Over the past 9 months, the adoption of telehealth and virtual care solutions by health systems has been fast and furious, and for many… bumpy. Early on in the pandemic, corners had to be cut in implementing these new solutions, under the assumption that if they were not launched quickly, patients would have zero access to critical health services. Some progressive health systems were more prepared to enhance their virtual options, and some adapted quickly to handle the change. Some, however, struggled through with short-term solutions and hopes of getting back to normal when the virus ramped down. Virtual delivery of cardiac and pulmonary rehab was no different.
With the start of a new year and a vaccine launched, despite high and rising numbers of COVID across the country, there is hope that 3-6 months down the road things will start to resemble normal. For a cardiac rehab program, that may mean removing restrictions for onsite classes from 50% capacity, back up to 100% capacity. More patients, while still in a high-risk class for the virus, may feel comfortable coming into the hospital three days a week for rehab. This is what we dream of, right?
Well… maybe we need to rethink our ideal scenario. A return back to “normal” in cardiac rehab would mean that just as it was pre-COVID, only 20% of patients who need cardiac rehab receive it. And that counts those who attend just a single session. While some hospital-based CR programs have room to add more patients if they could get them, many have long waiting lists and are at capacity, given their physical space limitations. In 2016, the Million Hearts initiative by the CDC set a goal of 70% participation in cardiac rehab by 2022. An ambitious but admirable goal. However, Randy Thomas, MD, a past president of AACVPR noted that “If we filled every cardiac rehabilitation program in the United States to full capacity, plus 10%, we could only serve about 45% of eligible patients, and there would be a 1-year wait list to get in.”
This should not be the “normal” we strive to return to. With all the negatives over the past year, one positive is that the cardiac rehab industry showed what successful virtual and hybrid delivery can do for patient access, engagement, satisfaction, and most importantly, outcomes. There is plenty of research showing that patients who participate in hybrid programs have the same improved outcomes as those who participate fully onsite. There are plenty of examples of how hybrid programs generate more revenue and operate profitably, even WITHOUT reimbursement for home-based sessions.
What would be a shame, is to spend our efforts trying to get back to the old “normal”. As Socrates said a couple thousand years ago, “the secret of change is to focus all of your energy, not on fighting the old, but building the new.” As an industry, we need to continue to build on the innovation we have shown over the past 9 months. We need to build on the best practices and evidence base we have. Because at the end of the day, virtual care is not a COVID solution. It is an ACCESS solution. It is a COMPLIANCE solution. It is a PATIENT solution. And it is how we reach and impact more patients.