By Wendy Atchley, MSN, RN, CCRP
Do you want to know how to bring quality care at a reasonable cost and provide value to your patients and organization through your cardiac rehabilitation (CR) or pulmonary rehabilitation (PR) programs? If so, AACVPR’s Value-Based Care Committee has a tool for you!
The committee has put together a comprehensive user guide called “Session in a Box” to help your team learn the basics of value-based care and why it is important. Included in the user guide are practical strategies for implementing value-based care in any rehab setting as well as several resources that have been assembled and published on the AACVPR website and made available to members.
To support adoption of best practices and change strategies that cultivate value-based care, the Session in a Box, among other objectives, aims to:
1) Demonstrate how to promote the value of cardiopulmonary rehabilitation (CR) in healthcare and have conversations with key personnel
2) Improve knowledge of population health and how it impacts the care that is delivered across the healthcare continuum — chronic disease management strategies, for example
3) Share quality and performance measures and show how to utilize data to make improvements and lead change
4) Introduce practical strategies to implement value-based-care principles in any rehab setting
A Hypothetical Scenario for Cardiac Rehab
One example of implementing value-based care in the cardiac rehab setting would be the establishment of a Supervised Exercise Therapy Program for Patients with Peripheral Artery Disease (SET-PAD). Through this tool, programs can use automatic referrals to increase referral rates; enlist an inpatient liaison to help boost enrollment rates; use the Plan, Do, Study, Act (PDSA) cycle to make improvements to an inefficient practice or process; or use these strategies to improve a quality metric such as adherence rate or wait times.
One Pulmonary Rehab's Real Experience
Here’s a real-life example of the PDSA process in action: A PR program in the Midwest recently used a technology solution to improve a manual referral process. This program had historically accepted referrals from outpatient medical offices via fax or through an in-person visit to the medical office. However, due to the need to have standing orders signed and faxed back from the outpatient provider offices, the practice was often delayed in contacting patients. Additionally, while the PR department and medical offices were owned by the same hospital, they used different electronic medical record (EMR) systems.
When the medical offices integrated into the same EMS as the hospital, the PR department used the PDSA cycle to plan and incorporate a change in their referral process. The team collaborated with the hospital IT department and other stakeholders to implement an internal order through the EMR for the providers to sign the orders directly.
A couple of months after implementation, physicians questioned why their patients were not being called after referrals had been entered. In reviewing the process and data and consulting with the IT department, the team discovered that there were multiple referrals that were active in the EMR. The issue was fixed by discontinuing the inappropriate referrals; and six months later, the PR department found that wait time to contact the patient had been reduced by half.
Efforts to adopt value-based care and to use data to implement change do not have to be scaled towards a large process modification. Multiple small changes also can add up to savings or more efficient and/or quality care. In today’s healthcare environment, services are getting more expensive and efficient processes are crucial. This makes it even more important to learn how to provide quality and cost-effective programing for our patients and our programs.