Abstract Body (Do not enter title and authors here): Introduction: Improving cardiac rehabilitation (CR) attendance is a national priority. However, insurance companies often charge copays for CR, and patients commonly report copays as a barrier to attendance.
Aim: To describe the prevalence of copays, their amounts, and the associations with attendance and drop-out in a national sample.
Methods: We analyzed the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) registry through the AACVPR Data Analytic Center. We included patients from 2012 to 2021 who had a value for copayment (including 0) and excluded patients with missing copay data. We described copay magnitude, prevalence, and associations with baseline factors, patient characteristics, region, and if copays were cited as a reason for drop out. In multivariable models, we analyzed if a copay of any amount was associated with CR attendance and if a dose-response existed. In all models, we adjusted for age, education, AACVPR risk category, surgical diagnosis, tobacco use, distance to CR, insurance, and median household income.
Results: Among 489,507 total patients, 59838 were included in analyses, of which 16339 (27.3%) had a copay. Patients with copays had lower educational attainment and were more likely to have Medicare or Medicaid insurance. The median (IQR) copay was $24 (20, 34). Medicare, Medicaid, Private, and Other insurances charged a median (IQR) copay of $20 (20-25), $3.7 (3, 12), $30 (20-40), and $25 (20 to 36), respectively. Copays were more common in Florida, New York, and the Rocky Mountain States, (>40% of patients) and more expensive in the northeast (median >$34). In multivariable models, the presence of a copay was associated with attendance at 5 (4.3 to 5.6, p < 0.001) fewer sessions of CR. When considering copay amount, every $10 increase in copay was associated with 0.5 (0.4 to 0.6, p < 0.001) fewer sessions of CR. Finally, copays were cited as the reason for early drop out in 21% of cases, with 2.2 (p<0.001) fewer sessions of CR compared to drop out for other reasons.
Conclusion: In this national sample, copays for CR are common, costly, and associated with fewer sessions of CR. Policy makers should reconsider these policies to promote CR participation.