Cardiac Rehabilitation as a Cardiovascular Quality Measure - A Must for All

November 12, 2021


•      Cardiac rehabilitation (CRE) is a new HEDIS® measure introduced by NCQA to promote access to quality of care

•      CRE is calculated as a percentage of patients who completed Initiation (at least 2 sessions), Engagement (at least 12 sessions), and Achievement (at least 36 sessions)

•      Opportunities exist to expand the applicability of CRE to telehealth-based approaches

The Healthcare Effectiveness Data and Information Set (HEDIS®) from the National Committee for Quality Assurance (NCQA) is a set of over 90 measures across six domains dedicated to tracking and improving the quality of medical care. HEDIS is one of the most comprehensive and widely used performance improvement tools in healthcare to track care quality. On June 5, 2020, driven by the need to continue to support health plans, clinicians and patients during the COVID-19 pandemic, NCQA approved a sweeping set of adjustments to its HEDIS measures.

A particular highlight was the introduction of Cardiac Rehabilitation (CRE) as a component of tracking the quality of cardiovascular care. The need for adopting CRE as a quality measure stems from the tremendous impact that Cardiac Rehabiitation (CR) provides in producing positive cardiovascular outcomes in its recipients’ lives. Participation in CR leads to decreased hospitalizations and lower costs to the healthcare system not to mention improve quality of life to patients who receive it. Thus, promoting the adoption of CRE would likely bring about a more concerted and coordinated effort to promote cardiac rehabilitation as a must-have follow-up after acute cardiovascular events.

Despite the Class IA recommendation and stated benefits, cardiac rehabilitation (CR) is historically underused, with participation ranging from 19%–34% nationally, with geographic variances. Another study of Medicare claims found that of more than 366,000 eligible beneficiaries, fewer than 24% participated in CR. Other studies that examined CR participation found that approximately 16% of CR eligible Medicare beneficiaries attended CR. The national gold standard for rehab as represented by the Million Hearts Initiative is 70%. Thus, a participation rate of 16%-34% represents an enormous gap in care and is an important driver for the adoption of CRE.

Measure Highlights

Here are some of the main highlights of the measure:

What is the definition?

The percentage of members 18 years and older, who attend cardiac rehabilitation following a qualifying cardiac event

What patients count as eligible?

Any patient who has had a recent myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, heart and heart/lung transplantation or heart valve repair/replacement. 

What ages would be counted as part of the measure?

18 years and older as of December 31 of the measurement year. Report the following age stratifications and total rate:

•      18–64 years

•      65 and older

•      Total

How is attendance defined?

Three rates are reported:

•      Initiation. The percentage of members who attended 2 or more sessions of cardiac rehabilitation following a qualifying event.

•      Engagement. The percentage of members who attended 12 or more sessions of cardiac rehabilitation within 90 days after a qualifying event.

•      Achievement. The percentage of members who attended 36 or more sessions of cardiac rehabilitation within 180 days after a qualifying event.

The denominator for calculating percentages in all these cases represents all eligible patients.

What is the anchor date for tracking each patient?

The anchor date is the episode date for that patient. Depending on the diagnosis/procedure, the episode date is described as below:

•     For MI, CABG, heart or heart/lung transplant or heart valve repair/replacement, the Episode Date is the date of discharge.

•     For PCI, the Episode Date is the date of service.

•     For direct transfers, the Episode Date is the discharge date from the last admission.

What patients might be excluded?

•     Higher risk patients or patients who need more detailed care after an episode may be excluded.

 More details on the measure can befound here.

Looking Ahead

At Moving Analytics, we strongly support the adoption of CRE as a measure for both health plans and clinicians. Promoting more rehab participation will bring widespread benefits to all stakeholders in the healthcare system. We believe that the implementation of this measure can be improved in several ways:

•     Providing quality-improvement toolkits for providers and health plans that detail practical steps on how they can implement the measure, for e.g. implementing automatic referrals, providing value-based incentives to physicians to educate patients about CR and so on.

•     Expansion of the definition of CRE to include delivery in home-based, telehealth or virtual CR settings – adding virtual CR as an option greatly increases access to care. Several health plans such as Highmark Health, Capital District Physicians’ Health Plan, Henry Ford Health System and Kaiser Permanente already offer virtual options.

•     Laying special emphasis on carving out calculations that are specifically addressing rural populations, minorities and women who have historically low participation rates.

•     Trying financial incentives at both the hospital and physician level that include both upside and downside risk if target goals are not met.

Overall, the implementation of CRE represents a positive step in promoting the life-saving service benefits of Cardiac Rehab. We look forward to the measure continuing and for further improvements to enhance its benefits.

FEATS IN HEARTBEATS  –  the moving analytics blog

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