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Professional- licensure, reimbursement, other

Phase 3 Cardiac Rehab
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Phase 3 was supposed to be a transitional phase between early outpatient cardiac (or pulmonary) rehabilitation, a.k.a. Phase 2, and independent exercise in the community, Phase 4. There is no national reimbursement for Phase 3, therefore no national regulations to govern it. Consequently, as Wanda mentioned, there's a LOT of different ways to structure a Phase 3 program.

Some things to consider (in no particular order):
How much space and equipment do you have, and will you be running Phase 2 and Phase 3 simultaneously or separately? There are pluses and minuses to both approaches. Simultaneously potentially gives your Phase 3 patients more time options to attend, however there will likely be competition for both equipment and staff attention. Separately lets you focus more on your newest patients, but you do lose some of the group support that more seasoned patients (Phase 3) can bring to the mix.

What services are you planning on offering the Phase 3 patients, e.g. BP and HR checks, routine glucose monitoring, periodic ECG monitoring, etc? When thinking about this stuff, remember that we want to make people more independent with exercise. Also try to avoid falling into essentially providing Phase 2 level service at Phase 3 prices. That can lead to some awkward conversations with both your administrators as well as third party insurances.

What is program going to cost, and who's going to collect the payment? I prefer to keep clinicians away from financial stuff as much as possible as I feel it changes the patient - clinician relationship in a not always positive way. If you can, I'd try to set something up with your billing department, but realistically it's probably going to fall to you. Take a look at what programs around you are charging, and set your rates to be competitive. I've always mirrored what the local YMCA charges for an individual membership using the rationale that I don't have basketball courts or a pool, but they don't have ready access to clinical exercise physiologists if a patient starts having issues. The patient can choose which of the above is most important for them.

I prefer pre-paid monthly memberships and clearly state upfront that with a few pre-defined exceptions (hospitalization, prolonged illness) that it's a "use it or lose it" deal. Otherwise it just gets really complicated, really fast trying to keep track of when memberships are due for renewal. I'm not a big fan of multi-month memberships because of the aforementioned hospitalization/prolonged illness issue, but have offered these. Again, accurate record keeping will be your friend here. Some programs offer per session rates, if you want to go that route I'd suggest using some kind of pre-paid punch card that doesn't have an expiration date to help both patients and staff keep track of how many sessions remain.

Lastly, go into this with your eyes open. Phase 3 programs seldom, if ever, pay for themselves. The overhead of running them is just too high. However, the value that satisfied Phase 3 patients add to the hospital by being community ambassadors for you is immeasurable. It would be best if you and your administrators were in agreement on this from the outset.
Unfortunately, phase 3 program design can vary as greatly as how institutions choose to run their phase 2 program. I’m not sure where you are located, but it might be helpful to talk with another program within your region that runs phase 3. If you don’t know of one, AACVPR has several affiliate societies around the country. I’d suggest contacting your local affiliate and they could help connect you with someone in your area for potentially sharing resources, etc. The AACVPR affiliate societies contact list is open for public viewing.
Is anyone currently running a Phase 3 cardiac rehab program? If so, I'd appreciate your help! We are trying to start up a program and would love some practical experience on where to begin.
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