HCFA Changes Name, Announces New Initiatives Department of Health and Human Services Secretary Tommy Thompson announced on June 14 that the Health Care Financing Administration (HCFA) is changing its name to the Centers for Medicare and Medicaid Services (CMS). According to Thompson, the change marks the beginning of a "new culture of responsiveness" at the agency that oversees Medicare and Medicaid. "We're making quality service the number one priority in this agency," he said. Several recently announced initiatives are intended to usher in the new culture of responsiveness. Communications will be enhanced through the establishment of open door policy committees, which will serve as points of contact for seven provider and beneficiary groups, including physicians, hospitals and rural health, nursing homes, health plans, nurses and allied health care professionals, home health and hospices, and end-stage renal disease (ERDS) and dialysis centers. Other new initiatives include the launch of a series of open listening forums across the country to hear directly from physicians and providers on the day-to-day effects of the Centers' rules, and the formation of in-house expert teams across CMS's program areas to generate new ways of reducing administrative burdens and simplifying regulations. CMS will also streamline the contractor process that pays nearly one billion fee-for-service Medicare claims each year. In addition to these initiatives, CMS will be restructured to offer three new service centers: the Center for Beneficiary Choices will handle Medicare+Choice; the Center for Medicare Management will oversee the fee-for-service program; and the Center for Medicaid and State Operation will focus on state programs. This fall, a $35 million media campaign will alert providers and beneficiaries to resources such as (800) MEDICARE, a 24-hour hot line. The administration will also invest $50,000 to update the HCFA Web site, which will maintain the same Web address (www.hcfa.gov). Providers will continue to use the same HCFA forms, and administration officials say that the new forms and letterhead will be phased in as they need to be restocked. Cardiac Rehab Addresses Patient Needs For the one out of every five individuals who has a cardiovascular disease,1 healthy living can be a formidable challenge. Cardiac rehabilitation focuses on helping heart patients develop a healthy lifestyle through a regimen of diet, exercise, and discipline. "There have been advances in the technology aspect, such as angioplasties and bypass surgeries, but there still is the need for that lifestyle element," says Bill Priest, MS, manager of cardiac rehabilitation at Fairview Health System, Minneapolis. "Cardiac rehabilitation holds a strong place because it brings that lifestyle aspect to the table." Cardiac rehabilitation addresses both inpatient and outpatient cases. Inpatient therapy follows immediately after heart surgery. In addition to teaching patients to avoid certain risk factors, therapists work with patients on low-level activities such as sitting up in bed and walking short distances. Priest says that with reduced hospital stays, specialists often have only 4 to 5 days to work with patients. "If you have less time to get someone moving, that puts more burden on the patient and family to keep that progress," he says. "It is a different type of teaching." On the outpatient side, patients meet with therapists approximately three times per week for 6 to 9 weeks. The program targets individual risk factors and modifications and includes an expanded exercise program with equipment such as treadmills, bikes, and recumbent steppers. At smaller facilities, cardiac rehabilitation specialists attend to all parts of the patient's education, but at Fairview, a dietician covers nutrition, the pharmacy provides medication information, and the social services department covers stress management. A third phase focuses on long-term rehabilitation, and programs are often held at fitness centers. The cash-based program allows patients to build relationships with staff members and other patients. "It is like a health club," Priest says. In 1998, nearly 1 million Americans died of cardiovascular disease.1 Even though heart disease is the leading cause of death, Priest says that only a small percentage of eligible patients participate in a program. This means only 15% of eligible women, according to a study published in the April issue of Mayo Clinic Women's HealthSource. Priest says the reasons for this low figure are not known, but potential causes include a lack of referring physicians and the fact that those eligible may not want to participate. Another challenge is reimbursement, which Priest says is limited to myocardial infarction, coronary bypass surgery, and stable angina for outpatient rehabilitation. Congestive heart failure is not covered. Still, cardiac rehabilitation is a growing field, and its interdisciplinary nature makes it complementary to other specialties, including pulmonary rehabilitation. Priest sees an opportunity for the two fields to work together, and possibly add more reimbursable diagnoses. "There is a national and local push for pulmonary rehabilitation," he says, adding that the field opens the door to cardiopulmonary professionals. "It shares many of the same needs with cardiac rehabili- tation from an exercise and education perspective." Priest, who serves as the Chairman for Minnesota with the American Association of Cardiovascular and Pulmonary Rehabilitation, believes that the need for cardiac rehabilitation will continue to increase and that reimbursement challenges will be overcome." He notes, "To see patients go from a real level of sickness to getting their energy, stamina, and lifestyle back, and then modifying that lifestyle-it's really nice to see someone go through that progression." Reference
