Cardiovascular Rounds

How virtual cardiac rehab can fill the Covid-19 treatment gap

by Julie Bass

Cardiac rehabilitation is a proven tactic to improve patient outcomes, reduce readmissions, and lower long-term costs, but it's highly underutilized as a post-acute service for CV patients—and Covid-19 just made it even more challenging to use.

Covid-19 and beyond: 2020 trends for cardiovascular leaders

That's because most cardiac rehab programs require patients to receive services in-person at a health care facility. But fortunately, virtual, or home-based, cardiac rehab has the potential to fill a utilization gap, especially during a time when nonessential direct patient contact isn't possible.  

Increasing evidence supports safety and efficacy of virtual cardiac rehab

Virtual cardiac rehab services are typically delivered through a variety of means, including one-on-one phone or video calls between a patient and cardiac rehab professional and group educational sessions. Programs can also employ a hybrid approach, which combines some center-based services with some home-based services.

Most of the virtual cardiac rehab platforms—such as Moving Analytics and Chanl Health—are app-based. Patients can record their own diagnostics to share with cardiac rehab professionals, receive personalized coaching, and access a direct connection to their cardiac rehab provider. Moving Analytics' program "MOVN" has 60% patient enrollment—which is much higher than the 24% of patients who participate in traditional, center-based rehab.

Last year, the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), the American Heart Association (AHA), and the American College of Cardiology (ACC), jointly released a scientific statement that supports home-based cardiac rehab as a "reasonable option" for some patients based on a growing body of clinical evidence. The authors do acknowledge that lack of reimbursement is a challenge to adoption, but hope that more research and support of home-based rehab as a safe option will impact payers' decisions moving forward. 

Slide deck: How to optimize your cardiac rehab program

How your peers are implementing virtual cardiac rehab

Even before Covid-19, some programs have been exploring opportunities to provide virtual cardiac rehab services to patients who are unable or unwilling to travel to receive consistent services at a facility.

For instance, several institutions in the United States offer the option for home-based cardiac rehab or a hybrid approach of both home-based and in-person rehab, including Henry Ford Health System and several Veterans Affairs (VA) facilities. More recently, a few programs have been doubling down on their efforts to expand virtual services:

  • Kaiser Permanente recently developed a virtual cardiac rehab program in collaboration with Samsung. The program has enrolled more than 2,300 patients and has graduated 1,880 patients since 2018. According to Kaiser's analysis reported in NEJM Catalyst, 80% of participants complete the program, compared to the national average completion rate of 50% for center-based cardiac rehab. Additionally, cardiac-related readmissions are less than 2% for patients in the program.

  • Highmark Health announced in November 2019 that it would begin testing Moving Analytics' MOVN virtual cardiac rehab solution through its VITAL Innovation Platform, which aims to evaluate innovations to improve diagnosis and treatment for patients with major disease. According to the company's press release, this is the first time a major U.S. health system is reimbursing a commercial home-based cardiac rehab program.

Why now is the time to explore virtual cardiac rehab

Since many cardiac rehab programs have had to temporarily close as a result of the crisis, many patients aren't receiving any cardiac rehab services, which can adversely affect outcomes.

To ensure cardiac patients receive needed post-acute care, AACVPR is supporting home-based rehab as a safe and effective option for patients—both in the short-term amid the Covid-19 epidemic, but also as a long-term care delivery strategy. Former AACVPR President Todd Brown in a recent article explains, "It is important to recognize that although the mode of delivery is different, cardiac rehabilitation is cardiac rehabilitation, regardless of whether it is delivered in a center or home-based environment."

That said, one large barrier to widespread adoption remains: Medicare still does not reimburse cardiac rehab delivered via telehealth, despite recently expanding its telehealth guidelines. But AACVPR and partners have submitted letters to CMS urging the agency to consider expanding telehealth reimbursement for both cardiac and pulmonary rehab services, particularly in light of the current crisis.

When the outbreak begins to subside, we urge CV programs to continue to seek opportunities to improve enrollment and attendance of cardiac rehab. Virtual rehab has been demonstrated to be a viable channel for care delivery and can ensure patients receive critical post-acute care services during the crisis and beyond. We also encourage payers to regularly evaluate clinical evidence and guidelines to make coverage decisions based on the most recent safety and quality outcomes for telehealth services, including virtual rehab.

Access AACVPR's Covid-19 resources and learn more about their response to the crisis here.  

Covid-19 and beyond: 2020 trends for cardiovascular leaders

Learn more about how CV programs are managing through the Covid-19 crisis during our May 5 webconference, 2020 Cardiovascular State of the Union.

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