Over the past three years, the adoption of tele-health and virtual care solutions by health systems has been fast and furious, and for many… bumpy. Early on in the pandemic, corners had to be cut with implementing these new solutions, under the assumption that if they were not launched quickly, patients would have zero access to critical health services. Some progressive health systems were more prepared to enhance their virtual options, and others adapted quickly to handle the change. However, many struggled with short-term solutions and hoped to get back to normal when the virus ramped down. Virtual delivery of cardiac and pulmonary rehab was no different. The Public Health Emergency (PHE), with the Hospital Without Walls Waiver, gave our programs the ability to deliver cardiopulmonary rehab virtually, and be reimbursed for their services. It was a win-win for our programs, at least those ready to take the leap into a different delivery model.
The PHE ended on May 11th, 2023. For many parts of medical care, tele-health services will continue to be delivered and reimbursed. For cardiac and pulmonary rehab programs, we lose the ability to access patients not willing or unable to attend center-based programs. Two steps forward and 6 steps back. The path forward is legislation and permanent reimbursement. That takes effort and time, which many are eager to support, but what about the now? How can we continue to reach more patients?
For some, a return back to “normal” in cardiac rehab can’t come quickly enough. What this means is that only 29% of patients who need cardiac rehab would receive it. In 2016, the CDC’s Million Hearts initiative set a goal of 70% participation in cardiac rehab by 2022. An ambitious but admirable goal. However, Randy Thomas, MD, a past president of AACVPR noted that “If we filled every cardiac rehabilitation program in the United States to full capacity, plus 10%, we could only serve about 45% of eligible patients, and there would be a 1-year wait list to get in.” 2022 has come and gone and despite a concerted effort and focus, we have barely moved the needle on enrollment. Million Hearts has again made enrollment an initiative and will strive to reach 70% by 2027. If we have learned anything these past few years, <30% enrollment is unacceptable, reimbursement or not. Simply stating a goal will not move the needle without action.
We should not strive to be back to “normal”. We must continue to be open to new delivery models. With all the negatives from the past three years, one positive is that the cardiac rehab industry showed what successful virtual and hybrid delivery can do for patient access, engagement, satisfaction, and most importantly, outcomes. There is plenty of research showing that patients who participate in hybrid programs have improved outcomes similar to those who participate fully onsite. There are plenty of examples of how hybrid programs generate more revenue and operate profitably, even WITHOUT reimbursement for video-based sessions.
It would be a shame to spend our efforts trying to get back to the old “normal”. As Socrates said a couple thousand years ago, “the secret of change is to focus all of your energy, not on fighting the old, but building the new.” As an industry, we need to continue to build on the innovation we have shown over the past three years. We need to build on the leading practices and evidence. Because at the end of the day, virtual care is an ACCESS solution. It is a COMPLIANCE solution. It is a PATIENT solution. Moving FORWARD is our path. The time is NOW.
For more on reimbursement of virtual cardiopulmonary rehab, click here.
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Why Chanl Health
At Chanl, we partner with health systems, clinics, and rehab programs to deliver a world-class virtual-hybrid cardiopulmonary rehab program. Our proven virtual-hybrid care solution removes patient barriers to access and provides innovative ways to meaningfully engage in their health. Healthcare providers that use our virtual-hybrid solution can deliver increased quality care to more patients at a lower cost.
