Sponsored Content from Aviary Health

Most of us in cardiopulmonary rehabilitation know the access problem by heart: only about a third of eligible patients are ever referred, and many who are, never start because of distance and long waits. In cardiac rehab, just 28.6% of eligible Medicare beneficiaries begin a program and 7.9% finish, far short of the Million Hearts 70% goal^1,2; pulmonary rehab (PR) is used even less. The clinical case for reaching these patients has always been clear; for years, the reimbursement to deliver care in the home was not.

The Policy Shift: What’s Changed?

The vast majority of CR/PR programs are operated out of hospital outpatient departments and cannot bill for virtual CR/PR via telehealth. The Consolidated Appropriations Act of 2026 reestablished in-home cardiac and pulmonary rehabilitation services through January 1, 2028. CMS made virtual direct supervision of CR, ICR (intensive cardiac rehab), and PR sessions permanent in its 2026 payment rules.³ A permanent statutory fix, the Sustainable Cardiopulmonary Rehabilitation Services in the Home Act, is before Congress with AACVPR's active backing.⁴

Systems can now build multi-year programs around home-based delivery with a sustainable financial model, and CMS has provided guidance on how to implement these programs.

What the Early Movers Are Seeing

A handful of health systems launched virtual and intensive cardiac rehab programs before or alongside these policy changes. Their early results are worth examining together.

Geisinger Health System ran center-based and virtual CR side by side after reopening its facilities post-COVID. Shah and colleagues compared outcomes across 3,006 patients (2,303 center-based, 703 virtual). After statistical adjustment, the virtual group had 38% fewer readmissions, 44% fewer emergency visits, and 16% lower total cost of care, with similar rates of repeat myocardial infarction and death. The virtual patients were sicker at baseline — higher rates of hypertension, diabetes, heart failure, kidney disease, and COPD — and completed an average of 34.4 sessions versus 21.4, about 60% more than the center-based cohort.⁵ Since launching the virtual option, systemwide CR participation grew three- to four-fold, with over 30,000 virtual appointments in the first two years, from a system whose six facilities previously carried a combined census of about 85 to 90 active patients.⁶

A partnered academic medical center in the Northeast added a virtual arm and saw 30-day post-discharge enrollment climb 43%, with more than 1,000 additional referrals per month. At graduation, patients are averaging 70 sessions using the Mass General Brigham Benson-Henry ICR model, which focuses on mental wellbeing and stress reduction alongside the traditional components of CR. The program carries a Net Promoter Score of 89.

Cone Health in North Carolina, with 87,000 eligible patients in its EHR and roughly 3% historically reached, launched intensive cardiac rehabilitation using the Benson-Henry model with Mass General Brigham. The program went from staff training to first patient session in about five weeks, with a virtual expansion planned for fall 2026. The program is now doing over 1,200 monthly visits in-person, with a combination of exercise and education sessions.

Common Patterns

These programs differ in geography, payer mix, and population size, but the ones scaling fastest share an approach the field has long advocated for:

• Opt-out referral orders at discharge rather than relying on individual physician initiative
• Systematic EHR screening for patients who were eligible but never referred
• Outreach prioritizing the highest-risk groups, including heart failure and advanced COPD

Done consistently, these steps surface three to four times as many eligible patients and lift referrals at existing center-based facilities by roughly 15%. The virtual and intensive models absorb the additional volume that center-based programs alone cannot serve, but only if the operational infrastructure keeps up. The identification, insurance verification, scheduling, staffing, and documentation required to run a hybrid program at scale is substantial, and it is often the administrative burden, not the clinical model, that limits growth. A navigation and administrative partner such as Aviary Health, working with Mass General Brigham on the Benson-Henry ICR model, takes that lift on so clinical staff can focus on care. Aviary also brings more than 100 clinical staff nationally to support virtual visits, with early morning, late evening, and weekend hours designed to reach patients whose schedules do not fit a traditional facility window.

Limitations and Partnership Opportunities:

The question facing CR and PR leaders is increasingly operational: how to identify the eligible patients existing programs never reach, match them to the right delivery model, and maintain clinical standards across both, while the reimbursement environment supports it. The systems seeing results early have not done it alone; they have leaned on partners that handle the administrative and staffing complexity at scale, freeing their teams to do what they do best.

Several of us from the Aviary Health team will be at the AACVPR 41st Annual Meeting in San Antonio, September 30 – October 2. If you are working through how your system might build or expand a virtual or intensive CR program, or want to discuss the data, reach out at hello@aviaryhealth.com or book time during the conference with this link: Aviary Health at AACVPR.

About Aviary Health

Aviary Health is a technology and staffing platform for cardiac and pulmonary rehabilitation. It provides health systems with the navigation, administrative, and clinical infrastructure behind program growth, eligibility identification, opt-out referral configuration, care-gap outreach, insurance verification, and live virtual delivery, alongside in-person intensive CR through a collaboration with Mass General Brigham on the Benson-Henry model. Aviary has supported roughly 400,000 video visits across more than 40 markets. Learn more at aviaryhealth.com.

References

1. Keteyian SJ, et al. Tracking cardiac rehabilitation utilization in Medicare beneficiaries: 2017 update. J Cardiopulm Rehabil Prev. 2022;42:235–245.
2. Wall HK, et al. The Million Hearts Initiative. J Cardiopulm Rehabil Prev. 2020;40:290–293.
3. Life Systems International. Medicare 2026 update: key CMS rule changes impacting cardiac and pulmonary rehabilitation. February 4, 2026.
4. AACVPR. Sustainable Cardiopulmonary Rehabilitation Services in the Home Act issue brief. 2025.
5. Shah ND, et al. Retrospective comparison of outcomes and cost of virtual versus center-based cardiac rehabilitation programs. J Am Heart Assoc. 2024;13:e036861.
6. Siwicki B. Geisinger is seeing big ROI with virtual cardiac rehab. Healthcare IT News. March 28, 2023.