On our mission to grow participation rates in cardiac rehab (CR) across the country, we often encounter programs that have a long waitlist for a patient to get in. The performance measure for time to enrollment is within 21 days of discharge. Cardiac rehab, in theory, should be a tool to reduce 30-day readmission rates, yet we often see waitlists to enter CR of 4-6 weeks, or even more. Not only are these patients much less likely to actually enroll by the end of that extended time, but the benefits of CR within that critical 30-day window have been lost.
As you explore the core reasons leading to a long waitlist for a program, it really comes down to what we call “Program Capacity”. Simply put, program capacity is the number of patients that can be served in the program at any one time, also referred to as program bandwidth. If your capacity is full, you can’t admit any more patients into your program, and hence the waitlist.
In discussions about how to increase program capacity if a waitlist exists, we often cover the basics of a) need more exercise equipment, space, or monitors to have bigger class sizes, b) need more staff or budget to have more classes, or c) need more intake slots.
What we don’t see talked about as often, is how the program model itself can effect capacity. Specifically, how having more flexible options for onsite session participation can actually increase your program capacity significantly.
Let's consider a basic example. Imagine a CR program runs two classes a day, every Monday, Wednesday, and Friday. Each class can accommodate 10 patients, amounting to 20 patients per day. If the program enrolls all patients into three classes per week, then their capacity is 20 patients. Until one patient ends their program and frees up a spot, there is a waitlist. Take that over the length of a year, and if each patient is enrolled a full 3 months, the program can accommodate 80 patients through the year.
Now tweak that basic model a bit, and add a second “track” to the program, where select low-risk patients can transition to a once-a-week onsite session schedule, after their first two weeks in the program. Let’s say 50% of patients fit this criteria, so you have half the patients still attending 3 days per week, and half attending 1 day per week. In that case, the capacity would increase from 20 patients a week to 40 patients a week. Annually, that program could accommodate 160 patients, instead of 80.
Note that this doubling of program capacity was achieved without adding any equipment, space, monitors, or class times. It also kept the same staffing ratios.
So what did need to change? The number of intakes through the year doubles, so you need to be two times as efficient with those (see our article on group intakes). Since the number of active patients doubled (even though your billed sessions and class sizes remained the same), you need to keep productivity up through efficient documentation, ITP management, and workflows (see our productivity tools).
It can seem too good to be true, but the main question is if patients are achieving the same or better clinical outcomes under this model? Does offering these different “tracks” improve outcomes for the target population? The short answer is yes it can! Programs that have select patients onsite once a week or even once a month are able to show comparable outcomes, provided they deliver adequate support, education and guidance through asynchronous care. It also is important to remember that for many of these patients, the alternative is no cardiac rehab at all, which is a worst case scenario.
While this is just a simple example, Chanl helps programs setup a variety of different “tracks” and hybrid models to fit their needs, and all programs are different. To help with the productivity and asynchronous care, we have developed tools and standard workflows that help programs succeed when increasing program capacity.
For more information on how a hybrid model such as this could look with your program, send us a message and we would love to connect.