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August 6, 2013

Hospitals get patients sweating after heart surgery

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    More hospitals are offering customized cardiac rehabilitation programs that include safe but rigorous workouts for "industrial athletes" and other patients with active lifestyles, the Wall Street Journal reports.

    • Keep cardiac patient out of the hospital. Learn how the Robert Wood Johnson Health Center leveraged Crimson data analysis to cut readmissions and LOS for patients suffering from heart attacks or heart failure.

    Baylor Heart and Vascular Hospital in Dallas is one of many hospitals that have piloted such efforts, offering unique job-specific regimens for policemen, firefighters, auto mechanics, farmers, and ranchers who want to return to work after heart procedures. In recent years, studies have found that more-rigorous exercise is acceptable during recovery and that it can benefit certain patients more than cautious, monitored exercise.

    Baylor officials say the program isn't just about fitness. "It isn't just about getting physically fit but giving [patients] the confidence to be able to do so at a high level and not be fearful," says Rafic Berbarie, medical director of cardiac rehabilitation at Baylor.

    Programs aim to boost subpar rehab attendance

    Custom-designed workouts are part of an overarching effort to boost participation in cardiac rehab programs, which are relatively underused despite strong evidence that completing them reduces mortality, prevents recurring heart events, and improves overall health. In a 2007 study of approximately 270,000 Medicare beneficiaries, only 14% of heart attack patients and 31% of patients who underwent coronary artery bypass graft surgery utilized cardiac rehab.

    Mayo Clinic cardiologist Randal Thomas says some patients assume that they no longer face cardiac risks after undergoing surgery. However, he says, "People are not cured after surgery, and there is still considerable prevention to do." At the same time, physicians do not often require that patients attend cardiac rehab, and many patients who do enroll in the programs leave them early.

    Moreover, cardiac rehab programs have been scaled back or shuttered in recent years because of declining reimbursements from Medicare, the Journal reports. A study commissioned by CMS in 2008 found that reimbursements for rehab programs did not cover the cost to administer them. However, Medicare payments increased to $68 in 2011 and are projected to reach $80 in 2014. 

    Readmissions penalties provide rehab incentive

    Hospitals likely will get better at referring patients for cardiac rehab now that they face Medicare penalties when patients with heart attacks or heart failure are readmitted within 30 days, the Journal notes.

                    Hospital readmissions: As penalties begin to bite, 'now they're paying attention'

    "Hospitals and doctors are realizing that cardiac rehabilitation fills a gap in care, and patients will be less likely to return to the hospital" if they complete the sessions, says Karen Lui, a consultant at the American Association of Cardiovascular and Pulmonary Rehabilitation (Landro, Journal, 8/5).

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