Dr. Barry Franklin Discusses Home-Based Rehab Benefits with Chanl Health
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Why is an alternative delivery model like hybrid rehab even needed?
Cardiovascular disease is the leading cause of death and largest healthcare expense in the U.S. Patients who are hospitalized from a cardiac event have a 30% readmission rate within 30-days and cost health plans 2-3x more. Cardiac rehab (CR) after a cardiac event is the standard of care. It is a clinically validated program that reduces readmissions, costs, and future events, but 80% of patients do not participate in CR. For the past several years, AACVPR, AHA and ACC have been working to increase participation in CR. The Million Hearts initiative has a goal of 70% by 2027. This ambitious goal requires us to have new innovative delivery models of care, one being, hybrid rehab.
The ONLY thing different about a hybrid program component is the delivery mechanism. Adding a hybrid option using both synchronous and asynchronous sessions is a way to reach the 80% of patients that cannot or will not attend traditional center-based CR (CBCR). Our goal remains to get as many patients as we can in our "tried and true" CBCR program. We can NOT be satisfied to reach only 20% of patients eligible. A hybrid delivery option is a compliment to your CBCR program.
What is meant by a hybrid rehab program?
Hybrid means the patient receives their rehab through a given mixture of three modalities. Synchronous/In-Person is delivered within a standard CBCR program where patients are physically with a provider. While meeting the Centers For Medicare & Medicaid Services (CMS) criteria for billing, this is considered a billable service. Asynchronous/Remote involves at-home engagement tasks and exercise when patients are not “synchronously” with a provider, this type of care delivery is considered non-billable. Synchronous/Virtual is delivered via video calls where patients are with a provider using two-way audio-visual technology. Please see CMS guidelines for billing and reimbursement of virtual CR. There is no perfect number or mixture of how many of each modality should be included in a patient's hybrid program, but it is instead, dependent upon each individual's needs.
Is there a difference between remote delivery and virtual delivery?
No, the difference is in whether or not the session is synchronous or asynchronous. Synchronous/Virtual refers to video sessions using real-time audio-visual technology while meeting CMS criteria for billing.
What is meant by an “asynchronous” task?
This refers to the patient doing either an exercise or education session without being observed by staff. Think of what you ask your CBCR patients to do on off days. These are not reimbursable.
Are the core components and requirements of hybrid the same as CBCR?
Yes, all requirements remain the same. The only change is HOW we deliver the services
Location - hospital (on-or off-campus) or physician office (See CMS for billing guidelines)
How do alternative delivery models compare to CBCR? (ie, safety, efficacy, outcomes)
The supporting literature has demonstrated no significant differences in safety and efficacy, clinical outcomes, or patient-centered outcomes (ie, cardiorespiratory fitness, quality of life, patient satisfaction etc.) between alternative delivery models and CBCR. Below is a list of research from major publications involving the comparison of CBCR to alternative delivery models and other evidence-based findings:
A hybrid solution can be delivered to any patient as an option to a CBCR program. It is intended for low to moderate risk patients and can, with proper guidance and instruction, serve a higher risk patient.
Can hybrid be applied to other patients in rehab? (ie, pulmonary, heart failure, PAD)
Yes, of course. Many rehab programs differ in terms of what subsets of patients they serve. No matter the type of program, (ie, CR, cardiopulmonary rehab, pulmonary rehab, cardiovascular rehab, etc.) patients are still facing the same barriers to attending. Increasing access is just as important for these patients.
Does the hybrid model replace CBCR delivery?
No, we want as many patients as possible to attend the proven evidence-based programs. That being said, <30% of eligible do attend. Offering a hybrid option is a compliment to the CBCR program for those that cannot or will not attend.
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