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Exercise Prescription & Programming

COVID 19 Program response
Robert Berry
Hi all, I'm wondering how others are coping with the COVID 19 crisis in their cardiac/pulmonary rehabilitation programs, or other exercise based programming you may be involved in.

At Henry Ford Hospital in Detroit, an executive order by the governor of Michigan on March 23rd effectively closed all outpatient exercise programs for the duration of the crisis. Henry Ford has had a telehealth CR program for a few years and we were able to transition some of our patients to that program and those folks are still receiving CR. We contracted with two third party payors to reimburse us for that service.

Other patients in the CR program have been placed on indefinite hold until the COVID 19 restrictions are lifted. This has been noted in their chart and we are no longer completing 30 day reviews of the ITPs per the recent communication from AACVPR on this issue. There is no need to burden physicians with unnecessary paperwork at this time. While the CR program is suspended we are still contacting each patient at least once a week to encourage them to continue to be as physically active as possible during this time. Some metrics regarding type, duration and frequency of exercise is collected and entered into a template in the EMR along with any disease management education that is provided. Entering this into the EMR helps ensure the clinicians are accountable for these contacts, but also helps demonstrate to administration that the staff is being productive during this time even if these contacts are not reimbursable.

Recognizing that this current crisis may continue for several more weeks, and that people unfortunately continue to experience events that make them eligible for CR, we have started a telehealth based home exercise program for those patients who should be starting in CR during this time. The patients receive a virtual orientation either via the telehealth system or just a phone call (pt choice). The clinician does a virtual assessment and gives the patient a home exercise program based on their medical history, comorbidities, and previous level of physical activity. These patients are contacted twice a week initially using a similar process as outlined above, with a greater emphasis on education. All of our education is available online (www.henryford.com/creducation) and patients are encouraged to watch these videos and discuss with staff during their phone sessions.

We're not trying to replace CR with these programs, just avoid potential deconditioning during this crisis and meet the needs of patients who have had recent cardiac events.

I'd love to hear what strategies other programs are using during this period of enforced social distancing.
Mark Patterson
Hi Bob. I am part of a group in Colorado that has their own discussion forum that was established with Colorado Department of Public Health and Environment. Essentially what you have stated is what is going on around here. If programs already had some version of tele/virtual rehab, they try to utilize it as best they can, if they have an inpatient program, they are at least delivering some rehab in the hospitals and outside of that are making weekly calls.

My hope is that this pandemic will help move forward the expansion of more virtual resources moving forward and those programs that have this kind of offering in place are considering tracking outcome data on those who started this program during this time to help the cause.

Y'all stay safe out there!
Brian Coyne
Hi Bob,
Duke has done much the same as Henry Ford. Tele rehab was started recently for cardiac rehab, and patients have been enrolled. Others not enrolled are being contacted regularly to encourage physical activity and provide education. Pulmonary rehab has continued in-person for pre- and post-lung transplant patients.
There's been much discussion between NCCRA members regarding tele rehab too. Programs are investigating this more. Hopefully we'll see continued growth.
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