Professional- licensure, reimbursement, other

Hello everyone, we have recently had a higher than normal drop out rate in our CR program due to patients going back to work. Our last class is at 2:30 we were wondering if anyone's program has had success running classes later in the afternoon. If so what times are most popular?

Hi Christopher,

While we haven't really had much luck having later classes, we have had TONS of success running an early-morning class with those going back to work or those who are currently working. We currently run our first class from 6:25-7:30ish. Hope this helps!

Aside from early morning and noon classes, build a network of local trainers-coaches who can help bridge that gap from CR release to training in a non-clinical setting supervised, then onto training on their own at home or at a local facility. Be prepared to share discharge data, VO2/HR peak from GXT/CPX, intensity Rx, RPE if necessary due to MEDS, and any and all relevant information. With the wearables today, monitoring intensity is more precise. Colleges, universities, local community-recreation-fitness centers may be interested in being a host site.

If we want to keep the folks moving for life, completion of CR is the launchpad forward. Build a network. IT goes both ways. Trainers-coaches need and want to refer to clinical settings. Too many middle-aged adults have multiple risk factors, and would benefit tremendously from a clinically supervised CR program, via a cardiologist or primary care referral referral.

Then, there is always Zoom, but most today have had enough of that.

I am currently developing a 12-hour course on this very topic for another organization, for certified/degreed trainers-coaches working in the non-clinical setting.

Lifespan movement, PA and training is a non-negotiable in our screen-driven-addicted society.

Pat

Hi there,

Does anyone of you know how many clients I am legally allowed to have in my Cardiac Rehab. exercise class? I am a Certified Clinical Exercise Physiologist and my group works out in a gym. in a Community Center?

CMS does not define a required staff to patient ratio for cardiac rehabilitation. Below is the statement from NCD for staffing phase two CR and ICR:

“The program must be staffed by personnel necessary to conduct the program safely and effectively, who are trained in both basic and advanced life support techniques and in exercise therapy for coronary disease. The program must be under the direct supervision of a physician, as defined in 42 CFR § 410.26(a)(2) (defined through cross reference to 42 CFR § 410.32(b)(3)(ii), or 42 CFR § 410.27(f)).”

https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&NCAId=164

That said you may want to check state/regional guidelines. The generally recognized ratio for safety is 1:5 for phase two cardiac rehabilitation. AACVPR is a great resource for program guidelines.