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  • 'Alternative' CR Programs, Better Reimbursement Both Necessary to Close Care Gap

    A recent survey of cardiac rehabilitation (CR) centers across the US has found that even if current facilities were able to expand modestly, more than half of the US patients in need of CR would remain unserved—a care gap that can only be filled through alternative delivery models and significant changes to reimbursement policies, according the study's authors.

    The study, published in the Journal of Cardiopulmonary Rehabilitation and Prevention (abstract only available for free), is based on survey results from 252 CR programs asked to assess their current utilization, current capacity, and potential expansion capacity. The bottom line: most were not running at capacity and could increase services by about 33% without having to expand—and by 68% "if they were given reasonable resources to expand."

    As unlikely as such expansion may be, authors write, the real issue is that even in the rosiest of scenarios in which staffing, facility, insurance copay, and other obstacles resolve themselves favorably, a full 33% of patients in need of CR would still go without due to lack of capacity. "As currently structured and staffed, center-based CR programs simply do not have the capacity, by themselves, to provide services to all eligible patients—even in the setting of perfect referral and enrollment," authors write.

    Authors believe that the current underutilization of CR has more to do with the structural and financial barriers encountered by the programs, and not patient behavior. These barriers, which include high copays, low reimbursements, and a limited range of conditions for which insurance companies will cover CR, make it difficult for the programs to make even marginal progress in addressing current gaps.

    Still, authors write, changes to when and at what level insurance companies cover CR won't themselves cover the shortfall in care—there simply isn't enough capacity. One solution? The development of alternative CR programs.

    "Our data suggest that alternative models of CR delivery will need to be explored and implemented to substantially increase national CR participation rates," they write, suggesting "group-based CR programs in community centers, home-based programs, and web-based methods" to provide the care. Combined with changes to reimbursement policy, authors believe better participation rates could be achievable. "If additional alternative models of CR delivery … were developed as additional options for patients," they write, "it seems possible that participation rates of >80% could become possible."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

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