Program 'CHIPs' away at heart disease

February 02, 2007

MONTREAL | At just over a decade in age, the McGill University-affiliated Cardiovascular Health Improvement Program (CHIP) is among the oldest lifestyle-oriented multidisciplinary heart disease recovery programs in Canada. In those 10 years, hundreds of patients have passed through its downtown Montreal doors, making it among the largest and, hence, most successful programs of its kind in the country.

But it wasn’t an immediate success, in part due to the reticence of other physicians who couldn’t see the value the program offered their patients, explained Dr. Steven Grover, CHIP’s executive medical director and a general internist who started the not-for-profit program in 1996.

“That was a big challenge, convincing people we had a program that really worked,” he said. “And as time went on, as the results of our program (became known), more and more patients and doctors realized what we were doing was really making a difference, and the referrals picked up dramatically.”

Patients, who have heard by word of mouth from other patients about CHIP, have even lobbied their physicians for a referral.

Dr. Grover recounted a typical patient exchange. “I ask: ‘So, your doctor, so and so, has sent you to see me?’ The patient says, ‘Well, actually, he didn’t—I insisted he send me to see you.’ ”

Today, as the program gains in popularity in the community, and because the program is not covered by Quebec’s medicare plan, patients arrive with referrals from all different sources. Said Marla Gold, CHIP’s executive director: “We take referrals directly from the hospital, from nurses and social workers and also general practitioners and cardiologists.”

One hurdle, especially in the early years, involved getting Dr. Grover’s colleagues to see the program relied on clinically sound thinking as well as an emphasis on getting patients to exercise more and to eat better, among other lifestyle changes.

“We weren’t like some lifestyle nuts who were determined we weren’t going to use drugs to treat people, we were physicians.” If, for instance, patients needed a drug to manage their condition, “We were going to use drugs,” said Dr. Grover matter-of-factly.

An ongoing challenge, given the state of the over-stretched health-care system in Quebec, where cardiac rehab services are not covered by the government, is the not-for-profit’s financial security. As Dr. Grover pointed out, Quebec is one of the few remaining provinces that doesn’t cover cardiac rehab as an insured medical service.

That has made managing CHIP’s finances stressful, said Gold. “We don’t get any funding from the government or the hospitals, so although we are a non-profit group affiliated with the McGill University teaching hospitals . . . we aren’t subsidized in any way. So yes, we charge user fees; yes, we do fundraising; yes, we get donations and industry support.”

The patient fees range from a low of $190 for a cardiovascular evaluation to $950 for a full program. A typical full program (CHIP now offers numerous programs) spans 38 sessions (a duration of roughly three to four months) and offers a customized “heart smart” approach from a team that includes nutritionists, exercise instructors, life-management coaches and doctors.

Physicians bill the province for all insured medical services they provide. The out-of-pocket fees patients pay go to cover the cost of the non-insured medical and health services. Its staff consists of approximately 20 fitness and health professionals, including seven physicians.

Gold said she believes the money covers only half the true cost of the uninsured services provided.

She added, “But we never turn anyone away if they can’t afford it. We offer financial assistance to anybody who wants to get into our program but doesn’t have the funds or the private insurance to cover it.” About 30% of CHIP’s patients subscribe to prevention services, with the balance there for rehab.

Despite the challenges, Dr. Grover calls working with the program the highlight of his professional life. “I have to tell you as a general internist, I still spend a fair amount of time up at the hospital taking care of really sick people. But this, my one day a week at the (CHIP) centre, is probably the time I spend clinically where I feel I am making the most difference. Compared with some of the frustrations you have taking care of really acutely ill patients in the hospital, seeing people turning their lives around, not just for a short period of time, is really rewarding.”