Welcome to Part 2 of Optimizing Enrollment in Cardiac Rehab. In Part 2, we provide strategies to implement group screenings (GS) which can improve staff efficiency and reduce appointment delays. If you haven’t already, check out Part 1, Minimizing Delays, for strategies on minimizing the delay from patient discharge to enrollment in cardiac rehabilitation. Part 3, Inpatient Liaisons, on scheduling a patient’s first visit in outpatient cardiac rehabilitation prior to their inpatient discharge, will be available May 18th.

Many providers struggle with the enrollment of qualified candidates to cardiac rehabilitation. Enrollment rates under 20% are common and in order for cardiac rehabilitation to be an effective element of post-acute strategy, screening processes need to be scrutinized.

As mentioned in Part 1, the optimal time from discharge to the first enrollment appointment is 14-17 days. It is recognized that participation in cardiac rehabilitation decreases by 1% for every day that enrollment is prolonged beyond the date of discharge. This decrease in participation renders cardiac rehabilitation less effective in reducing unnecessary readmissions and handicaps the hospital from benefiting from the cardiac incentives.

If you work with a cardiac rehabilitation provider, you may be familiar with individual or face to face assessments. Individual assessments (IA) can cause a bottleneck in the enrollment process, particularly when referral rates of cardiac rehabilitation candidates are higher than normal. Appointments are made at the earliest convenience of the provider leaving patients on a waitlist to begin their rehabilitation.

Providers can reduce these appointment delays with the use of group screenings (GS). Pre-enrollment GS reduce appointment delays, are relatively low cost to benefit and can be implemented with few people involved. Additionally, GS can provide a reduction in required staffing hours by up to 44%. Here, we outline a few strategies that you can use to implement a successful group screening program.

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:

• Patient intake/Reception
• Administrators
• Facility leaders

Strategy 2: Identify relevant metrics

1. Time to enrollment baseline: Review 50-100 charts in order to calculate the days from discharge or outpatient CR order to enrollment.
2. Enrollment staff time baseline: Measure the average time to complete patient facing screening duties plus time to complete documentation.
3. Enrollment staff time: Measure the time needed to complete screening duties, individual patient facing duties and time to complete documentation.
4. Clearly document these metrics in a suitable digital format for easy reference and create weekly/monthly reports to measure progress.

Strategy 3: Identify group screening components

1. Group screening components: Identify components of your screening process that are repeated with every new patient. Goal setting worksheets, questionnaires, and consent forms are a few examples.
2. Individual assessment components: Identify the components of your screening process that cannot be adapted to a group setting such as medicine reconciliation, goal discussion, review of depression screening, measurement of exercise capacity and individual patient Q&A.

Strategy 4: Adapt materials for group screenings and a brief individual assessments

1. Group screening: Adapt repetitive materials for delivery in a group setting. Review your program’s history of referrals to determine how frequently your group screenings will be needed. Find a meeting place that will accommodate 6-12 patients for the screenings and design them so that one staff member can deliver the group screening session. This is a non-billable service as the patient does not exercise.
2. Individual assessment: Design a very brief individual meeting at the beginning of the patient’s first cardiac rehabilitation exercise session for the completion of your materials unable to be adapted for a group setting. This is a billable service.
3. Consider utilizing digital tools to push screening and assessment forms or educational materials to patients ahead of the screening and/or assessment session.

Strategy 5: Engage departments

1. Scheduling support: Adjust scheduling with appropriate staff to accommodate for defined process.
2. Include appropriate patient intake/reception staff in planning to ensure the best experience for patients.
3. Engage with administrators/facility leaders to discuss space needed for group screenings.
4. Demonstrate return on investment using metrics collected in strategy 2.

Transitioning from individual assessments to group screenings can take three to six months depending on time dedicated to planning and operationalization. Costs involved include the printing of materials and time taken for the identification of components repeated with every new patient.

Some of the strategies above are sourced from AACVPR’s Roadmap to Reform, of which Movn Health is a proud sponsor. Check out Part 1, Minimizing Delays and Part 3, Inpatient Liaisons, for additional methods to optimizing cardiac rehabilitation enrollment processes.

‍