Transitioning to a Remote CR During COVID-19


Transitioning to a Remote CR During COVID-19

COVID-19 has forced many cardiac and pulmonary rehabilitation services to shut their doors. But for the CR team at Atrium Health in North Carolina, it’s allowed them to pivot their model of care.

Adam deJong, assistant vice president of surgical services at the Sanger Heart and Vascular Institute at Atrium Health, said he and his team have adjusted their methods to accommodate their patients stuck at home—and new patients looking for care.

“We had two main concerns: how are we going to track our referrals and ensure we’re getting the people who are being referred here to communicate with them and explain what cardiac rehab is,” he said. “And the other was making sure we were in contact with current enrollees so they didn’t just go home and become less active and get off their regimen.”

At Atrium Health, there was already an existing remote CR program for low- to moderate-risk patients, but it wasn’t widely implemented. They used that model to scale a program to help all their CR patients, which includes phone calls and/or online video conferences to patients from every member of the CR team—including dietitians and behavioral health specialists. Staff use programs like Google Voice to make phone calls and Skype to make internet calls.

They also use technology to connect with one another. DeJong said the staff has daily team meetings to discuss treatment plans and any issues that arise. Everyone gets summaries on how the vitals patients are sending over and reports from the specialists on the team.

The goal is to keep that one-on-one touchbase with patients to be able to not only track their progress, but help answer questions and encourage them through this difficult time.

“It’s been interesting to see the dynamics,” deJong said. “As people have gotten into the program, we’ve gotten significant feedback on how great it’s been. Although a lot of people wish they could be in person, they are enjoying the frequent contact with us.”

The success of the program has proven what deJong says many in the CR/PR community already know: home-based care can be done relatively easily, and could bridge the gap for many people who won’t—or can’t—participate in an in-person program. Atrium Health’s existing online program was popular, and this proves it can be implemented on a larger scale. This can be especially beneficial for people who live in rural areas.

“We’ve been able to transition to this model in zero notice,” deJong said. “Our patients see other models exist and it can be an easier sell. Patients can say, ‘Yes, I can’t come in, but I’m able to track my progress and work with you remotely.’”

At the moment, deJong said they’re unable to bill for this type of care. Atrium is more focused on the health of its patients. He hopes that after showing how effective and essential telemedicine can be for CR/PR, lawmakers will cover it for reimbursement.

“Being able to continue with individualized treatment plan and have all the parameters of a CR program remotely makes a lot of sense. There are ways to do it and do it well,” he said. “Sometimes it’s not top of mind for [politicians] so it gets left off the bill, but hopefully this trial period and the ability for a lot of large organizations to make this transition with show the Centers for Medicare and Medicaid Services there is a benefit to doing this.”