1. Programs are successfully implementing strategies to increase referral and enrollment
CMS has set an ambitious goal for cardiac rehab as part of the 2022 update to its Million Hearts initiative: increase cardiac rehab utilization from 20% to 70% in just five years. It's a big jump for institutions, but some CV programs are taking it in stride by implementing new strategies to increase both referral and enrollment in cardiac rehab.
Cardiac rehab programs that have evaluated the impact of the method of referral on patient attendance have learned that while an automated standing order in the EHR increases enrollment, adding a bedside visit from a cardiac rehab liaison while the patient is still in the hospital can double referral and enrollment numbers.
Some CV programs are offering home-based virtual cardiac rehab programs to increase accessibility of cardiac rehab services to patients not able to travel to the rehab facility. While virtual rehab is not reimbursable for Medicare fee-for-service patients, private payers in a few states are starting to reimburse virtual rehab for commercially insured CV patients as a means to increase patient participation.
2. Increased efficiency increases capacity, likelihood of enrollment
To accommodate growing patient volumes resulting from strategies to increase referrals, cardiac rehab programs are evaluating opportunities to improve program efficiency. Since there is a 1% decrease in cardiac rehab participation for every day enrollment is delayed after hospital discharge, reducing the time between discharge and enrollment is critical.
A recent study at Vanderbilt University Medical Center analyzed the impact of group enrollment, or "open gym," cardiac rehab sessions on enrollment wait times. The study found that open gym sessions decreased cardiac rehab wait times by 22%, or 3.7 days. Most importantly, there was no difference in outcomes for patients, as patients who participated in the group enrollment sessions showed similar clinical benefit to patients with individual appointments.
3. Cardiac rehab supports value-based care initiatives
One of the most important takeaways from our discussion was the impact of cardiac rehab on value-based care outcomes. Cardiac rehab has well-established clinical benefits for participants, and the wealth of supporting evidence is one of the main reasons CMS introduced the Cardiac Rehab Incentive Payment Model in 2015 before it's cancellation alongside the mandatory Episode Payment Models (EPMs) in 2017. Despite the cancellation of the EPMs, there are current value-based care initiatives that stand to benefit from patients attending cardiac rehab.The newest risk-based payment model, BPCI Advanced, includes several CV conditions for which Medicare Part B reimburses cardiac rehab:
- Acute myocardial infarction (AMI)
- Cardiac valve
- Congestive heart failure (CHF)
- Coronary artery bypass graft (CABG)
- Percutaneous coronary intervention (PCI) (inpatient or outpatient)
Since the program evaluates 90-day episodic cost, the post-acute care setting is an area to target strategies that improve quality outcomes and reduce costs—like cardiac rehab.
Even for programs not considering participating in BPCI Advanced or other risk-based payment models, cardiac rehab is an effective post-acute care strategy to reduce readmissions for AMI, HF, and CABG patients. In fact, CABG patients who do not attend cardiac rehab are three times more likely to be readmitted compared to CABG patients who do attend.
But the cost burden of readmissions and negative outcomes doesn't just impact hospitals anymore. Physicians in the MIPS track of MACRA are held accountable for the total spending on each Medicare beneficiary as an episodic cost measure. CV specialists and primary care physicians now have to more critically evaluate opportunities to reduce unnecessary utilization. Cardiac rehab is a proven strategy to both reduce total costs and improve quality outcomes by improving physical function, catching complications early, reducing stress and anxiety related to a patient's CV condition, reducing readmissions, and more.
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