Cardiac Rehab Key to Preventing Patient Readmissions

The data are clear. After patients have a heart attack, bypass surgery or stent implantation, they fare better if they then undertake cardiac rehabilitation therapy — which includes exercise training, nutrition counseling and stress-reduction techniques.

Yet, less than one-third of eligible patients enroll in cardiac rehab programs. To increase participation, the Centers for Medicare & Medicaid Services (CMS) recently finalized a new incentive model that will pay hospitals more if their cardiac patients stay in rehab longer — up to 36 sessions.

For some perspective on preparing for the new incentive policy, Consult QD recently spoke with Haitham Ahmed, MD, preventive cardiologist in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine.

Q: What do the data say about cardiac rehab programs?

A: The data, based on 600,000 Medicare beneficiaries, show that patients who do cardiac rehab will live up to 34 percent longer compared to those who don’t. And patients who stick with it do progressively better — people who do 12 sessions compared to one session live longer, and people who do 24 compared to 12 live even longer, and people who do 36 compared to 24 live even longer.

Q: Can you explain the new incentive program?

A: Every year CMS, because they recognize how important this is with regard to health outcomes, increases reimbursement for cardiac rehab. But they are now changing the incentives further so hospitals that have patients who stay longer than a certain number of sessions will get reimbursement at an even higher rate.

Q: What is Cleveland Clinic doing to prepare for the new incentive program?

A: We’re changing from an opt-in to an opt-out approach. We think this should be the standard of care and no one should leave our hospitals after a heart attack, stent or bypass without at least a discussion of cardiac rehab. So it will be a mandatory part of our order sets for patients being discharged with those diagnoses.

We’re also creating an educational video for patients to watch before they leave and we’re streamlining scheduling so a patient who has bypass surgery at the main campus but wants to do rehab at a different facility can schedule it before they leave.

Q: Anything else providers should know about cardiac rehab?

A: It’s safe to enroll patients in cardiac rehab sooner than we thought. After a stent is placed, for instance, we can enroll patients as soon as two weeks after surgery, and for bypass patients with no significant issues, we can have them on the treadmill after four weeks.