Medicare to foot the bill for treadmill therapy for leg pain
Posted August 29
CHICAGO — Three times a week, Rita Driscoll steps onto a treadmill at a Minnesota hospital under the eye of a rehab therapist. She walks until it hurts — pushing her limits, walking faster and adding steeper inclines.
The retired school aide has leg pain caused by clogged blood vessels. Until recently, monitored walking wasn't an option for people with peripheral artery disease, or PAD, because most insurance doesn't cover it.
"I'm not giving up my legs," said Driscoll, who walks as part of a study. "Hopefully it will keep me away from surgery and keep me walking and dancing."
Medicare has decided to pay for supervised exercise therapy for older Americans hobbled by PAD, a serious condition linked to smoking and diabetes that puts people in danger of heart attacks, strokes and amputations. It costs Medicare nearly $4 billion a year on surgeries and procedures to treat it.
Research shows treadmill workouts overseen by a medical professional improve the distances patients can walk and their quality of life. This low-tech approach may reduce hospitalizations and help people live longer too. But virtually none of them now gets exercise therapy outside of studies.
Drugs don't work well, so doctors have used surgery or catheter procedures with balloons or stents to bypass or unblock blood vessels in the legs. The expensive procedures — costing thousands of dollars — do work, but experiments show treadmill walking works just as well for a fraction of the cost.
About 2,600 hospital-based rehab centers are gearing up for an influx of patients after Medicare's decision . Other insurers usually follow Medicare's lead so coverage for younger patients may be ahead. Peripheral artery disease affects about 8 million Americans; about 2 million of them have disabling leg pain.
"It's often described as a cramping feeling as if someone has their leg in a vice," said Diane Treat-Jacobson of the University of Minnesota. Her research shows that walking through the pain in short sessions with rest breaks eventually improves the distances people can walk pain-free.
A simple test of ankle and arm blood pressure in any doctor's office can detect the condition. Beginning in January, Medicare will pay for 12 weeks of supervised exercise at $53 apiece with a doctor's referral. Sessions will be about three times a week for 30 minutes to an hour.
"Right now I tell all my patients with peripheral artery disease to walk. But it's really hard for them," said Dr. Mary McDermott of Northwestern University Feinberg School of Medicine in Chicago. Without someone checking on them and encouraging them, many patients won't keep at it, she said.
Leg pain forced Chicago resident Zella Coleman to give up bowling and trips with her choir. After four months of supervised treadmill walking in a Northwestern program at a gym, her pain has eased enough that she's started walking with friends in her neighborhood.
"I'm trying to get well so I can get back to my life," said the 63-year-old.
The American Heart Association and other heart specialists came together to ask Medicare to cover supervised exercise therapy for people with artery disease. The government's leading insurance program occasionally reviews the value of treatments and decides what to cover.
Over the past two decades, Medicare officials have been finding ways for the program to cover things like counseling to help people stop smoking or to lose weight. Medicare already pays for supervised exercise for people recovering from heart attacks.
"Now we don't have to wait for them to have a heart attack," said Dr. Elizabeth Ratchford of the Johns Hopkins Center for Vascular Medicine in Baltimore.
The decision resulted from medical specialty groups uniting behind a low-tech intervention, said Dr. Louis Jacques, who oversaw Medicare coverage recommendations for five years until 2014.
"From the patient's point of view, nobody is cutting you open, you're not getting anesthesia, you're not getting hospitalized," said Jacques of the health care consulting firm ADVI.
Patients need to keep walking or the pain will return.
Driscoll is committed, walking several times a week at the University of Minnesota Medical Center.
The 69-year-old doesn't want to end up like her grandmother who "couldn't walk down the sidewalk without having to rest."
"My grandma was an old lady, but at the same age I'm not," Driscoll said. "This grandma still dances."
Follow AP Medical Writer Carla K. Johnson on Twitter: @CarlaKJohnson