Welcome to Part 1 of Optimizing Enrollment in Cardiac Rehab, a series that provides you with 3 methods to optimizing your post-acute cardiac rehabilitation processes. If you find this article helpful, be sure and check out Part 2 on the implementation of group screenings to increase enrollment participation rates, available May 11th, and Part 3, Inpatient Liaisons on the use of inpatient liaisons to maximize the capture of qualified candidates who participate in cardiac rehabilitation, available May 18th.

As you may be aware, Medicare’s bundled payment initiative for cardiac care is slated to begin January 1st, 2018. Under bundled payment models, hospitals will have to bear the brunt of readmission costs and post-discharge care. Post-discharge care coordination will be key in controlling those costs.

CMS has outlined cardiac rehabilitation (CR) as a key element of a robust post-acute strategy, but enrollments rates of 20% for qualified candidates are common, a metric that cardiac rehabilitation has struggled to improve. In order for hospitals to increase cardiac rehabilitation participation rates, they will need to reduce delays between inpatient discharge and outpatient enrollment. It is estimated that participation in cardiac rehabilitation decreases by 1% for every day that enrollment is prolonged beyond the date of discharge. The optimal time from discharge to the first enrollment appointment is 14-17 days.

Reducing this delay requires the optimization of referral and enrollment systems. Fortunately this process provides other benefits, in fact once completed, hospitals will find themselves well positioned for cardiac bundle incentives paid at the rate of $25 per session for the first 11 sessions and $175 per session for every additional session thereafter. Not only that, but planning for the operationalization of this process also offers an opportunity to lower staff overhead by lowering required hours for scheduling support. Below, Movn Health has outlined some methods for reducing the delay between discharge and enrollment in cardiac rehabilitation.

Strategy 1: Identify key staff members
As with any effort, the first step is to identify and involve key members of your hospital. Here are some common titles that should be involved:

• Scheduling support staff
• Supervisors or program managers
• Cardiac Rehabilitation staff
• Referring providers
• Administrative assistants

Proactive engagement of these team members ensures all stakeholders are involved in the concerted effort to reduce enrollment delays.

Strategy 2: Identify a realistic goal
Accurately capturing an acceptable time delay from inpatient discharge to outpatient enrollment in cardiac rehabilitation for your hospital is necessary in order for you to set realistic goals. In order to do that, it’s extremely important to collect relevant metrics such as below:

1. What is your current time to enrollment?
2. Review 50-100 charts (or the last 3 months of patient enrollments).
3. Calculate the days from discharge (outpatient CR order) to enrollment.
4. Identify the number of enrollment appointment slots that are available.
5. Identify your hospital’s interval between discharge/referral and the first cardiac rehabilitation appointment (range and average).
6. Determine your goal interval. (Goal interval will vary among programs due to unique local factors.)

Strategy 3: Identify barriers to achieving your goal
Once you have set a goal interval, it is important to identify barriers that stand in the way. Barriers can be categorized as follows:

Barrier TypeDescriptionSolutionPatient BarriersLack of transportation options.Provide a bus/public transportation option for patients. Consider virtual care by using home-based cardiac rehabilitation to create greater access for patients.Patients cannot afford co-pays.See if foundation or charity funds can offset co-pays. Try soft financial incentives like providing free parking. Consider offering programs with reduced number of sessions.Patients are not comfortable speaking English Language.Consider hiring interpreters. Look at having a multi-cultural staff that can speak a variety of languages as relevant to population.Program BarriersPatients cannot meet during hours of operation.Consider offering weekend appointments.Program does not have adequate staffing.Implement group screenings (covered in Part 2). Triage patients into low, moderate and high risk and consider reducing sessions/offering home-programs when appropriate.Program lacks space.Petition management for expanding space. Consider vitual care delivery models like home-based cardiac rehabilitation approaches.Other BarriersUnique barriers to your program.

‍Strategy 4: Leverage technology

Thanks to modern technology, many solutions exist today that were not possible 10 years ago. Mobile applications now provide options like ride-sharing services, such as Uber and Lyft, that help solve transportation issues. Virtual care delivery models like home-based cardiac rehabilitation are now available, overcoming barriers to scheduling, distance and space by accommodating more patients.

It is incumbent on each program to identify which strategies address their unique barrier set and diligently implement solutions that work best. Central to these strategies will be setting up the right information management tools to track performance and measure success or failure.

Some of the the methods above are sourced from Roadmap to Reform of which Moving Analytics is a proud sponsor. This article is the first in a 3 part series Optimizing Enrollment in Cardiac Rehab. If you are interested in learning about how group screenings will lead to increased participation in outpatient cardiac rehabilitation, be sure to check out Optimizing Enrollment in Cardiac Rehab - Part 2, Group Screenings, available May 11th.

1Reducing the Delay Between Hospital Discharge and Enrollment in Outpatient cardiac rehabilitation

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