Costs of Cardiac Rehabilitation and Enhanced Lifestyle Modification Programs

PURPOSE: 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.