Earlier this month, we had the pleasure of hosting ‘The State of Cardiac Rehab’ webinar, where we were joined by expert cardiac care panelists Dean Ornish, MD, Founder and President of Preventive Medicine Research Institute, and Terry Rogers, President of Pritikin ICR (see the webinar video here).
During the live event, we held a Q&A session with our audience and received many great questions throughout. In fact, we ran out of time and had several left that we wanted to address.
Below are questions from the audience with follow-up answers. If you happen to have any additional questions, please use the form below or email us at firstname.lastname@example.org.
Question: What has the attendance been like in virtual cardiac rehab?
Answer: This varies by demographics/geography, but what we have seen is since there has been a convenience issue for center-based, in many cases, we’ve seen high engagement rates that are 60, 70, and 80% for individuals to complete a program.
Q: Are there any new studies showing the efficacy of ICR over traditional?
A: There is a large evidence base for ICR. While we haven't seen recent head-to-head comparisons of CR vs ICR, there is evidence that demonstrates a dose-response relationship between CR and mortality/morbidity. Since ICR is a more rigorous program with more sessions, there is good reason to believe that the benefits would continue to accrue with ICR. Article: https://www.ahajournals.org/doi/10.1161/JAHA.120.021356
Q: How does Recora facilitate care beyond cardiac rehab (CR)/intensive cardiac rehab (ICR)?
A: Recora's focus is on the CR/ICR virtual program, and it works with health system/provider partners to determine the preferred care program beyond CR/ICR. Examples of this involve Phase 3 programs, care management programs, or broader virtual health initiatives.
Q: I am an Ornish ICR program director. Have there been similar reimbursement rates from CMS for both virtual and center-based ICR?
A: Currently CMS reimbursement for virtual and center-based ICR is similar.
Q: Will the ICR agreements assist considering programs to execute virtual ICR as an option to improve participation?
A: Pritikin and Ornish ICR do have virtual ICR offerings and are happy to discuss these options.
Q: Any experiences with virtual rehab in other countries? Were prelim results similar?
A: There have been studies in Europe and Australia using virtual CR, with similar results to U.S. based studies. Here's a link to a UK study: https://www.bmj.com/content/373/bmj.n1270
Q: Could you speak to virtual preventive and post-Cardiac Rehab services once the insurance stops covering? What would it take for programs that are not tied directly to a hospital or formal program to be adopted as a part of the solution?
A: After an individual completes Phase 2 CR, insurance and Medicare generally does not cover additional CR. Phase 3 programs are typically self-pay. In the case of a Medicare Advantage program, there may be exercise/counseling benefits offered as part of that MA plan.
Q: Can you share a little on completion rates for ICR - are people able to complete it in person or virtual?
A: ICR can generally be completed in either a virtual or in-person format. There are some clinical conditions and insurance variances that may require that an individual complete this in-person at a CR center.
Q: Have you had hospitals doing center-based CR that have wanted to improve their access options?
A: The vast majority, maybe not 100%, but well over 50% of our partner facilities who operate ICR would love to extend to the virtual population. Many have (started virtual) because they wanted to be out in front of this and they’ve had great success.
Q: How has the provider/patient relationship been impacted as a result of virtual cardiac rehab?
A: We have a lot of patients that were in a care gap because they didn’t get cardiac rehab. We’ve seen virtual CR increase the engagement of patients with their providers, and we’ve seen a lot of patients be more accountable to their medications, diet and nutrition options, and exercise.
Q: We manage a cardiac rehab unit in a rural area at a critical access hospital. We seem to be getting less support from physicians telling patients that they, “really don’t need CR”. Do you have any suggestions?
A: One of the reasons people may say that is they tend not to recommend things they don’t offer, understand or do. It’s just an educational process, or maybe they think it’s too far for the patient to drive. What we’ve found is by educating patients and physicians and helping them understand, we can make it very convenient for them.