Financial analysis of cardiac rehabilitation and the impact of covid-19

Heidi S. Melbostad, Patrick D. Savage, Katharine Mahoney, Diann E. Gaalema, Philip A. Ades, Donald S. Shepard

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Purpose: Provision of phase 2 cardiac rehabilitation (CR) has been directly impacted by coronavirus disease-19 (COVID-19). Economic analyses to date have not identified the financial implications of pandemic-related changes to CR. The aim of this study was to compare the costs and reimbursements of CR between two periods: (1) pre-COVID-19 and (2) during the COVID-19 pandemic. Methods: Health care costs of providing CR were calculated using a microcosting approach. Unit costs of CR were based on staff time, consumables, and overhead costs. Reimbursement rates were derived from commercial and public health insurance. The mean cost and reimbursement/participant were calculated. Staff and participant COVID-19 infections were also examined. Results: The mean number of CR participants enrolled/mo declined during the pandemic (-10%; 33.8 ± 2.0 vs 30.5 ± 3.2, P = .39), the mean cost/participant increased marginally (+13%; $2897 ± $131 vs $3265 ± $149, P = .09), and the mean reimbursement/participant decreased slightly (-4%; $2959 ± $224 vs $2844 ± $181, P = .70). However, these differences did not reach statistical significance. The pre-COVID mean operating surplus/participant ($62 ± $140) eroded into a deficit of -$421 ± $170/participant during the pandemic. No known COVID-19 infections occurred among the 183 participants and 14 on-site staff members during the pandemic period. Conclusions: COVID-19-related safety protocols required CR programs to modify service delivery. Results demonstrate that it was possible to safely maintain this critically important service; however, CR program costs exceeded revenues. The challenge going forward is to optimize CR service delivery to increase participation and achieve financial solvency.

Original languageEnglish (US)
Pages (from-to)308-314
Number of pages7
JournalJournal of Cardiopulmonary Rehabilitation and Prevention
Issue number5
StatePublished - Sep 2021
Externally publishedYes


  • COVID-19
  • Cardiac rehabilitation
  • Cost
  • Reimbursement

ASJC Scopus subject areas

  • Rehabilitation
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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