Paying for cardiac rehab
In Canada and other countries, health-care providers cannot directly bill government health-care systems for cardiac rehabilitation like they can for a stent or a cardiologist visit, despite all the clinical recommendations for patients to get rehab. We advocate for this reimbursement, or other innovative payment models, to make it more financially viable to offer cardiac rehab and ensure enough cardiac rehab spots for all the patients who need it.
For example, if a patient gets a stent or heart bypass surgery, the hospital could be paid one “bundled” fee that includes money not only for the procedure, but also the rehabilitation that follows. Bundled payments that include rehab have been rolled out now for hip and knee replacements in Ontario for example, but we are still waiting for heart procedures as promised.
As a cardiac rehab advocate, I’ve heard the argument that heart risks are lifestyle-related, and government-funded health systems should not be in the business of individual health behaviour change. This is despite evidence that cardiac rehabilitation is cost-effective, results in earlier return to work, as well as reductions in deaths and repeat visits to the hospital (which are very expensive for the health system).
Moreover, the same unhealthy lifestyle behaviours that underlie heart disease are also associated with cancer, but we don’t blame cancer patients for their condition.
Arguably, it is lack of public policy — to ensure citizens have access to safe green spaces to exercise, sources of healthy food and clean air in all neighbourhoods regardless of socio-economic status, as well as better tobacco control — that leads to heart disease; so governments clearly have an important role in lifestyle change.
People need support to learn how to manage their condition and change multiple health behaviours, as well as to address their high rate of psychosocial issues that not only hinder their ability to manage their condition but also result in poorer health outcomes.
Other solutions include leveraging electronic health records so that, for example, when a heart patient gets a stent or bypass surgery, their file is flagged automatically for cardiac rehab because of its clear benefits in these patients. Systematic referrals such as these increase rehab use eight times, and this is augmented even further by training inpatient clinicians to inform and encourage patients to enrol in cardiac rehabilitation at the bedside.