Hi everyone, this is Erica Spicer Mason with Becker's Hospital Review.
Thanks so much for tuning into the Becker's Healthcare podcast series.
Today I'm thrilled to be joined by two guests, Dr. Ed Wu,
the co-founder and chief medical officer at rera. And Terry Rogers,
the president of Kin i c r, ed and Terry,
welcome and thank you so much for joining us today.
You're welcome.
Thank you. Looking forward to it.
Wonderful. I'm looking forward to this as well.
So just to kind of get us started,
I wanted to start a bit broadly and get both of your perspectives
on what you're seeing as some of the biggest challenges that health system
leaders are facing today. Terry,
maybe we can start with you to get us going here.
Yeah, thanks Erica. Um, what we're hearing in the marketplace,
some of the more, uh,
common issues are declining revenues,
the always present payer pressures that systems face
increase labor costs, labor shortages,
and employee burnout due to the pandemic and the tail associated with it.
Ed, what else, um, would you add to that list?
Yeah, Terry, I would, I would certainly agree with those. Uh,
I have had many discussions with, uh, sweet C-Suites, um,
and, and officers of, of hospitals and,
and echo the need to reduce cost and address labor shortages.
Um, I've also picked up on a couple of other ones,
including patient leakage that me,
meaning patients that are going from health system to health system or medical
group to medical group and not really having loyalty.
Also seeing some care coordination issues as,
um, as patients truly try to find out how to better care for themselves.
And that seemed to be lost in some of the, the,
the labor shortages and the cost cutting and the,
and the revenue reductions that, that we're seeing out there. Uh,
also a more recent one is how best to deploy telehealth
and virtual and digital solutions amidst the sea of options.
Thank you both so much.
I think that really hits the nail on the head in terms of what we at Becker's
are also seeing just in our daily coverage of issues that hospitals and
health systems continue to face. So what you're saying really resonates,
and it really speaks to how these bigger issues of financial challenges,
for example, and staffing issues, how they,
those issues trickle down into kind of those more day-to-day operations.
So I appreciate you sharing that.
And I know we're here today to talk a bit more specifically about the cardiac
services space. So I know in this specialty area,
we typically see revenue and driving patient volumes,
and I'm wondering what gaps you're seeing here in terms of operations
and strategy. I was thinking, ed, you might be able to speak to that one.
Yeah, thanks, Erica. There are a couple of, of trends and gaps that,
that we've seen in our discussions with hospital leaders.
As I mentioned as Terry and I mentioned a a little bit earlier,
this sense of disintermediation, the, the cost cutting,
the revenue shortages, um,
is really making it difficult for hospitals to operate.
We're seeing retrenching of costs by 10% or greater.
That's not unheard of. Uh,
and cardiovascular service lines are certainly included in this. Uh,
they have seen huge pressures to perform fiscally, um,
as well as on in clinical outcomes. Uh,
and unfortunately this has resulted in what I like to call a,
a subsequent gap that has led to a shift in cardiovascular care
to procedural interventions as opposed to preventative or recovery,
uh, interventions, uh, such as, um, cardiac rehab. And,
and let me highlight this gap a little bit more. This is quite stark.
Research has actually shown that about 8%,
only 8% have completed a post-surgical or
post-hospitalization course of cardiac rehab.
That means there's a gap of 92% where there's a,
there's a huge area of unmet need for these cardiovascular patients to get
better care to recover from their conditions and actually prove that the
hospital that they're, they came from, um, is, is doing a great job. Um,
further exacerbating this, we had covid, and during C O V I D,
we had about 200, uh,
220 cardiac rehab centers that shut down.
That's about 10% of national capacity of cardiac rehab centers.
And that's actually exacerbated this, this big gap.
So that's just an example of, of, um, a gap that's,
that's really painful as a provider myself to, to see. Um, this,
um, this has led to a lot of patient leakage. You know, you,
as I mentioned before,
you're seeing patients that aren't really getting good follow through. And, um,
this has, uh,
really impacted cardiovascular aftercare.
So post hospitalization, post procedure, um, the,
the, the silver lining here is that this,
this time of cardiovascular aftercare after,
after they've been discharged,
this is a golden moment to really improve patient experience,
improve procedural outcomes or document procedural outcomes for that facility.
And we've actually had some chief financial officers,
some CFOs that have spoken, um,
spoken to us that have focused on this cardiovascular aftercare,
say that this has been a way to drive patient revenues back into the black.
Absolutely.
And what you're saying about aftercare really rings
true. There's so much that can, I don't wanna say go wrong,
but patients who've had a significant procedure really do need support
after the fact, especially when they're back at home.
And so having that area overlooked, I'm sure, um,
you know,
really doesn't support patient outcomes nor the health system's outcome either.
Right. Um, so thanks so much for sharing about that, ed.
I'd like to dive a little bit more into cardiac care
post-discharge, um,
because it looks like both of your organizations really focus on this,
and particularly in the cardiac rehab space.
So I'm wondering if you can discuss how cardiac rehab fits into the overall
cardiovascular service line. Terry, maybe we can have you get us started here.
Sure. Uh,
let me level set with a little background to start and, uh,
you'll hear me refer to conventional CR going forward as
cr so I don't have to say it every time, CR or I C r,
meaning intensive cardiac rehab,
but conventional car cardiac rehab has really been the mainstay of a
cardiovascular rehab service since 1982 when it was first approved by
Medicare. Now,
fast forward to 2010 when C M S approved
two i c r programs under the national coverage determination process.
And since then,
the precon Intensive Cardiac Rehab program that I'm responsible for
has been the fastest growing c r or I C R program in the
nation.
With over 175 licensed providers expected to
provide the service by the end of this year. Now,
both CR and I c r programs consist of this multidisciplinary
evidence-based intervention that utilize individualized, uh,
patient treatment plans that have been proven to, I, uh,
improve clinical outcomes in quality of care.
The primary difference between CR and intensive cardiac rehab is that
intensive cardiac rehab offers an additional 36
lifestyle educational, uh,
sessions that consist of these immersive group workshops,
professionally produced videos,
one-on-one consults in the areas of exercise healthy mindset,
stress reduction, and heart healthy nutrition.
The results for patients who go through our I C R program are
improved functional capacity and stress reduction lowering of
cardios, uh, vascular risk factors like weight, blood pressure,
lipids, triglycerides,
and ultimately decreased readmissions and mortality,
and simultaneously helping the health systems bottom line.
Now,
an important factor that most people don't know is that cardiac rehab
and intensive cardiac rehab are considered Class one A interventions.
And for those of you, just in case you don't know, class one a intervention is,
it means it's accepted as the standard of care in
post-acute coronary syndrome. And in P C I,
CR and I C R are considered Class one A in, um,
interventions just like aspirin, beta blockers, statins, and ACE inhibitors.
However,
unlike those drug therapies that I mentioned that have
utilization rates in the 75 to 95% range,
CR and ICR R discharge uses at an abysmal 24 to
26%. As Ed said earlier, he sta he stated,
research is shown only 8% have completed post-surgical or post-hospitalization
rehab. So it's not utilized like some of the more commonly,
um, known and effective therapies.
Now these really,
these cardiovascular rehab services should just be just like physical therapy
after an orthopedic procedure.
A physician or patient wouldn't consider going home and not going through,
uh, physical therapy after a knee or hip replacement,
and they shouldn't go home,
not expected to participate in cardiac rehab air, um, as well.
But we've got referral rates that are overall low.
We've got participation rates that are low nationwide due to a lot of barriers
that we'll discuss a little later in the conversation.
But in the last couple things I'll mention,
our cardiac rehab hasn't historically been seen as a profit center for the
hospital as a standalone service. However,
it is a valuable offering for a full cardiac service line and quality
patient care program. And like the health system in general,
there are a fair amount of headwinds, um,
in cr in the form of labor and capital cost,
like we were talking about earlier in the conversation.
But these can be addressed with some alternative approaches like intensive
cardiac rehab as well as virtual CR and I C R that Ed can speak to
next.
Thanks Terry. Um, really great, uh,
recap and discussion of cardiac cardiac rehab and, and icr r uh,
CR and ICR R. And now let's talk a little bit about the modality.
So you, CR and ICR has traditionally been done in a facility,
um, more recently we're talking the past few years,
this has been done virtually, and this can really increase access.
So God are the days where you have to show up, uh,
36 to 72 times, um, you know, to, to go to,
to these sessions in person. You can actually do this virtually.
And what we've seen and what we've heard from hospitals that are
doing this and allowing for virtual sessions is that they're actually able to
see many more patients. And in some cases,
three to four times the number of patients are able to get cardiac
rehab, uh, whether it's CR or i c r. And this is great because,
you know, you're, at the end of the day, it's about providing patient choice,
patient access, and, um, this can be done in a more scalable fashion.
And so, you know, their staffing, um, can be, can be more,
more leveraged to see this larger population.
And so it really starts to turn the tide in term terms of being an
operationally, um, you know, efficient, more efficient, uh, program.
That being said, uh, Terry, you,
you hit the nail on the head historically has not been a huge money maker,
but we actually just had a chief medical officer of a health system in Florida
who said, you know, having a virtual and,
and a more robust program dedicated to cardiac rehab allows him to
more confidently, um,
talk about the cardiovascular outcomes of their bypass program,
of their transplant program and of their cath program.
And so this is how they're really able to both increase not only cardiac rehab
volumes,
but increase overall procedural volumes when they go out into the marketplace
and say, Hey, we're, we're doing great in terms of our procedural and surgical,
um, quality me measures too. So it kind of is, uh, it, you know,
going back to your questionnaire,
how does this fit into a whole cardiovascular program?
It really helps to just lift the entire program up in terms of
quality, revenue, outcomes and patient loyalty.
Absolutely. And Ed,
as you were explaining what's possible with virtual appointments in terms
of expanding reach and really driving operational efficiency,
it really does lead,
lead me to think more about that overall issue of access to care.
And so I'd like to dive a little bit deeper into that issue. Uh,
so what about the patient who is truly too far from a rehab center?
Can virtual care for cardiac rehab,
can it be done fully remotely? And if so,
how does this impact facility volumes?
Wondering if you can speak to that a little bit. Ed.
Thanks Erica. Really great question. It's very timely. Uh,
just in the last week or so, uh, both Terry and I came across, uh,
a research study that, uh,
demonstrates that about 14% of patients across
cardiovascular patients across the country live in what's called a cardio,
uh, cardiac rehab desert. Uh,
translated that means there's zero supply of a cardiac rehab program
for these regions and, and counties where there is, uh,
a good solid amount of demand for cardiovascular SER services.
So that's, and that's 14%. Now,
beyond that, they're upwards of 40 to 50% of,
of patients in the country where they're at an hour, hour and a half,
two hours from the nearest facility.
And now it just becomes a convenience and, and, um, and sadly, you know,
how much are you gonna pay to make that trip in on, uh, uh, you know,
in terms of gas, and that's if they have a car.
And so there's the arduous component of making it in to facility.
Um, and, and then so what we have seen,
we've talked to hospital executives and,
and physio physicians saying that this can be done, uh, virtually. Um,
there's supervision, there's phy, it's a clinical clinically supervised,
uh, audio and visual program where patients can really,
uh, have all safety measures at, um,
at their disposal that's monitored and it's exercise,
it's diet, and it's smoking cessation, uh, lifestyle, um, modification.
Many of these things that Terry mentioned, and they can be done virtually, uh,
for those that aren't able to get into facility. Um,
what's interesting is that when a,
when a health system or a hospital takes on a virtual program,
this increases overall uptake.
So three to four times of,
of pre implementing a virtual program in some cases,
then that's just because you're getting with a virtual program,
you more access is out there, more patient choice, more,
more patients are talking to each other and family members are talking about it.
And so not only are are they enrolling more in virtual programs,
but they're enrolling into a facility program too.
And then when they find out about I c R,
that helps 'em both in a facility as well as virtual. Um, maybe Terry,
you could share some of your successes that you've, you've seen in,
in some of the provider partners that you've,
you've had that have done some programs like this.
Yeah, sure, ed,
great points to kind of piggyback on what Ed was talking about and,
and why virtual cardiac rehab and intensive cardiac rehab makes sense.
I'm gonna highlight a few other things that we've seen in our providers who are
doing it.
So many of our licensed hospitals have limited limited
capacity to handle the volume of patients who've actually qualified for cardiac
rehab. They're limited in space and equipment and staff resources,
uh, to support that. In fact,
some of our clients are reporting wait lists of three months post-discharge
before they can even get the patient into their cardiac rehab program.
And some of our providers are actually discharging patients from rehab early.
In other words, not,
not having them complete the full 36 or 72 sessions
to address that backlog in those long wait lists of patients.
And that's not a good solution given that there is a,
there's a dose response between the number of sessions that a patient
attends and the long-term clinical outcomes.
So that's not a great solution either. In fact, there was some research,
you know, ed referenced research, there was one I was reading recently as well.
Part of that same, uh, study,
it shows that the median time from discharge to cardiac rehab initiation
across the country is 39 days.
And ideally you want a patient in as soon as possible within three weeks or
sooner at least. And it also shows that for every day,
and this is previous research,
it's shown that for every day delayed in starting cardiac rehab,
you get a 1% decrease in probability of a patient actually
enrolling in cardiac rehab.
Thus the virtual and and hybrid options,
which we really haven't talked specifically about,
but hybrid is a combination of patient comes in person a few times
in the bulk of their, uh, rehab is done virtually, but both,
whether it's a hundred percent virtual or hybrid or facil or, or a hybrid model,
it offers a way to reach rural and underserved
populations that don't have access to a nearby facility like those cardiac
rehab deserts that Ed was talking about earlier and
the decre.
And that decreases the backlog of patients waiting for this very important
clinical service.
Absolutely.
And what you both have shared really highlights how
virtual care in this space is becoming essential, you know,
not just in order to reach those patients who might live in rural areas and
need better access,
but to really augment the services that facilities are able to provide
in order to, you know, meet the standards of care,
which is so important for these patients. So thank you again for sharing that.
And I'm really,
I really like how this conversation has kind of accumulated to focusing so much
on, um,
the patient and the patient experience and their outcomes and comfort and their
safety. And so I'm wondering,
among both of your organization's health system partners, um,
I know patient satisfaction is continuing to be a top priority among all of the
other priorities that leaders are focusing on right now.
So I'm wondering if you can share a little bit more about how cardiac recovery
and the services that you provide,
how it does contribute to improved patient satisfaction.
Ed, maybe you can get us started there.
Thanks, Erica. And at the end of the day,
it really is about patient care, patient experience,
patient satisfaction and access and choice go a really
long way. Um,
allowing patients to have the choice to do this in their own home or the
choice to do this in a facility has, has proven, uh,
to improve patient satisfaction. Um,
for those that are have done a virtual program, um, in,
in health systems that we've worked with,
they've seen net promoter scores of 80 plus, uh percent.
We've seen some almost hit, um, you know, 85, 90. Um,
they love the option and the home-based experience because it's very
personalizable. They can, uh, when they're talking about diet or nutrition, um,
on a virtual encounter,
you actually can talk about the spices that are on their spice rack or let's
open the fridge, let's see, let's see what, what, what's going on there,
you know, and, and there may be nutritionist on that,
that advise them how to best customize their next meal. So,
uh, stories like that, um, really helped to improve the patient experience.
One thing that Terry touched upon was the fact that there are, um,
there's a broad swath of, of demographics out there,
and there are some underserved areas. There are some underserved populations.
Um, those that, that are, are bilingual or, or, um, not,
may, maybe not, uh, able to communicate well, um, in,
in English. And there, there may not be if there's hard to have,
if it's difficult to get translation services onsite. Um,
that's one benefit of leveraging a a virtual platform is that you can
quickly, um, have an, an audio visual, um,
interpreter or translation service come on board. Uh, we've,
we've seen patients, um, Portuguese, Ukrainian, uh,
of course Spanish, uh, Korean, that, uh, and they,
and they feel really at home when they're as part of a virtual encounter that
has someone that speaks their their native language.
And that's that that certainly has improved the patient experience. Um,
at the end of the day, it's a bit of common sense that when you provide these,
these options and access to patients that you do see higher satisfaction and,
and more uptake of services. Terry,
perhaps you could share what you've seen on the I C R side of things.
Yeah, absolutely, ed.
So I was with one of our, um,
licensed providers in Washington a few weeks back,
and we had a chance to talk and actually utilize her,
her outcomes data of her virtual program. Um,
and they have three different sites where they run our intensive cardiac rehab
program. And back to the transportation issue that,
that Ed mentioned,
in addition to maybe living in an area or a I C R or CR Desert
where they don't have one in the area,
those that are coming into their facility from the rural areas on,
she said the average patients that are participating in,
in their program are over 40 miles one way to their
facility Now,
who's gonna drive 40 miles one way or 80 plus miles
both ways, two to three times a week, not many.
You've gotta be a pretty committed patient and have the means not only
financial means,
but trans transportation means to get to a brick and mortar cardiac rehab
facility.
But she said she's been extremely pleased with how their,
their patient satisfaction scores and their clinical outcomes are all
comparable to that,
that they're seeing in their face-to-face brick and mortar outpatient cardiac
rehab and intensive cardiac rehab program,
which she said she wouldn't have intuitively thought about it first,
but in fact, all the data is pointing that direction.
It's saying that patients are getting equivalent satisfaction scores because
it gives them more flexi flexibility and the schedules,
the time it's re uh, required to go through it. They can do it in the, uh,
safety of their own home and,
and patients are really engaged in enjoying it and it's reflected in their
patient satisfaction scores. In fact, um,
just to kind of put a bow on this,
the Paga program and the in the intensive cardiac rehab program allows for
more patient engagement than traditional cardiac rehab because you've got
36 additional sessions where the clinical personnel at the hospital,
or in the case of virtual, uh,
ed staff to interact with a patient two to three times per week over a
12 to 18 week period through these exercise classes, cooking classes,
nutrition workshops, um,
stress and healthy mindset education,
which all combined lead to better patient loyalty and satisfaction.
We just completed our recent net promoter score survey.
We had a great response. We had a 57% response rate,
and our net promoter score at KIN came back at an 81.
And for those of you that aren't familiar and anything, you know,
in the eighties is world class in patient satisfaction or client
satisfaction. Um, so we were extremely pleased,
uh,
to see those results and know that our providers and their patients are finding
value that not only do they feel better physically and mentally,
um, but it's creating a solution that's more sustainable,
something that they're learning through time they can sustain even after they
finish cardiac rehab.
Absolutely.
I really appreciate you both sharing how each of your organizations are
approaching what kind of sounds like a much more tailored approach to
what somebody, what a patient will want in recovery, you know, whether it's the,
the capability to have culturally and linguistically competent
services within the home and in the kitchen and helping with, uh,
kind of with some of those skills and cooking and other areas that can support
recovery. But then Terry, as you were saying, um, what KIN offers is just,
it sounds like really beyond the minimum or what you might expect in another
rehab program. So really appreciate you both sharing all of this,
and I think this is such a great note for us to, to end our conversation on. Um,
so I wanna thank you both so much for what you've shared and how you've
illuminated the innovation in this space. And then on a personal note too,
my mom is about to have open heart surgery within the next few months,
so it's just so reassuring to hear about, um,
how many motivated folks there are behind these services and who are really
trying to improve what's out there. So thank you both. Thank you Erica.
Thank, thank you Erica, and we wish, um, you and,
and your mother good health and and recovery.
Absolutely. Thank you. Yeah. Oh, thank you so much.
I think the conversation today was meant to be , so I appreciate it.
And we'd also like to thank our podcast sponsor today, record and kin.
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