In telehealth boom, can rehab go virtual?

For the first time since the novel coronavirus was confirmed in Iowa in March 2020, the University of Iowa Hospitals and Clinics has reopened its outpatient cardiac rehabilitation lab to patients.

Though activity resumed at the Iowa River Landing clinic location Nov. 15, patients will still have the option to complete their rehabilitation following a cardiovascular event virtually — and not in-person at the clinic.

The pandemic sparked an explosion in telehealth services across the country, and home-based rehabilitation care was among many types of patient services that have had to pivot during the unprecedented times.

“I think it's a moment not only in cardiac rehab, but when you look at health care in a broader perspective, its just a drop in the bucket for the good things that have happened in the last few years,” said Michael Powell, program manager at the UI Heart and Vascular Center.

“If there’s one thing the pandemic is going to teach us, it's the fact that it has really accelerated health care to adapt to new models to ensure we’re able to continue patient care and meet patients’ needs where they’re at,” he said.

But among other rehabilitation facilities in the Corridor, the Iowa City-based health care system is unique in embracing a virtual format for the long-term.

After closing down operations for several weeks starting in March 2020, cardiac rehabilitation specialists at Cedar Rapids hospitals reopened to in-person services with COVID-19 mitigation strategies that included mask requirements and social distancing, among others. Rehabilitation providers at UnityPoint Health-St. Luke’s Hospital were closed for eight weeks, and Mercy Medical Center resumed classes in June 2020.

Though officials at other facilities say they are open to the idea of tele-rehabilitation services, they also say the technology may not be the best substitute for in-person in certain cases.

But that’s not to say there could be more virtual programs in the future, should regulations and insurance payment models and other factors that are barriers to some providers change.

“We’re just in the beginning phases on virtual cardiac rehab,” said Julie Peterson, manager of St. Luke’s cardiac rehabilitation.

Cardiac rehabilitation is recommended for some patients following a cardiovascular event, such as a heart attack or stroke. Rehabilitation is meant to help improve patients’ cardiovascular health through training and education about lifestyle changes.

When the coronavirus arrived in March 2020, the UIHC cardiac rehabilitation program, like many medical services, explored home-based cardiac rehab programs. Powell said they found many providers across the country that provided those virtual services and identified the opportunity to introduce that option under their own roof.

The virtual format also was in place as UIHC relocated and renovated its cardiac rehabilitation services clinic, a project that cost $259,000 and was completed in October.

Throughout the virtual program — which was available only to individuals who were categorized as low to moderate risk — patients would meet with a cardiac rehabilitation specialist through a video feed. UIHC helped provided exercise and medical equipment to those who needed it, Powell said.

UIHC cardiac rehabilitation providers still encourage patients to participate in programming at the facility, especially those who are at high-risk, Powell said.

But if they qualify, some patients still can make the choice to participate in virtual sessions at UIHC. This option is available for individuals who are low to moderate risk

“We understand the pandemic is still here,” Powell said. “We still have to be mindful of patients who don't feel comfortable visiting us in a center-based facility, so we want to be respectful of that and also support them in their cardiac care.”

Cardiac rehabilitation specialists at St. Luke’s explored virtual options, but the logistics involved and patients’ desire to return in-person ultimately meant they did not go down that path, Peterson said.

"Pandemic has changed how we look at a lot of different things, not just health care,“ Peterson said. ”People are doing things differently. I’m not saying it can’t be done, but is it the best way? I don’t know.“

Cardiac rehabilitation programs are not just about physical activity, but also serve an important emotional support for many patients, Peterson said.

Oftentimes patients were caught off guard by the cardiac episode, she said. Juggling new medications and lifestyle changes in addition to anxiety about their health can be “a lot for people to deal with.”

In addition to more access to knowledgeable providers to answer their questions, in-person patients also have the opportunity to interact with others who have gone through a similar experience, she said.

“We have heard from our patients and know that they benefit from the social aspect of group classes as well as the face-to-face interaction with their care providers, so we have chosen to provide cardiac rehab services in that setting,” said Michelle Wehr, Mercy’s manager of non-invasive cardiology. “Another benefit to an in-person setting is that staff are able to really get to know the patients, and assess their needs and their progress more completely.”

Peterson’s solution would be to combine telehealth services with in-person care by creating a program where patients spend half the time at the rehabilitation facility, and half their time at home.

“The best value for a patient would be a hybrid program,” she said. "To do 100 percent virtual, you can do that, but it would be better for the patient if it’s a hybrid program.”

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