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Standardizing outpatient Cardiac Rehabilitation practices in a large multistate Medical system: A practice Convergence Project

Ray W Squires

The United States healthcare system is evolving from fee-for-service reimbursement to paying for high-value care. This paper describes work to standardize 20 separate outpatient cardiac rehabilitation programs (CR) in a multistate medical system with the goal of providing consistent high-value CR services. The project is part of a medical system-wide practice convergence initiative to provide services common to more than one location at the same level of high quality and with the same level of individualized, yet standardized patient experience. The CR project began in August 2014 and the initial phase was completed in October 2018. Fifty-two staff members participated. Six areas of practice were selected: patient exercise session data management system (clinical database) standardization, patient assessment tools, the individual patient treatment plan (ITP), patient education procedures, policies and procedures, and staff competencies. Information technology work involved database interfaces, the ITP, and documentation of CR services in the electronic medical record with the goal of maximizing CR staff efficiency. Progress was made in standardization of several areas: patient exercise session data management system, patient assessments, the ITP, patient education and staff competencies. Standardization of emergency procedures and patient exercise prescription was accomplished. Variability in program facilities, staff expertise and local practice patterns underscored the complexity of standardization of all policies and procedures. A CR Committee was formed to continue work on unresolved issues and to incorporate innovations as the practice of CR evolves over time. The United States healthcare system is in the process of undergoing structural changes in reimbursement for services that will eventually aspect all providers, hospitals, and clinics. Historically, reimbursement has been provided for each episode of care in a “fee for service” model.