By Denise Williams | News & Views

AACVPR’s certification process continues to evolve. Next year, two new performance measures each will be added to cardiac rehabilitation and pulmonary rehabilitation program certification applications. With all of 2022 still ahead of us, getting ready for the 2023 cycle might not be front of mind at the moment. But Quinn Pack, MD, MSc, who chairs the AACVPR Quality of Care Committee, says now is precisely the time for programs to start preparing, i.e., collecting data on relevant metrics.

Including the standards that are making their debut during the next certification cycle, there are now a total of 11 performance measures—six for cardiac rehabilitation and five for pulmonary rehabilitation—that are required for AACVPR certification.

The organization started down this path five years ago, largely as a response to changes in the healthcare landscape. “More and more insurers are looking for interventions that actually improve patient care, survival and quality of life,” explains Pack, an internist and cardiologist with Baystate Health. “In order to survive insurance reform and make sure we’re well-aligned with our insurance partners, it’s important that we be able to prove to payers and insurance systems that we’re worth the money they’re paying. Performance measures will help us, both as a society and as individual programs, to justify and prove the value of the product we’re delivering.”

Like the metrics before them, Pack emphasizes that the new additions—enrollment and adherence, for both program types—are measurable and actionable, are within control of programs, and are value-based. Importantly, they also are intended to place very little burden on programs. Although tracking a metric such as five-year mortality might ultimately have great value, it also would require a significantly more time and resources. But enrollment and adherence are considered critical to program management which, according to Pack, means programs theoretically should be collecting data on these metrics, anyway.

“Most programs already keep track of how many sessions a patient attended rehab, but I do get the sense that many are not keeping track of their referrals,” Pack surmises. “The main thing that needs to be happening today is that programs need to start tracking in some way, in some kind of database, the number of eligible referrals sent to their program. And then, everybody should already be tracking those who were already enrolled—those who came in for a session and those who completed 12 sessions.” A year from now, programs can go back and review their data and submit it to AACVPR as part of the 2023 Program Certification Application. Having programs gather and report this information through a standardized process, Pack explains, facilitates useful comparisons across the industry in the pursuit of excellence.

Excellence, Beyond Measure

The Program Certification process has moved past just measuring outcomes and now challenges programs with analyzing data, making a plan for improvement and implementing change in your program. Ultimately, Pack says that’s exactly what certified programs will get out of the performance measures, especially during this period while benchmarks are still being developed and rolled out. He says it’s important to understand that poor numbers—or perceived poor numbers—actually have no bearing at this point on whether or not an applicant will be certified. Rather, low performance scores can help practices see where they can do better. “We want programs to catch the vision,” Pack says, “and then have them try to start making progress to improve.”

… But Nobody’s Perfect

With that being said, Pack makes it clear that there has never been an expectation of 100% achievement for any of the metrics. In fact, he suggests, it’s unreasonable under most scenarios. For enrollment and adherence both, developers are anticipating rates to closer to between 50% and 70%. Pack acknowledges that perfect performance might be possible with a very small program including maybe 10 patients. “But once you get a program of 30, 40, or 50 patients, it just isn’t possible,” he maintains. “There are things that just happen in people’s lives and getting everyone to enroll in a program and getting everyone to adhere” is highly unlikely.

Programs that report perfect numbers probably reflect a misunderstanding somewhere along the line, Pack suspects. He recommends referring to AACVPR’s website, which houses algorithm flow sheets and an FAQ document on all of the performance measures. He and the Quality of Care Committee, as well as the Program Certification Committee, are also available to help. For assistance, please contact certification@aacvpr.org or (312) 321-5146.