Facility-Level Variation in Cardiac Rehabilitation Completion

PURPOSE: To quantify facility-level variation in cardiac rehabilitation (CR) completion among Medicare beneficiaries after major cardiovascular procedures. METHODS: We analyzed Medicare fee-for-service claims for beneficiaries discharged alive after common cardiovascular procedures between July 2016 and December 2018. Beneficiaries were attributed to CR facilities via the national provider identifier on CR claims. Facilities with <20 patients were excluded. CR completion was defined as finishing 36 sessions within 1 year of hospital discharge. Hierarchical logistic regression estimated risk-adjusted facility completion rates, adjusting for demographics, procedure, clinical complexity, and clustering between facilities. The model cluster-level variance informed the median OR to quantify the between-facility variation in CR completion. Bivariate analyses compared risk-adjusted completion across urbanicity, facility-volume quartiles, US census region, and local community distress. RESULTS: Among 183 888 beneficiaries who attended ≥1 CR session across 2194 facilities, the mean ± SD number of sessions attended was 25.6 ± 12.4, with 53 558 (29%) completing CR. Risk-adjusted facility-level completion rates ranged from 0% to 90.9% (median: 32.9%; IQR: 18.7%, 44.9%). After adjusting for patient factors, the median OR for CR adherence between facilities was 2.34 (95% CI, 2.26-2.43), indicating a facility-level difference in completion independent of patient mix. Completion did not differ significantly by urbanicity or facility volume but varied by region and level of community distress (P < .001). CONCLUSIONS: Completion of CR varies widely across facilities and is highly facility-dependent, indicating opportunities for quality improvement.