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Bastiaan Nakano
August 7, 2017


Value-based Care Calls for Open Gyms in Cardiac Rehab Centers

For patients recovering from a heart attack, convenient cardiac rehabilitation session are important. Today, many cardiac rehabilitation programs use the set-class-time (SCT) model for the scheduling of cardiac rehabilitation sessions but programmatic and patient side drawbacks have been reported. The SCT model represents a straightforward and structured method to deliver cardiac rehab. However, the model does not always allow programs to maximize their capacity. As cardiac rehab centers optimize processes to adapt to bundled payments and decrease hospital readmissions, many believe that the way cardiac rehab sessions are scheduled is worthy of inspection.

Set-class-times, the Good and the Bad
The popularity of the SCT model can be attributed to its scheduling framework – its structure lets cardiac rehab nurses know how many staff members they will need at times throughout the day, when nutritionists and psychologists can speak with new patient participants and how much exercise equipment and printed educational material to have available.

Some issues have been reported, however - higher volume programs report shortages of telemetry monitors and difficulty in entering data during larger sized classes. Set-class-times also cause down times between classes, leaving resources sitting idle. Additionally, patients have difficulty in attending set appointment times during the regular hours of 8am-6pm.

How Does the Open Gym Model Work?
The Open Gym (OG) model increases access for CR participants by replacing set class times with appointment time slots in a schedule book. Cardiac rehab nurses can adjust the scheduling table according to program volume and staff availability, participants select what times work best for them. This wider range of available appointment times makes participation more convenient.

In addition to increasing access and convenience, the OG model progresses participants to an independence closer to how they will operate in the real world and in a Phase III or community gym. The Open Gym model grants participants their independence through independent flexibility and self-directed warm-up and cool down exercises that are taught through initial guidance from cardiac rehab nurses.

Utilizing the Open Gym Schedule Book
Below is an example of a schedule book ( table1 ). The OG schedule consists of rows1 with 15 minute time slots, and columns2 with patient types. Columns are to be used for Phase II, Phase III and first/second day participant patient types. Each column allows for 4 participants and staff can subtract or add columns if they have a smaller or larger capacity program, respectively. For example, the 2nd column of Phase II has been crossed out3; this center can accommodate a maximum of 8 patient participants at any time of the day. At noon, a subset of staff takes a lunch break4 and the number of participants able to be accommodated is reduced from 8 to 4. Notice the column labeled “Day One / Two”5, for first and second day participants; this lets staff to plan for one on one orientations and for nutritionists and psychologists to schedule appointments.

Open Gym Schedule Book Example

Transitioning to the Open Gym Model
Transitioning to the OG model will take about a month. Programs should review performance after a month in order to assess whether an increase appointment flexibility is needed. Increasing appointment flexibility can be accomplished by extending gym hours to evenings and/or weekends. Attendance records and the progression of patient status can be analyzed to assess the performance and to demonstrate the effectiveness of the program as a post-acute strategy in reducing hospital readmissions.

Leveraging Technology
During the transition, consider using smart scheduling software. Smart scheduling software helps eliminate confusion and disorganization that results from manual methods of scheduling. The automation of tasks, normally completed by cardiac rehab nurses, like sending schedule alerts to CR staff and appointment alerts to patients, will reduce operational staff hours. In addition, CR programs may be asked to demonstration their value as a readmission prevention strategy. CR centers with scheduling software already in use will find that their software has been tracking pertinent data like attendance records and patient status day by day, saving many hours of data collection.

Conclusion
For cardiac rehab centers that need to reduce hospital readmissions and increase participation, adherence, and completion rates in preparation of bundled payments; the Open Gym model could be a good fit. Centers should consider advocating for the use of smart scheduling software as well, to further increase the efficiency of day-to-day operations and streamline the collection of data.

Check out Feats in Heartbeats for more articles about CR. Articles like our 3 part series on Optimizing Enrollment in Cardiac Rehab, which includes methods to overcoming barriers to enrollment. Some of the information above was sourced from AACVPR’s Roadmap to Reform1, of which Moving Analytics is a proud sponsor.

1Matching Capacity to Demand: Open Gym


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