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Improving Cardiovascular Care Through Outpatient Cardiac Rehabilitation: An Analysis of Payment Models That Would Improve Quality and Promote Use

Mead, Holly PhD; Grantham, Sarah MHS; Siegel, Bruce MD, MPH

Journal of Cardiovascular Nursing: March/April 2014 - Volume 29 - Issue 2 - p 158–164
doi: 10.1097/JCN.0b013e31828568f7
Articles

Background: Much attention has been paid to improving the care of patients with cardiovascular disease by focusing attention on delivery system redesign and payment reforms that encompass the healthcare spectrum, from an acute episode to maintenance of care. However, 1 area of cardiovascular disease care that has received little attention in the advancement of quality is cardiac rehabilitation (CR), a comprehensive secondary prevention program that is significantly underused despite evidence-based guidelines that recommending its use.

Purpose: The purpose of this article was to analyze the applicability of 2 payment and reimbursement models–pay-for-performance and bundled payments for episodes of care — that can promote the use of CR.

Conclusions: We conclude that a payment model combining elements of both pay-for-performance and episodes of care would increase the use of CR, which would both improve quality and increase efficiency in cardiac care. Specific elements would need to be clearly defined, however, including: (a) how an episode is defined, (b) how to hold providers accountable for the care they provider, (c) how to encourage participation among CR providers, and (d) how to determine an equitable distribution of payment.

Clinical Implications: Demonstrations testing new payment models must be implemented to generate empirical evidence that a melded pay-for-performance and episode-based care payment model will improve quality and efficiency.

Holly Mead, PhD Assistant Professor, Department of Health Policy, School of Public Health and Health Services, George Washington University, Washington, DC.

Sarah Grantham, MHS Research Assistant, Department of Health Policy, School of Public Health and Health Services, George Washington University, Washington, DC.

Bruce Siegel, MD, MPH Research Pofessor and Drector, Center for Health Care Quality, Department of Health Policy, School of Public Health and Health Services, George Washington University, Washington, DC.

The research noted in this article was funded by the Pfizer Foundation.

The authors have no conflicts of interest to disclose.

Correspondence Holly Mead, PhD, Department of Health Policy, School of Public Health and Health Services, George Washington University, 2121 K St, NW, Ste 200, Washington, DC 200037 (khmead@gwu.edu).

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins