Virtual Pulmonary Rehab and Matched Care, With Omid Pourshahid, MD

Omid Pourshahid, MD, MPH, FCCP, told HCPLive at the American College of Chest Physicians (CHEST) 2026 Annual Meeting in Phoenix how new Medicare coverage for virtual pulmonary rehabilitation could support a matched-care approach to assigning patients to center-based, hybrid, or virtual programs.¹

Pourshahid, director of pulmonary rehabilitation at the Lewis Katz School of Medicine at Temple University, argued the pro side of a CHEST 2026 debate on tailoring pulmonary rehabilitation to each patient.¹ The 2023 American Thoracic Society (ATS) clinical practice guideline strongly recommends offering patients a choice between center-based pulmonary rehabilitation and telerehabilitation.³ Pourshahid noted patient-tailored therapy has been part of the ATS definition of pulmonary rehabilitation since 2013, but the delivery setting was rarely part of it.

“Until recently…the support and the financial approval were coming only for center-based pulmonary rehab,” Pourshahid said.

Medicare Coverage for Virtual Pulmonary Rehabilitation Through 2027

Pourshahid said flexibilities introduced during the COVID-19 pandemic opened the door to alternative delivery models. The Consolidated Appropriations Act, 2026, amended the Social Security Act to allow hospital outpatient departments to furnish pulmonary rehabilitation to patients at home through real-time audio and video technology.² According to an April 2026 Centers for Medicare & Medicaid Services (CMS) FAQ, audio-only communication does not qualify, and virtual sessions are paid at the same rate as in-person pulmonary rehabilitation.²

Before these changes, programs delivered rehabilitation in the same setting, with the same providers and the same group, which limited how much exercise intensity and program structure could be individualized, Pourshahid said.

“It was very narrow in terms of what was achievable for the program to be able to tailor it, but with more models and more methods of delivery, this hopefully will be changing in the near future,” he said.

The virtual flexibility runs through December 31, 2027.² Pourshahid noted further approval will likely depend on outcome data collected during this period, and he encouraged clinicians to learn which pulmonary rehabilitation resources are available in their area and to advocate for patients who could benefit from alternative options.

Matched Care vs Stepped Care in Pulmonary Rehabilitation

Pourshahid described his matched-care pathway as an alternative to stepped care, in which every patient enters the same pathway and is stepped up as needed. For an effective intervention with multiple gaps and barriers to access, he said, matching patients to the right setting from the start could set them up for success.¹ He acknowledged multiple guidelines support tailoring, but matched assignment has not been established as a recommended approach.

Under the proposed framework, patients with interstitial lung disease, pulmonary hypertension, or high oxygen requirements needing titration during exercise, as well as patients with significant cardiovascular symptoms on exertion, may be safer starting in a center-based program.¹ If the team finds these patients stable after the initial sessions, they could transition to a hybrid model. Stable patients whose main 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.”

Pourshahid said he and his debate opponent agree pulmonary rehabilitation is effective and underused. In a cohort of 197,376 Medicare beneficiaries hospitalized for COPD in 2014, only 1.5% initiated pulmonary rehabilitation within 90 days of discharge.³ Their disagreement is over how best to reach the many eligible patients who are not receiving pulmonary rehabilitation.

“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.

Watch part 1 of our interview with Pourshahid here: Tailoring Pulmonary Rehab to Close the COPD Gap, With Omid Pourshahid, MD.

Editor’s note: Reported disclosures for Pourshahid include Boehringer Ingelheim Pharmaceuticals & Mylan Specialty.

References

1. 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.

2. Virtual cardiac rehabilitation (CR), intensive cardiac rehabilitation (ICR) and pulmonary rehabilitation (PR) furnished by hospital outpatient departments (HOPDs) FAQ. Centers for Medicare & Medicaid Services. Published April 9, 2026. Accessed October 19, 2026. https://www.cms.gov/files/document/virtual-cardiac-rehabilitation-cr-intensive-cardiac-rehabilitation-icr-pulmonary-rehabilitation-pr.pdf

3. 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