were the two primary sources of referrals (30.6% and 51.6%, respectively). A total of 207 patients (49.9%) completed SET. Statistically significant and clinically meaningful improvements were observed in all outcomes. Conclusion: SET referral and completion rates are low in the 5 years following CMS reimbursement, despite the advocacy of vascular medicine specialists. SET is effective in improving patient functional capacity and quality of life. Additional efforts are needed to increase both SET availability and referrals as part of comprehensive treatment of PAD.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1358-863X 1477-0377
DOI:	10.1177/1358863X231215246