Medicare beneficiaries requiring pulmonary rehabilitation can now access virtual care from home under a federal policy extension running through December 31, 2027. A proposed matched-care framework presented at the CHEST 2026 annual meeting in Phoenix, Arizona, is aimed at addressing underutilization by tailoring initial treatment settings to individual patient needs.
Pulmonary rehabilitation programs traditionally require patients to travel to hospital outpatient centers. However, a published cohort analysis of 197,376 Medicare beneficiaries hospitalized for chronic obstructive pulmonary disease in 2014 demonstrated that only 1.5% initiated pulmonary rehabilitation within 90 days of discharge. Commuting barriers are a factor keeping eligible patients from starting these physician-prescribed exercise and education programs.
In Plain English: The Clinical Takeaway
- Matched Care vs. Stepped Care: Instead of forcing every patient to start in a supervised hospital facility and step up only if needed, a matched-care model assesses patients upfront to assign them directly to center-based, hybrid, or virtual home programs.
- Virtual Care Rules: Under current federal guidelines, hospital outpatient departments can deliver reimbursed pulmonary rehabilitation sessions directly to patients at home via real-time audio and video platforms. Audio-only sessions do not qualify for coverage.
- Clinical Safety First: A center-based program may be a safer starting point for individuals dealing with pulmonary hypertension, interstitial lung disease, elevated oxygen demands, or pronounced cardiovascular symptoms during physical activity.
Assessing Patient Risk Before Program Assignment
Omid Pourshahid, MD, introduced the matched-care framework during a pro-con debate session at the CHEST 2026 conference, held October 18–21, 2026. Pourshahid argued that traditional stepped care fails to capture many eligible individuals. While existing clinical guidelines support tailoring, matched assignment has not been established as a recommended approach.
Under the proposed framework, clinicians conduct an initial assessment, preferably in person, to evaluate stability and risk factors. Pourshahid noted that patients diagnosed with interstitial lung disease, pulmonary hypertension, or those requiring oxygen titration during exercise may be safer starting in a center-based program. Individuals exhibiting significant cardiovascular symptoms on exertion also require direct monitoring. Once clinical stability is confirmed during initial sessions, care teams can transition these patients to a hybrid model.
Stable patients whose primary barrier is commuting to a center could complete virtual pulmonary rehabilitation at home. “Trying to set the patient up for the right pathway requires a proper assessment, preferably in person,” Pourshahid said. “That proper assessment would give us all the information that we need to set the patients up in the right step and help them get something, which is a lot better than nothing with the data that we have at this point.”
Regulatory Framework and Coverage Deadlines
Home-based pulmonary rehabilitation is made possible through virtual flexibilities authorized by the Consolidated Appropriations Act, 2026, which permits hospital outpatient facilities to provide these services via live video and audio connections.
According to guidance issued by the Centers for Medicare & Medicaid Services, this reimbursement authorization remains active through December 31, 2027. Regarding future reimbursement, Pourshahid mentioned that the continuation of these policies will likely rely on outcome metrics gathered during this timeframe. He also urged medical professionals to familiarize themselves with local pulmonary care options and advocate for alternative pathways on behalf of eligible patients.
| Delivery Setting | Target Patient Profile | Regulatory & Clinical Status |
|---|---|---|
| Center-Based Outpatient | Interstitial lung disease, pulmonary hypertension, high oxygen requirements, significant cardiovascular symptoms during exercise. | Established standard of care. |
| Hybrid Model | Patients starting in-center who are found stable after initial sessions. | Proposed transitional model. |
| Virtual At-Home | Stable patients whose main barrier is commuting to a center. | Reimbursed through December 31, 2027, under the Consolidated Appropriations Act, 2026. |
Contraindications & When to Consult a Doctor
Patients are advised to consult their pulmonologist regarding their eligibility for specific rehabilitation settings based on their individual health status and stability.
Future Outlook for Personalized Respiratory Care
The debate over matched versus stepped care highlights a push toward personalized medicine within pulmonary care. Participation rates underscore the necessity of exploring delivery methods.
“I think personalization [and] customization of the setting of the prescription of the pulmonary rehab to best accommodate the patient needs would be the way to capture more patients, rather than continuing with the same template, which has not captured many, many patients for a few decades,” Pourshahid said. Reported disclosures for Pourshahid include Boehringer Ingelheim Pharmaceuticals & Mylan Specialty.
References
- Pourshahid O. Pulmonary rehabilitation is not one-size-fits-all: we need to tailor it for each patient (pro). Presented at: CHEST 2026; October 18-21, 2026; Phoenix, AZ.
- Centers for Medicare & Medicaid Services. Frequently Asked Questions Regarding Virtual Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, and Pulmonary Rehabilitation Provided by Hospital Outpatient Departments. Published April 9, 2026. Accessed October 19, 2026.
- Lindenauer PK, Stefan MS, Pekow PS, et al. Association between initiation of pulmonary rehabilitation after hospitalization for COPD and 1-year survival among Medicare beneficiaries. JAMA. 2020;323(18):1813-1823. doi:10.1001/jama.2020.4437
