1
00:00:00,280 --> 00:00:04,310
Hi everyone, this is Erica Spicer
Mason with Becker's Hospital Review.

2
00:00:04,540 --> 00:00:07,950
Thanks so much for tuning into the
Becker's Healthcare podcast series.

3
00:00:08,550 --> 00:00:12,470
Today I'm thrilled to be joined
by two guests, Dr. Ed Wu,

4
00:00:12,470 --> 00:00:16,950
the co-founder and chief medical
officer at rera. And Terry Rogers,

5
00:00:16,950 --> 00:00:19,950
the president of Kin i c r, ed and Terry,

6
00:00:19,950 --> 00:00:22,510
welcome and thank you so
much for joining us today.

7
00:00:23,180 --> 00:00:24,013
You're welcome.

8
00:00:24,820 --> 00:00:26,300
Thank you. Looking forward to it.

9
00:00:26,900 --> 00:00:29,460
Wonderful. I'm looking
forward to this as well.

10
00:00:30,270 --> 00:00:32,340
So just to kind of get us started,

11
00:00:32,530 --> 00:00:37,140
I wanted to start a bit broadly
and get both of your perspectives

12
00:00:37,230 --> 00:00:41,380
on what you're seeing as some of the
biggest challenges that health system

13
00:00:41,380 --> 00:00:43,900
leaders are facing today. Terry,

14
00:00:43,900 --> 00:00:46,820
maybe we can start with
you to get us going here.

15
00:00:47,900 --> 00:00:52,010
Yeah, thanks Erica. Um, what
we're hearing in the marketplace,

16
00:00:52,520 --> 00:00:54,130
some of the more, uh,

17
00:00:54,130 --> 00:00:57,810
common issues are declining revenues,

18
00:00:58,230 --> 00:01:03,050
the always present payer
pressures that systems face

19
00:01:03,530 --> 00:01:05,610
increase labor costs, labor shortages,

20
00:01:06,190 --> 00:01:10,490
and employee burnout due to the pandemic
and the tail associated with it.

21
00:01:12,030 --> 00:01:14,430
Ed, what else, um, would
you add to that list?

22
00:01:15,180 --> 00:01:18,310
Yeah, Terry, I would, I would
certainly agree with those. Uh,

23
00:01:18,310 --> 00:01:23,070
I have had many discussions
with, uh, sweet C-Suites, um,

24
00:01:23,290 --> 00:01:25,990
and, and officers of, of hospitals and,

25
00:01:25,990 --> 00:01:30,310
and echo the need to reduce cost
and address labor shortages.

26
00:01:30,720 --> 00:01:32,910
Um, I've also picked up
on a couple of other ones,

27
00:01:32,910 --> 00:01:35,350
including patient leakage that me,

28
00:01:35,350 --> 00:01:39,230
meaning patients that are going from
health system to health system or medical

29
00:01:39,230 --> 00:01:41,790
group to medical group and
not really having loyalty.

30
00:01:42,340 --> 00:01:46,790
Also seeing some care
coordination issues as,

31
00:01:47,080 --> 00:01:51,710
um, as patients truly try to find out
how to better care for themselves.

32
00:01:52,250 --> 00:01:55,110
And that seemed to be
lost in some of the, the,

33
00:01:55,730 --> 00:01:58,510
the labor shortages and
the cost cutting and the,

34
00:01:58,510 --> 00:02:01,230
and the revenue reductions that,
that we're seeing out there. Uh,

35
00:02:01,230 --> 00:02:05,870
also a more recent one is
how best to deploy telehealth

36
00:02:06,170 --> 00:02:10,230
and virtual and digital solutions
amidst the sea of options.

37
00:02:11,780 --> 00:02:13,180
Thank you both so much.

38
00:02:13,410 --> 00:02:17,780
I think that really hits the nail on
the head in terms of what we at Becker's

39
00:02:17,780 --> 00:02:22,700
are also seeing just in our daily
coverage of issues that hospitals and

40
00:02:22,700 --> 00:02:26,740
health systems continue to face. So
what you're saying really resonates,

41
00:02:26,960 --> 00:02:31,140
and it really speaks to how these
bigger issues of financial challenges,

42
00:02:31,140 --> 00:02:33,780
for example, and staffing
issues, how they,

43
00:02:33,780 --> 00:02:37,620
those issues trickle down into kind
of those more day-to-day operations.

44
00:02:37,790 --> 00:02:39,220
So I appreciate you sharing that.

45
00:02:40,040 --> 00:02:43,860
And I know we're here today to talk a
bit more specifically about the cardiac

46
00:02:44,010 --> 00:02:48,100
services space. So I know
in this specialty area,

47
00:02:48,470 --> 00:02:52,900
we typically see revenue
and driving patient volumes,

48
00:02:53,400 --> 00:02:57,980
and I'm wondering what gaps you're
seeing here in terms of operations

49
00:02:58,000 --> 00:03:02,190
and strategy. I was thinking, ed, you
might be able to speak to that one.

50
00:03:03,460 --> 00:03:07,960
Yeah, thanks, Erica. There are a
couple of, of trends and gaps that,

51
00:03:07,960 --> 00:03:10,960
that we've seen in our
discussions with hospital leaders.

52
00:03:11,570 --> 00:03:14,400
As I mentioned as Terry and I
mentioned a a little bit earlier,

53
00:03:14,910 --> 00:03:19,040
this sense of disintermediation,
the, the cost cutting,

54
00:03:19,040 --> 00:03:21,200
the revenue shortages, um,

55
00:03:21,330 --> 00:03:24,400
is really making it difficult
for hospitals to operate.

56
00:03:24,880 --> 00:03:29,280
We're seeing retrenching
of costs by 10% or greater.

57
00:03:29,870 --> 00:03:31,720
That's not unheard of. Uh,

58
00:03:31,720 --> 00:03:35,920
and cardiovascular service lines
are certainly included in this. Uh,

59
00:03:35,920 --> 00:03:39,920
they have seen huge pressures
to perform fiscally, um,

60
00:03:39,920 --> 00:03:43,120
as well as on in clinical outcomes. Uh,

61
00:03:43,120 --> 00:03:47,040
and unfortunately this has
resulted in what I like to call a,

62
00:03:47,040 --> 00:03:51,600
a subsequent gap that has led to
a shift in cardiovascular care

63
00:03:52,210 --> 00:03:56,840
to procedural interventions as
opposed to preventative or recovery,

64
00:03:57,570 --> 00:04:02,160
uh, interventions, uh, such
as, um, cardiac rehab. And,

65
00:04:02,300 --> 00:04:05,560
and let me highlight this gap a
little bit more. This is quite stark.

66
00:04:06,360 --> 00:04:08,640
Research has actually shown that about 8%,

67
00:04:08,640 --> 00:04:12,640
only 8% have completed a post-surgical or

68
00:04:12,980 --> 00:04:15,720
post-hospitalization
course of cardiac rehab.

69
00:04:15,830 --> 00:04:20,520
That means there's a gap
of 92% where there's a,

70
00:04:20,520 --> 00:04:25,360
there's a huge area of unmet need for
these cardiovascular patients to get

71
00:04:25,360 --> 00:04:29,440
better care to recover from their
conditions and actually prove that the

72
00:04:29,640 --> 00:04:34,240
hospital that they're, they came from,
um, is, is doing a great job. Um,

73
00:04:34,240 --> 00:04:38,640
further exacerbating this, we
had covid, and during C O V I D,

74
00:04:38,640 --> 00:04:40,280
we had about 200, uh,

75
00:04:40,440 --> 00:04:43,800
220 cardiac rehab centers that shut down.

76
00:04:43,800 --> 00:04:47,960
That's about 10% of national
capacity of cardiac rehab centers.

77
00:04:48,540 --> 00:04:51,040
And that's actually
exacerbated this, this big gap.

78
00:04:51,040 --> 00:04:55,360
So that's just an example
of, of, um, a gap that's,

79
00:04:55,360 --> 00:05:00,320
that's really painful as a provider
myself to, to see. Um, this,

80
00:05:00,530 --> 00:05:04,040
um, this has led to a lot of
patient leakage. You know, you,

81
00:05:04,040 --> 00:05:05,000
as I mentioned before,

82
00:05:05,000 --> 00:05:09,280
you're seeing patients that aren't really
getting good follow through. And, um,

83
00:05:09,280 --> 00:05:11,200
this has, uh,

84
00:05:11,200 --> 00:05:14,600
really impacted cardiovascular aftercare.

85
00:05:14,730 --> 00:05:19,560
So post hospitalization,
post procedure, um, the,

86
00:05:19,820 --> 00:05:23,080
the, the silver lining here is that this,

87
00:05:23,350 --> 00:05:26,800
this time of cardiovascular
aftercare after,

88
00:05:26,800 --> 00:05:28,440
after they've been discharged,

89
00:05:28,750 --> 00:05:32,520
this is a golden moment to really
improve patient experience,

90
00:05:33,010 --> 00:05:37,240
improve procedural outcomes or document
procedural outcomes for that facility.

91
00:05:37,460 --> 00:05:40,320
And we've actually had some
chief financial officers,

92
00:05:40,320 --> 00:05:42,920
some CFOs that have spoken, um,

93
00:05:42,920 --> 00:05:47,160
spoken to us that have focused
on this cardiovascular aftercare,

94
00:05:47,160 --> 00:05:51,760
say that this has been a way to drive
patient revenues back into the black.

95
00:05:52,810 --> 00:05:53,660
Absolutely.

96
00:05:54,400 --> 00:05:59,120
And what you're saying
about aftercare really rings

97
00:05:59,120 --> 00:06:03,200
true. There's so much that can,
I don't wanna say go wrong,

98
00:06:03,200 --> 00:06:07,520
but patients who've had a significant
procedure really do need support

99
00:06:07,720 --> 00:06:10,360
after the fact, especially
when they're back at home.

100
00:06:10,740 --> 00:06:15,720
And so having that area
overlooked, I'm sure, um,

101
00:06:16,420 --> 00:06:16,960
you know,

102
00:06:16,960 --> 00:06:21,240
really doesn't support patient outcomes
nor the health system's outcome either.

103
00:06:21,520 --> 00:06:25,160
Right. Um, so thanks so much
for sharing about that, ed.

104
00:06:25,340 --> 00:06:29,480
I'd like to dive a little
bit more into cardiac care

105
00:06:29,500 --> 00:06:31,120
post-discharge, um,

106
00:06:31,120 --> 00:06:34,000
because it looks like both of your
organizations really focus on this,

107
00:06:34,580 --> 00:06:37,520
and particularly in the
cardiac rehab space.

108
00:06:38,090 --> 00:06:42,480
So I'm wondering if you can discuss
how cardiac rehab fits into the overall

109
00:06:42,540 --> 00:06:46,800
cardiovascular service line. Terry, maybe
we can have you get us started here.

110
00:06:48,080 --> 00:06:49,570
Sure. Uh,

111
00:06:49,570 --> 00:06:54,210
let me level set with a little
background to start and, uh,

112
00:06:54,210 --> 00:06:58,690
you'll hear me refer to
conventional CR going forward as

113
00:06:58,940 --> 00:07:02,490
cr so I don't have to say
it every time, CR or I C r,

114
00:07:02,490 --> 00:07:04,490
meaning intensive cardiac rehab,

115
00:07:04,490 --> 00:07:09,490
but conventional car cardiac rehab
has really been the mainstay of a

116
00:07:09,490 --> 00:07:14,410
cardiovascular rehab service since
1982 when it was first approved by

117
00:07:14,650 --> 00:07:15,930
Medicare. Now,

118
00:07:15,930 --> 00:07:20,450
fast forward to 2010 when C M S approved

119
00:07:20,910 --> 00:07:25,690
two i c r programs under the national
coverage determination process.

120
00:07:25,870 --> 00:07:26,930
And since then,

121
00:07:27,310 --> 00:07:32,010
the precon Intensive Cardiac Rehab
program that I'm responsible for

122
00:07:32,510 --> 00:07:37,330
has been the fastest growing
c r or I C R program in the

123
00:07:37,330 --> 00:07:37,770
nation.

124
00:07:37,770 --> 00:07:42,570
With over 175 licensed
providers expected to

125
00:07:42,570 --> 00:07:46,090
provide the service by
the end of this year. Now,

126
00:07:46,840 --> 00:07:51,410
both CR and I c r programs
consist of this multidisciplinary

127
00:07:51,930 --> 00:07:56,050
evidence-based intervention
that utilize individualized, uh,

128
00:07:56,050 --> 00:07:59,930
patient treatment plans that
have been proven to, I, uh,

129
00:08:00,220 --> 00:08:03,290
improve clinical outcomes
in quality of care.

130
00:08:03,950 --> 00:08:08,930
The primary difference between CR
and intensive cardiac rehab is that

131
00:08:09,050 --> 00:08:12,890
intensive cardiac rehab
offers an additional 36

132
00:08:13,370 --> 00:08:16,130
lifestyle educational, uh,

133
00:08:16,130 --> 00:08:20,090
sessions that consist of these
immersive group workshops,

134
00:08:20,390 --> 00:08:22,290
professionally produced videos,

135
00:08:22,290 --> 00:08:26,610
one-on-one consults in the areas
of exercise healthy mindset,

136
00:08:26,680 --> 00:08:29,970
stress reduction, and
heart healthy nutrition.

137
00:08:30,830 --> 00:08:35,530
The results for patients who go
through our I C R program are

138
00:08:36,120 --> 00:08:40,610
improved functional capacity
and stress reduction lowering of

139
00:08:40,620 --> 00:08:45,090
cardios, uh, vascular risk factors
like weight, blood pressure,

140
00:08:45,360 --> 00:08:47,010
lipids, triglycerides,

141
00:08:47,390 --> 00:08:51,130
and ultimately decreased
readmissions and mortality,

142
00:08:51,630 --> 00:08:55,680
and simultaneously helping the
health systems bottom line.

143
00:08:56,380 --> 00:08:56,800
Now,

144
00:08:56,800 --> 00:09:01,640
an important factor that most people
don't know is that cardiac rehab

145
00:09:01,640 --> 00:09:06,360
and intensive cardiac rehab are
considered Class one A interventions.

146
00:09:06,980 --> 00:09:11,440
And for those of you, just in case you
don't know, class one a intervention is,

147
00:09:11,450 --> 00:09:16,370
it means it's accepted as
the standard of care in

148
00:09:16,370 --> 00:09:19,370
post-acute coronary
syndrome. And in P C I,

149
00:09:20,100 --> 00:09:23,570
CR and I C R are considered
Class one A in, um,

150
00:09:23,910 --> 00:09:28,810
interventions just like aspirin, beta
blockers, statins, and ACE inhibitors.

151
00:09:29,020 --> 00:09:29,853
However,

152
00:09:30,400 --> 00:09:34,770
unlike those drug therapies
that I mentioned that have

153
00:09:34,770 --> 00:09:38,570
utilization rates in the 75 to 95% range,

154
00:09:39,540 --> 00:09:44,530
CR and ICR R discharge
uses at an abysmal 24 to

155
00:09:44,530 --> 00:09:48,570
26%. As Ed said earlier, he sta he stated,

156
00:09:48,890 --> 00:09:53,250
research is shown only 8% have completed
post-surgical or post-hospitalization

157
00:09:53,250 --> 00:09:58,210
rehab. So it's not utilized
like some of the more commonly,

158
00:09:58,820 --> 00:10:01,810
um, known and effective therapies.

159
00:10:02,830 --> 00:10:04,410
Now these really,

160
00:10:04,410 --> 00:10:08,970
these cardiovascular rehab services
should just be just like physical therapy

161
00:10:08,970 --> 00:10:10,770
after an orthopedic procedure.

162
00:10:11,200 --> 00:10:15,850
A physician or patient wouldn't consider
going home and not going through,

163
00:10:16,300 --> 00:10:19,330
uh, physical therapy after
a knee or hip replacement,

164
00:10:19,330 --> 00:10:20,650
and they shouldn't go home,

165
00:10:20,910 --> 00:10:25,330
not expected to participate in
cardiac rehab air, um, as well.

166
00:10:26,150 --> 00:10:29,490
But we've got referral
rates that are overall low.

167
00:10:29,730 --> 00:10:34,570
We've got participation rates that are
low nationwide due to a lot of barriers

168
00:10:34,570 --> 00:10:37,210
that we'll discuss a little
later in the conversation.

169
00:10:37,830 --> 00:10:39,610
But in the last couple
things I'll mention,

170
00:10:39,610 --> 00:10:44,130
our cardiac rehab hasn't historically
been seen as a profit center for the

171
00:10:44,370 --> 00:10:46,410
hospital as a standalone service. However,

172
00:10:47,100 --> 00:10:52,010
it is a valuable offering for a full
cardiac service line and quality

173
00:10:52,010 --> 00:10:56,530
patient care program. And like
the health system in general,

174
00:10:56,930 --> 00:10:59,730
there are a fair amount of headwinds, um,

175
00:10:59,740 --> 00:11:03,090
in cr in the form of
labor and capital cost,

176
00:11:03,090 --> 00:11:05,930
like we were talking about
earlier in the conversation.

177
00:11:06,190 --> 00:11:10,690
But these can be addressed with some
alternative approaches like intensive

178
00:11:10,690 --> 00:11:15,610
cardiac rehab as well as virtual
CR and I C R that Ed can speak to

179
00:11:15,610 --> 00:11:16,443
next.

180
00:11:17,210 --> 00:11:20,460
Thanks Terry. Um, really great, uh,

181
00:11:20,460 --> 00:11:24,860
recap and discussion of cardiac
cardiac rehab and, and icr r uh,

182
00:11:24,860 --> 00:11:29,380
CR and ICR R. And now let's talk
a little bit about the modality.

183
00:11:29,750 --> 00:11:33,940
So you, CR and ICR has traditionally
been done in a facility,

184
00:11:34,510 --> 00:11:37,820
um, more recently we're
talking the past few years,

185
00:11:37,820 --> 00:11:42,620
this has been done virtually, and
this can really increase access.

186
00:11:42,710 --> 00:11:46,860
So God are the days where
you have to show up, uh,

187
00:11:46,860 --> 00:11:51,460
36 to 72 times, um,
you know, to, to go to,

188
00:11:51,460 --> 00:11:54,920
to these sessions in person. You
can actually do this virtually.

189
00:11:55,460 --> 00:12:00,400
And what we've seen and what we've
heard from hospitals that are

190
00:12:00,400 --> 00:12:05,160
doing this and allowing for virtual
sessions is that they're actually able to

191
00:12:05,300 --> 00:12:07,600
see many more patients. And in some cases,

192
00:12:08,000 --> 00:12:12,880
three to four times the number of
patients are able to get cardiac

193
00:12:12,960 --> 00:12:17,400
rehab, uh, whether it's CR or i
c r. And this is great because,

194
00:12:17,460 --> 00:12:20,880
you know, you're, at the end of the day,
it's about providing patient choice,

195
00:12:20,880 --> 00:12:25,800
patient access, and, um, this can
be done in a more scalable fashion.

196
00:12:25,800 --> 00:12:30,240
And so, you know, their staffing,
um, can be, can be more,

197
00:12:30,240 --> 00:12:33,280
more leveraged to see
this larger population.

198
00:12:33,500 --> 00:12:37,160
And so it really starts to turn
the tide in term terms of being an

199
00:12:37,160 --> 00:12:41,960
operationally, um, you know,
efficient, more efficient, uh, program.

200
00:12:42,190 --> 00:12:43,920
That being said, uh, Terry, you,

201
00:12:43,920 --> 00:12:47,920
you hit the nail on the head historically
has not been a huge money maker,

202
00:12:48,420 --> 00:12:52,760
but we actually just had a chief medical
officer of a health system in Florida

203
00:12:52,760 --> 00:12:55,680
who said, you know, having a virtual and,

204
00:12:55,680 --> 00:13:00,680
and a more robust program dedicated
to cardiac rehab allows him to

205
00:13:00,680 --> 00:13:02,680
more confidently, um,

206
00:13:03,070 --> 00:13:07,320
talk about the cardiovascular
outcomes of their bypass program,

207
00:13:07,690 --> 00:13:10,800
of their transplant program
and of their cath program.

208
00:13:11,140 --> 00:13:16,080
And so this is how they're really able
to both increase not only cardiac rehab

209
00:13:16,080 --> 00:13:16,520
volumes,

210
00:13:16,520 --> 00:13:19,840
but increase overall procedural volumes
when they go out into the marketplace

211
00:13:19,840 --> 00:13:23,800
and say, Hey, we're, we're doing great
in terms of our procedural and surgical,

212
00:13:24,010 --> 00:13:28,720
um, quality me measures too. So
it kind of is, uh, it, you know,

213
00:13:28,720 --> 00:13:30,360
going back to your questionnaire,

214
00:13:30,460 --> 00:13:34,240
how does this fit into a
whole cardiovascular program?

215
00:13:34,730 --> 00:13:39,440
It really helps to just lift the
entire program up in terms of

216
00:13:39,530 --> 00:13:43,360
quality, revenue, outcomes
and patient loyalty.

217
00:13:44,430 --> 00:13:46,480
Absolutely. And Ed,

218
00:13:46,490 --> 00:13:51,320
as you were explaining what's possible
with virtual appointments in terms

219
00:13:51,320 --> 00:13:56,200
of expanding reach and really
driving operational efficiency,

220
00:13:56,690 --> 00:13:59,000
it really does lead,

221
00:13:59,070 --> 00:14:03,160
lead me to think more about that
overall issue of access to care.

222
00:14:03,540 --> 00:14:08,000
And so I'd like to dive a little
bit deeper into that issue. Uh,

223
00:14:08,000 --> 00:14:12,280
so what about the patient who is
truly too far from a rehab center?

224
00:14:12,820 --> 00:14:16,200
Can virtual care for cardiac rehab,

225
00:14:16,200 --> 00:14:19,200
can it be done fully remotely? And if so,

226
00:14:19,200 --> 00:14:21,520
how does this impact facility volumes?

227
00:14:21,520 --> 00:14:23,880
Wondering if you can speak
to that a little bit. Ed.

228
00:14:24,410 --> 00:14:28,300
Thanks Erica. Really great
question. It's very timely. Uh,

229
00:14:28,300 --> 00:14:31,460
just in the last week or so, uh,
both Terry and I came across, uh,

230
00:14:31,690 --> 00:14:34,020
a research study that, uh,

231
00:14:34,020 --> 00:14:38,980
demonstrates that about
14% of patients across

232
00:14:38,980 --> 00:14:43,460
cardiovascular patients across the
country live in what's called a cardio,

233
00:14:44,270 --> 00:14:47,020
uh, cardiac rehab desert. Uh,

234
00:14:47,020 --> 00:14:51,100
translated that means there's zero
supply of a cardiac rehab program

235
00:14:51,980 --> 00:14:55,640
for these regions and, and
counties where there is, uh,

236
00:14:55,710 --> 00:14:59,520
a good solid amount of demand
for cardiovascular SER services.

237
00:14:59,520 --> 00:15:03,160
So that's, and that's 14%. Now,

238
00:15:03,710 --> 00:15:06,840
beyond that, they're
upwards of 40 to 50% of,

239
00:15:07,050 --> 00:15:10,520
of patients in the country where
they're at an hour, hour and a half,

240
00:15:10,520 --> 00:15:13,360
two hours from the nearest facility.

241
00:15:13,780 --> 00:15:18,040
And now it just becomes a convenience
and, and, um, and sadly, you know,

242
00:15:18,040 --> 00:15:21,400
how much are you gonna pay to make
that trip in on, uh, uh, you know,

243
00:15:21,400 --> 00:15:23,840
in terms of gas, and
that's if they have a car.

244
00:15:23,840 --> 00:15:28,120
And so there's the arduous component
of making it in to facility.

245
00:15:28,610 --> 00:15:32,120
Um, and, and then so what we have seen,

246
00:15:32,120 --> 00:15:34,200
we've talked to hospital executives and,

247
00:15:34,200 --> 00:15:38,760
and physio physicians saying that
this can be done, uh, virtually. Um,

248
00:15:38,760 --> 00:15:43,200
there's supervision, there's phy,
it's a clinical clinically supervised,

249
00:15:43,570 --> 00:15:48,360
uh, audio and visual program
where patients can really,

250
00:15:48,730 --> 00:15:51,880
uh, have all safety measures at, um,

251
00:15:52,010 --> 00:15:56,520
at their disposal that's
monitored and it's exercise,

252
00:15:56,520 --> 00:16:01,520
it's diet, and it's smoking cessation,
uh, lifestyle, um, modification.

253
00:16:01,520 --> 00:16:05,800
Many of these things that Terry mentioned,
and they can be done virtually, uh,

254
00:16:05,800 --> 00:16:08,840
for those that aren't able
to get into facility. Um,

255
00:16:09,190 --> 00:16:12,040
what's interesting is that when a,

256
00:16:12,190 --> 00:16:15,560
when a health system or a hospital
takes on a virtual program,

257
00:16:16,030 --> 00:16:18,960
this increases overall uptake.

258
00:16:18,960 --> 00:16:21,320
So three to four times of,

259
00:16:21,650 --> 00:16:24,840
of pre implementing a virtual
program in some cases,

260
00:16:24,840 --> 00:16:27,800
then that's just because you're
getting with a virtual program,

261
00:16:28,100 --> 00:16:31,880
you more access is out there,
more patient choice, more,

262
00:16:32,270 --> 00:16:36,120
more patients are talking to each other
and family members are talking about it.

263
00:16:36,120 --> 00:16:39,040
And so not only are are they
enrolling more in virtual programs,

264
00:16:39,040 --> 00:16:40,800
but they're enrolling into
a facility program too.

265
00:16:40,800 --> 00:16:42,920
And then when they find out about I c R,

266
00:16:43,030 --> 00:16:47,560
that helps 'em both in a facility
as well as virtual. Um, maybe Terry,

267
00:16:47,560 --> 00:16:50,240
you could share some of your
successes that you've, you've seen in,

268
00:16:50,240 --> 00:16:52,560
in some of the provider
partners that you've,

269
00:16:52,560 --> 00:16:54,640
you've had that have done
some programs like this.

270
00:16:55,270 --> 00:16:56,400
Yeah, sure, ed,

271
00:16:56,400 --> 00:17:01,160
great points to kind of piggyback
on what Ed was talking about and,

272
00:17:01,160 --> 00:17:06,000
and why virtual cardiac rehab and
intensive cardiac rehab makes sense.

273
00:17:06,380 --> 00:17:10,880
I'm gonna highlight a few other things
that we've seen in our providers who are

274
00:17:10,880 --> 00:17:11,713
doing it.

275
00:17:11,770 --> 00:17:16,720
So many of our licensed
hospitals have limited limited

276
00:17:17,480 --> 00:17:22,160
capacity to handle the volume of patients
who've actually qualified for cardiac

277
00:17:22,240 --> 00:17:26,880
rehab. They're limited in space
and equipment and staff resources,

278
00:17:27,530 --> 00:17:29,160
uh, to support that. In fact,

279
00:17:29,630 --> 00:17:34,320
some of our clients are reporting wait
lists of three months post-discharge

280
00:17:34,320 --> 00:17:37,840
before they can even get the patient
into their cardiac rehab program.

281
00:17:38,980 --> 00:17:43,880
And some of our providers are actually
discharging patients from rehab early.

282
00:17:43,970 --> 00:17:45,520
In other words, not,

283
00:17:45,620 --> 00:17:50,080
not having them complete
the full 36 or 72 sessions

284
00:17:50,330 --> 00:17:53,920
to address that backlog in those
long wait lists of patients.

285
00:17:53,920 --> 00:17:56,640
And that's not a good solution
given that there is a,

286
00:17:56,640 --> 00:18:01,220
there's a dose response between the
number of sessions that a patient

287
00:18:01,230 --> 00:18:04,420
attends and the long-term
clinical outcomes.

288
00:18:04,420 --> 00:18:08,260
So that's not a great solution either.
In fact, there was some research,

289
00:18:08,260 --> 00:18:12,740
you know, ed referenced research, there
was one I was reading recently as well.

290
00:18:13,050 --> 00:18:14,980
Part of that same, uh, study,

291
00:18:15,470 --> 00:18:20,380
it shows that the median time from
discharge to cardiac rehab initiation

292
00:18:21,050 --> 00:18:23,460
across the country is 39 days.

293
00:18:24,090 --> 00:18:28,790
And ideally you want a patient in as
soon as possible within three weeks or

294
00:18:28,790 --> 00:18:33,670
sooner at least. And it also
shows that for every day,

295
00:18:34,050 --> 00:18:35,670
and this is previous research,

296
00:18:35,670 --> 00:18:39,910
it's shown that for every day
delayed in starting cardiac rehab,

297
00:18:40,050 --> 00:18:44,550
you get a 1% decrease in
probability of a patient actually

298
00:18:44,550 --> 00:18:46,550
enrolling in cardiac rehab.

299
00:18:47,380 --> 00:18:50,670
Thus the virtual and and hybrid options,

300
00:18:50,670 --> 00:18:53,230
which we really haven't
talked specifically about,

301
00:18:53,230 --> 00:18:57,670
but hybrid is a combination of
patient comes in person a few times

302
00:18:58,080 --> 00:19:02,310
in the bulk of their, uh, rehab
is done virtually, but both,

303
00:19:02,310 --> 00:19:07,150
whether it's a hundred percent virtual
or hybrid or facil or, or a hybrid model,

304
00:19:07,480 --> 00:19:12,030
it offers a way to reach
rural and underserved

305
00:19:12,030 --> 00:19:16,710
populations that don't have access to
a nearby facility like those cardiac

306
00:19:16,710 --> 00:19:21,190
rehab deserts that Ed was
talking about earlier and

307
00:19:21,890 --> 00:19:22,750
the decre.

308
00:19:22,750 --> 00:19:27,390
And that decreases the backlog of
patients waiting for this very important

309
00:19:27,870 --> 00:19:28,703
clinical service.

310
00:19:29,980 --> 00:19:30,830
Absolutely.

311
00:19:31,490 --> 00:19:36,430
And what you both have
shared really highlights how

312
00:19:36,720 --> 00:19:41,630
virtual care in this space is
becoming essential, you know,

313
00:19:41,630 --> 00:19:46,510
not just in order to reach those patients
who might live in rural areas and

314
00:19:46,510 --> 00:19:47,670
need better access,

315
00:19:47,670 --> 00:19:52,230
but to really augment the services
that facilities are able to provide

316
00:19:52,360 --> 00:19:54,870
in order to, you know,
meet the standards of care,

317
00:19:54,870 --> 00:19:59,510
which is so important for these patients.
So thank you again for sharing that.

318
00:20:00,090 --> 00:20:00,923
And I'm really,

319
00:20:01,500 --> 00:20:06,150
I really like how this conversation has
kind of accumulated to focusing so much

320
00:20:06,150 --> 00:20:07,310
on, um,

321
00:20:07,310 --> 00:20:12,070
the patient and the patient experience
and their outcomes and comfort and their

322
00:20:12,070 --> 00:20:14,430
safety. And so I'm wondering,

323
00:20:15,030 --> 00:20:19,190
among both of your organization's
health system partners, um,

324
00:20:20,180 --> 00:20:25,110
I know patient satisfaction is continuing
to be a top priority among all of the

325
00:20:25,110 --> 00:20:27,110
other priorities that leaders
are focusing on right now.

326
00:20:27,360 --> 00:20:31,910
So I'm wondering if you can share a
little bit more about how cardiac recovery

327
00:20:32,110 --> 00:20:33,710
and the services that you provide,

328
00:20:33,730 --> 00:20:37,830
how it does contribute to
improved patient satisfaction.

329
00:20:38,830 --> 00:20:40,110
Ed, maybe you can get us started there.

330
00:20:40,720 --> 00:20:43,170
Thanks, Erica. And at the end of the day,

331
00:20:43,180 --> 00:20:47,090
it really is about patient
care, patient experience,

332
00:20:47,240 --> 00:20:52,000
patient satisfaction and
access and choice go a really

333
00:20:52,000 --> 00:20:53,440
long way. Um,

334
00:20:53,440 --> 00:20:58,360
allowing patients to have the choice
to do this in their own home or the

335
00:20:58,360 --> 00:21:02,200
choice to do this in a
facility has, has proven, uh,

336
00:21:02,200 --> 00:21:04,560
to improve patient satisfaction. Um,

337
00:21:04,560 --> 00:21:08,080
for those that are have done
a virtual program, um, in,

338
00:21:08,250 --> 00:21:10,200
in health systems that we've worked with,

339
00:21:10,210 --> 00:21:14,520
they've seen net promoter
scores of 80 plus, uh percent.

340
00:21:14,520 --> 00:21:17,880
We've seen some almost hit,
um, you know, 85, 90. Um,

341
00:21:17,880 --> 00:21:21,360
they love the option and the
home-based experience because it's very

342
00:21:21,640 --> 00:21:26,360
personalizable. They can, uh, when they're
talking about diet or nutrition, um,

343
00:21:26,690 --> 00:21:28,600
on a virtual encounter,

344
00:21:28,600 --> 00:21:33,440
you actually can talk about the spices
that are on their spice rack or let's

345
00:21:33,440 --> 00:21:36,560
open the fridge, let's see, let's see
what, what, what's going on there,

346
00:21:36,560 --> 00:21:39,520
you know, and, and there
may be nutritionist on that,

347
00:21:39,520 --> 00:21:44,000
that advise them how to best
customize their next meal. So,

348
00:21:44,450 --> 00:21:48,880
uh, stories like that, um, really helped
to improve the patient experience.

349
00:21:49,060 --> 00:21:53,720
One thing that Terry touched upon
was the fact that there are, um,

350
00:21:53,720 --> 00:21:57,200
there's a broad swath of,
of demographics out there,

351
00:21:57,420 --> 00:22:00,880
and there are some underserved areas.
There are some underserved populations.

352
00:22:01,410 --> 00:22:05,960
Um, those that, that are, are
bilingual or, or, um, not,

353
00:22:06,300 --> 00:22:10,840
may, maybe not, uh, able to
communicate well, um, in,

354
00:22:11,010 --> 00:22:14,240
in English. And there, there may
not be if there's hard to have,

355
00:22:14,250 --> 00:22:17,560
if it's difficult to get
translation services onsite. Um,

356
00:22:17,560 --> 00:22:22,200
that's one benefit of leveraging a
a virtual platform is that you can

357
00:22:22,200 --> 00:22:25,840
quickly, um, have an, an audio visual, um,

358
00:22:25,840 --> 00:22:29,800
interpreter or translation
service come on board. Uh, we've,

359
00:22:29,800 --> 00:22:34,560
we've seen patients, um,
Portuguese, Ukrainian, uh,

360
00:22:34,560 --> 00:22:37,720
of course Spanish, uh,
Korean, that, uh, and they,

361
00:22:37,720 --> 00:22:42,640
and they feel really at home when they're
as part of a virtual encounter that

362
00:22:42,640 --> 00:22:45,120
has someone that speaks
their their native language.

363
00:22:45,120 --> 00:22:49,280
And that's that that certainly has
improved the patient experience. Um,

364
00:22:49,690 --> 00:22:53,000
at the end of the day, it's a bit of
common sense that when you provide these,

365
00:22:53,080 --> 00:22:58,040
these options and access to patients
that you do see higher satisfaction and,

366
00:22:58,040 --> 00:23:00,800
and more uptake of services. Terry,

367
00:23:00,800 --> 00:23:03,880
perhaps you could share what you've
seen on the I C R side of things.

368
00:23:04,230 --> 00:23:05,760
Yeah, absolutely, ed.

369
00:23:06,170 --> 00:23:09,880
So I was with one of our, um,

370
00:23:10,720 --> 00:23:13,720
licensed providers in
Washington a few weeks back,

371
00:23:13,720 --> 00:23:17,280
and we had a chance to talk
and actually utilize her,

372
00:23:17,740 --> 00:23:21,680
her outcomes data of
her virtual program. Um,

373
00:23:21,680 --> 00:23:26,040
and they have three different sites where
they run our intensive cardiac rehab

374
00:23:26,040 --> 00:23:30,040
program. And back to the
transportation issue that,

375
00:23:30,150 --> 00:23:31,320
that Ed mentioned,

376
00:23:31,410 --> 00:23:36,040
in addition to maybe living in
an area or a I C R or CR Desert

377
00:23:36,400 --> 00:23:38,240
where they don't have one in the area,

378
00:23:38,960 --> 00:23:42,760
those that are coming into their
facility from the rural areas on,

379
00:23:42,760 --> 00:23:45,080
she said the average patients
that are participating in,

380
00:23:45,080 --> 00:23:50,040
in their program are over
40 miles one way to their

381
00:23:50,360 --> 00:23:51,400
facility Now,

382
00:23:51,400 --> 00:23:56,040
who's gonna drive 40 miles
one way or 80 plus miles

383
00:23:56,070 --> 00:23:59,600
both ways, two to three
times a week, not many.

384
00:23:59,750 --> 00:24:04,480
You've gotta be a pretty committed
patient and have the means not only

385
00:24:04,520 --> 00:24:05,600
financial means,

386
00:24:05,600 --> 00:24:10,200
but trans transportation means to get
to a brick and mortar cardiac rehab

387
00:24:10,880 --> 00:24:11,460
facility.

388
00:24:11,460 --> 00:24:15,960
But she said she's been
extremely pleased with how their,

389
00:24:15,960 --> 00:24:20,880
their patient satisfaction scores
and their clinical outcomes are all

390
00:24:20,880 --> 00:24:22,640
comparable to that,

391
00:24:22,640 --> 00:24:26,760
that they're seeing in their face-to-face
brick and mortar outpatient cardiac

392
00:24:26,800 --> 00:24:28,880
rehab and intensive cardiac rehab program,

393
00:24:28,880 --> 00:24:32,360
which she said she wouldn't have
intuitively thought about it first,

394
00:24:32,780 --> 00:24:36,360
but in fact, all the data
is pointing that direction.

395
00:24:36,360 --> 00:24:41,360
It's saying that patients are getting
equivalent satisfaction scores because

396
00:24:41,360 --> 00:24:44,840
it gives them more flexi
flexibility and the schedules,

397
00:24:45,220 --> 00:24:49,680
the time it's re uh, required to go
through it. They can do it in the, uh,

398
00:24:49,680 --> 00:24:52,680
safety of their own home and,

399
00:24:52,820 --> 00:24:57,120
and patients are really engaged in
enjoying it and it's reflected in their

400
00:24:57,130 --> 00:25:01,280
patient satisfaction scores. In fact, um,

401
00:25:01,280 --> 00:25:02,840
just to kind of put a bow on this,

402
00:25:03,220 --> 00:25:08,080
the Paga program and the in the intensive
cardiac rehab program allows for

403
00:25:08,350 --> 00:25:13,120
more patient engagement than traditional
cardiac rehab because you've got

404
00:25:13,590 --> 00:25:18,560
36 additional sessions where the
clinical personnel at the hospital,

405
00:25:19,250 --> 00:25:21,400
or in the case of virtual, uh,

406
00:25:21,680 --> 00:25:26,680
ed staff to interact with a patient
two to three times per week over a

407
00:25:26,680 --> 00:25:31,680
12 to 18 week period through these
exercise classes, cooking classes,

408
00:25:32,280 --> 00:25:34,800
nutrition workshops, um,

409
00:25:34,830 --> 00:25:37,520
stress and healthy mindset education,

410
00:25:37,520 --> 00:25:41,960
which all combined lead to better
patient loyalty and satisfaction.

411
00:25:42,490 --> 00:25:46,920
We just completed our recent
net promoter score survey.

412
00:25:47,530 --> 00:25:51,480
We had a great response.
We had a 57% response rate,

413
00:25:51,480 --> 00:25:55,800
and our net promoter score
at KIN came back at an 81.

414
00:25:56,380 --> 00:26:01,200
And for those of you that aren't
familiar and anything, you know,

415
00:26:01,200 --> 00:26:05,640
in the eighties is world class
in patient satisfaction or client

416
00:26:05,640 --> 00:26:10,160
satisfaction. Um, so we
were extremely pleased,

417
00:26:10,730 --> 00:26:11,290
uh,

418
00:26:11,290 --> 00:26:16,040
to see those results and know that our
providers and their patients are finding

419
00:26:16,040 --> 00:26:20,920
value that not only do they feel
better physically and mentally,

420
00:26:21,690 --> 00:26:25,560
um, but it's creating a solution
that's more sustainable,

421
00:26:25,560 --> 00:26:30,360
something that they're learning through
time they can sustain even after they

422
00:26:30,360 --> 00:26:31,600
finish cardiac rehab.

423
00:26:32,900 --> 00:26:33,750
Absolutely.

424
00:26:34,140 --> 00:26:38,510
I really appreciate you both sharing
how each of your organizations are

425
00:26:38,710 --> 00:26:42,830
approaching what kind of sounds like
a much more tailored approach to

426
00:26:43,630 --> 00:26:48,040
what somebody, what a patient will want
in recovery, you know, whether it's the,

427
00:26:48,340 --> 00:26:53,080
the capability to have culturally
and linguistically competent

428
00:26:53,080 --> 00:26:57,200
services within the home and in
the kitchen and helping with, uh,

429
00:26:57,200 --> 00:27:02,120
kind of with some of those skills and
cooking and other areas that can support

430
00:27:02,440 --> 00:27:06,600
recovery. But then Terry, as you were
saying, um, what KIN offers is just,

431
00:27:07,090 --> 00:27:11,680
it sounds like really beyond the minimum
or what you might expect in another

432
00:27:11,960 --> 00:27:16,240
rehab program. So really appreciate
you both sharing all of this,

433
00:27:16,240 --> 00:27:21,000
and I think this is such a great note for
us to, to end our conversation on. Um,

434
00:27:21,130 --> 00:27:24,720
so I wanna thank you both so much
for what you've shared and how you've

435
00:27:24,720 --> 00:27:28,960
illuminated the innovation in this
space. And then on a personal note too,

436
00:27:29,210 --> 00:27:32,720
my mom is about to have open heart
surgery within the next few months,

437
00:27:32,720 --> 00:27:35,640
so it's just so reassuring
to hear about, um,

438
00:27:35,700 --> 00:27:39,720
how many motivated folks there are
behind these services and who are really

439
00:27:39,720 --> 00:27:43,720
trying to improve what's out there.
So thank you both. Thank you Erica.

440
00:27:44,520 --> 00:27:47,520
Thank, thank you Erica,
and we wish, um, you and,

441
00:27:47,520 --> 00:27:50,360
and your mother good
health and and recovery.

442
00:27:50,750 --> 00:27:53,760
Absolutely. Thank you.
Yeah. Oh, thank you so much.

443
00:27:53,830 --> 00:27:56,880
I think the conversation today was
meant to be <laugh>, so I appreciate it.

444
00:27:57,420 --> 00:28:01,640
And we'd also like to thank our
podcast sponsor today, record and kin.

445
00:28:02,020 --> 00:28:03,600
For all of those listening,

446
00:28:03,600 --> 00:28:07,640
you can tune into more podcasts
from Becker's Healthcare
by visiting our podcast

447
00:28:07,750 --> 00:28:10,200
page at becker's podcast.com.