Costs of cardiac rehabilitation and enhanced lifestyle modification programs.
OBJECTIVE
Inadequate payment to providers for traditional cardiac rehabilitation (CR) and lifestyle modification programs may contribute to low utilization, but little systematic evidence exists. This article estimates and compares the per-patient costs and revenues for 3 types of secondary prevention programs: the Dr Dean Ornish Program for Reversing Heart Disease (Ornish), the Benson-Henry Mind/Body Medical Institute's Cardiac Wellness Program (M/BMI), and CR.


METHODS
The authors developed an Excel spreadsheet template for the costs of a secondary prevention program and calibrated it to 7 programs that provided the necessary data. The calibration was based on budgets, cost accounting, statistical reports, and structured interviews (in person or by telephone).


RESULTS
The 4 lifestyle programs (2 Ornish and 2 M/BMI) cost almost 4 times as much per patient as the 3 traditional CR programs (means of $7,176 and $1,828, respectively; difference P < .05). The Ornish program costs averaged more than twice those of M/BMI ($9,895 and $4,458, respectively; difference P < .10). Medicare-allowed charges (including co-payments) were $5,650 for Ornish, $4,800 for M/BMI, and about $32.50 per session or $683 overall for CR.


CONCLUSIONS
Programs achieved the lowest costs per patient by carefully matching program capacity to demand. In none of the programs did net revenues cover costs. The findings suggest that 4 patients could attend a traditional CR program for the cost of 1 patient in an enhanced program.
Lee
A James
AJ
School of Health and Environment, University of Massachusetts-Lowell, Lowell, MA 01854, USA. AJames_Lee@uml.edu
Shepard
Donald S
DS
D003324:Coronary Artery Disease / Q000191:economics / Q000517:prevention & control* / Q000534:rehabilitation*; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics; D006801:Humans; D008404:Massachusetts; D006278:Medicare / Q000191:economics; D009043:Motor Activity; D015397:Program Evaluation; D040242:Risk Reduction Behavior; D055502:Secondary Prevention / Q000191:economics*; D057185:Sedentary Behavior; D014481:United States