HA 630 Unit 1 marketing environment brief example

Most Eligible Patients Never Come: A Marketing Environment Brief for a Community Hospital's Cardiac Rehabilitation Program

Student Name

Health Care Administration, Herzing University

HA 630: Marketing and Strategic Growth in Healthcare

Instructor Name

January 15, 2026

Most Eligible Patients Never Come: A Marketing Environment Brief for a Community Hospital's Cardiac Rehabilitation Program

Purpose and Setting

This brief is for the incoming marketing manager assigned to the cardiac rehabilitation program at a composite 210-bed community hospital in south-central Kentucky. The program runs outpatient, monitored exercise and education sessions for patients recovering from heart attacks, coronary stents, bypass surgery, valve surgery and stable heart failure. It enrolled 164 new patients last year, and leadership has asked for a plan to grow it. Before any budget is set, the manager needs to understand who decides whether a patient comes, what drives or blocks that decision, and what the hospital may and may not say in trying to influence it.

The central fact of this market is that the main competitor is not another program. Nationally, only about a quarter of Medicare beneficiaries eligible for cardiac rehabilitation attend even one session, and participation is lowest, about 19%, in the East South Central census division where the hospital sits (Ritchey et al., 2020). Most eligible patients in the service area are simply not attending anywhere.

Who Decides

Four parties shape whether a patient attends, and a message can reach them in different ways.

The referring physician. Medicare covers cardiac rehabilitation only with a physician's referral for a qualifying condition (42 C.F.R. § 410.49). In practice, the decision is made at hospital discharge by the cardiologist or cardiac surgeon, or weeks later by a primary care physician. The hospital's own interventional cardiologists refer most of the program's patients; patients who have bypass or valve surgery at the regional heart center 70 miles away are referred, if at all, by surgeons there who may not know this program exists. Physicians are reached through direct contact, electronic referral tools and reports back on their patients, not through advertising.

The patient. A referral is not attendance. The patient must choose to come three times a week for up to 12 weeks, usually while recovering, often while returning to work, and frequently with a family member driving. The patient is reachable at discharge, by phone in the first week home, and through the family, but not efficiently through mass media, because the eligible group at any moment is small.

The health plan. Traditional Medicare covers the service with a 20% coinsurance per session. Medicare Advantage and commercial plans set their own cost sharing, and some require prior authorization. The plan decides what the patient pays, which matters here more than in most services.

The employer. For working-age patients, the employer's choice of plan sets the copay, and the employer's flexibility about time off decides whether a 10 a.m. session is possible.

How Demand Behaves

Cardiac rehabilitation sits between emergency and elective care. The qualifying event, a heart attack or a stent, is not chosen and is rarely shopped for. The rehabilitation that follows is entirely discretionary from the patient's point of view: nothing happens immediately if the patient does not attend, the benefit is long term, and the costs, time, travel and copays, are immediate. That makes it behave like a consumer decision in which convenience, cost and encouragement from a trusted person decide the outcome.

Cost sharing shows this clearly. In one health system's study, patients with any copay or deductible attended about 6 fewer sessions than those without, and each $10 increase in copay was associated with about 1.5 fewer sessions (Farah et al., 2019). Distance and session times matter for the same reason. Participation also varies widely between states and between hospitals serving similar patients, which suggests that local practices, especially how and whether patients are referred, explain much of the gap (Beatty et al., 2018).

Reputation as an Asset

The program's reputation among physicians rests on whether referred patients enroll quickly, whether the physician receives a progress report, and whether patients come back stronger. Its reputation among patients rests on the first session's experience and on word of mouth from former participants in a small community. Neither can be bought with a campaign. What marketing can do is make that reputation visible: a report to the referring physician after the first and last sessions, and a program listing that shows current hours, parking, and what the first visit involves.

What This Means for the Budget

Because the eligible population at any moment is small and already known to the hospital, most of the program's growth will come from actions aimed at physicians and at patients before they leave the hospital, not from broad advertising. A billboard reaches thousands of people who will never need the service; a discharge conversation reaches every patient who does. The marketing manager's first spending decisions should therefore favor referral processes, patient follow-up calls and practical changes such as early-morning sessions, with paid media reserved for the smaller task of making the program easy to find when a patient or family member searches for it.

What May Not Be Claimed

Outcome guarantees. The program may describe the evidence that cardiac rehabilitation reduces the risk of death and rehospitalization, with a source, but may not promise any individual patient a result.

Comparative claims. "Best" or "leading" requires objective support; the program has no published comparative outcomes and should not use those words.

Patient stories and testimonials. Using a patient's name, photo or story in marketing requires the patient's written authorization under the Privacy Rule's marketing provisions (45 C.F.R. § 164.508). The story must reflect the patient's typical experience or be clearly qualified, under the federal rules on endorsements in advertising (16 C.F.R. § 255.2).

Contact lists. The hospital may contact its own patients about its own services as part of treatment and care coordination, but may not buy or sell patient lists, or use a list of cardiac patients for anything other than their care, without authorization.

Forces Now Changing the Environment

Three developments should shape the plan. First, national quality efforts, led by the Million Hearts initiative, have set a goal of 70% participation, which gives the hospital's cardiologists and quality staff a shared target (Ritchey et al., 2020). Second, professional societies have endorsed home-based and hybrid cardiac rehabilitation for selected patients, which could reach people for whom travel is the barrier (Thomas et al., 2019). Third, health plans are paying closer attention to readmissions after heart attack, which gives the program a case to make to payers about cost sharing. The next unit turns these observations into a numerical estimate of how many patients in the service area are eligible and how many the program reaches.

References

Beatty, A. L., Truong, M., Schopfer, D. W., Shen, H., Bachmann, J. M., & Whooley, M. A. (2018). Geographic variation in cardiac rehabilitation participation in Medicare and Veterans Affairs populations: Opportunity for improvement? Circulation, 137(18), 1899-1908. https://doi.org/10.1161/CIRCULATIONAHA.117.029471

Cardiac rehabilitation program and intensive cardiac rehabilitation program: Conditions of coverage, 42 C.F.R. § 410.49 (2025).

Farah, M., Abdallah, M., Szalai, H., Berry, R., Lagu, T., Lindenauer, P. K., & Pack, Q. R. (2019). Association between patient cost sharing and cardiac rehabilitation adherence. Mayo Clinic Proceedings, 94(12), 2390-2398. https://doi.org/10.1016/j.mayocp.2019.07.018

Guides concerning use of endorsements and testimonials in advertising, 16 C.F.R. § 255.2 (2025).

Ritchey, M. D., Maresh, S., McNeely, J., Shaffer, T., Jackson, S. L., Keteyian, S. J., Brawner, C. A., Whooley, M. A., Chang, T., Stolp, H., Schieb, L., & Wright, J. (2020). Tracking cardiac rehabilitation participation and completion among Medicare beneficiaries to inform the efforts of a national initiative. Circulation: Cardiovascular Quality and Outcomes, 13(1), Article e005902. https://doi.org/10.1161/CIRCOUTCOMES.119.005902

Thomas, R. J., Beatty, A. L., Beckie, T. M., Brewer, L. C., Brown, T. M., Forman, D. E., Franklin, B. A., Keteyian, S. J., Kitzman, D. W., Regensteiner, J. G., Sanderson, B. K., & Whooley, M. A. (2019). Home-based cardiac rehabilitation: A scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. Circulation, 140(1), e69-e89. https://doi.org/10.1161/CIR.0000000000000663

Uses and disclosures for which an authorization is required, 45 C.F.R. § 164.508 (2025).