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Program allows patients to stay in network
Your facility should consider cardiac rehabilitation if it handles cardiac patients but refers them to other facilities for rehabilitation, Lance Crosby, RN, MA, says. Crosby is director of the Einstein Cardiac Rehab and Fitness Center, part of the Albert Einstein Healthcare Network in Philadelphia.
"A lot of networks see rehab as a value-added service, not a profit center. The reimbursement is good enough so it can be profitable, but it’s more a value-added service so you can manage all aspects of cardiac patients within your own network," he says.
If you’re thinking of adding cardiac rehab services to your continuum of care, consider these tips from Crosby:
• Assess whether physicians within your system are demanding to have this service for their patients.
• Determine how many potential patients your cardiac rehab program might expect. Crosby estimates about 20% to 30% of patients treated for myocardial infarction or receiving bypass surgery are potential candidates for outpatient cardiac rehab services. Providers can get this information from referring hospitals in their areas, he says.
• Look at how much space you have available and how many patients you can expect your program to treat before deciding on staffing.
• Remember that when a patient participates in an HMO, the primary care physician has to take an initiative on behalf of the patient. "The doctors have to write a letter recommending your cardiac rehab services for the patient in order for you to get paid. If you’ve got physician commitment, you can have a successful rehab service," he says.
• Make sure your key referring physicians have a lot of patients. You need volume to make your cardiac rehab program succeed.
• Educate local cardiologists and primary care physicians about the benefits of cardiac rehab. "If the patient avoids a future episode, everybody wins. The patient wins. The doctor wins. It’s good for the rehab facility and good for the payer," Crosby says.
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