Dr. Randal J. Thomas

So they've helped to gather business leaders and educational leaders, researchers, patient groups, and really making some good headway. And for the first time, as we looked at changes over time, we're seeing some improvements. So after heart attack and stenting, and after heart attack and bypass surgery, those combinations

So they've helped to gather business leaders and educational leaders, researchers, patient groups, and really making some good headway. And for the first time, as we looked at changes over time, we're seeing some improvements. So after heart attack and stenting, and after heart attack and bypass surgery, those combinations

from about 1990 till about 2020, we've seen a near doubling of participation rates. It's still way below where we need to be, but it's much, much better. There are some groups where it's still not going up. For example, if you have a heart attack and no procedure, it's not looking good still. It looks like procedures were more tuned in on plugging people into these protocols. But on the other end,

from about 1990 till about 2020, we've seen a near doubling of participation rates. It's still way below where we need to be, but it's much, much better. There are some groups where it's still not going up. For example, if you have a heart attack and no procedure, it's not looking good still. It looks like procedures were more tuned in on plugging people into these protocols. But on the other end,

And how do we expand the reach to get to more people? Because if I have to go into a cardiac rehabilitation center, particularly if, say, I live in New York City or I live in a major metropolitan city, it's going to take me an hour to get to the center and exercise and an hour to get home. I'm not going to do that. Right. Or if a program, the closest program to me, I live in the rural areas,

And how do we expand the reach to get to more people? Because if I have to go into a cardiac rehabilitation center, particularly if, say, I live in New York City or I live in a major metropolitan city, it's going to take me an hour to get to the center and exercise and an hour to get home. I'm not going to do that. Right. Or if a program, the closest program to me, I live in the rural areas,

is say the closest program is an hour away. I'm not going to do that either. So over the years, home-based rehabilitation has been studied and has been shown to be effective. In fact, in my fellowship back in 1990, a long time ago, when I was at Stanford, I was part of a group that did a project looking at home-based rehabilitation and found it to be very effective.

is say the closest program is an hour away. I'm not going to do that either. So over the years, home-based rehabilitation has been studied and has been shown to be effective. In fact, in my fellowship back in 1990, a long time ago, when I was at Stanford, I was part of a group that did a project looking at home-based rehabilitation and found it to be very effective.

And that model has been implemented through the Kaiser Permanente system in California very effectively. It's not effectively covered elsewhere, unfortunately, yet. During the pandemic, when we all shifted to home-based care, home-based rehabilitation was covered temporarily by Medicare. Now it's not, or it's going away. So we're trying to get that covered again.

And that model has been implemented through the Kaiser Permanente system in California very effectively. It's not effectively covered elsewhere, unfortunately, yet. During the pandemic, when we all shifted to home-based care, home-based rehabilitation was covered temporarily by Medicare. Now it's not, or it's going away. So we're trying to get that covered again.

So we can have home-based options. It's not the only thing that we need.

So we can have home-based options. It's not the only thing that we need.

Yeah. In fact, there's some studies showing it may be more effective. There's a study out of Australia, for example, a few years ago that showed that people are actually more likely to complete cardiac rehabilitation at home. And it makes sense.

Yeah. In fact, there's some studies showing it may be more effective. There's a study out of Australia, for example, a few years ago that showed that people are actually more likely to complete cardiac rehabilitation at home. And it makes sense.

That's exactly where it needs to go, definitely. And that's, I think, where we're getting out with the Million Hearts work. Yeah, yeah.

That's exactly where it needs to go, definitely. And that's, I think, where we're getting out with the Million Hearts work. Yeah, yeah.

And the CDC is really, really, really committed to this. I know you mentioned here in Minnesota that you worked with the CDC on some of this before, too. But the CDC is very invested in this, which has been a great thing to see. And there's some real champions at the CDC and Medicare and really in the government.

And the CDC is really, really, really committed to this. I know you mentioned here in Minnesota that you worked with the CDC on some of this before, too. But the CDC is very invested in this, which has been a great thing to see. And there's some real champions at the CDC and Medicare and really in the government.

And so making coverage of rehabilitation a higher priority is one way that can come into being, of course. And then especially looking at alternative methods of delivery being covered. And that's also being pursued very aggressively, you know, through national coverage policies. And then allowing other health professionals to be part of the equation.

And so making coverage of rehabilitation a higher priority is one way that can come into being, of course. And then especially looking at alternative methods of delivery being covered. And that's also being pursued very aggressively, you know, through national coverage policies. And then allowing other health professionals to be part of the equation.