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  • 24 Feb 2016 11:42 AM | Julie Feirer (Administrator)

    Recent OIG audits of cardiac and pulmonary rehabilitation programs, in New Jersey, have provided some clarification on CMS rules and expectations of programs.  The key findings were related to the individual treatment plan (ITP).  We must be diligent in creating thorough ITPs for our patients, and making sure our medical directors or supervising physicians have direct contact with the patient prior to the initiation of services, and every 30 days thereafter.  In the past we had been told that some MACs acknowledged the challenge of being able to always obtain a signed ITP at exactly 30 days, and allowed flexibility.  However, the AACVPR recommends moving forward with a strict 30-day protocol.  The AACVPR Program Certification requirements are in line with the recommendations made by the OIG, therefore there are no changes in the requirements for the ITP for 2016.

  • 25 Jan 2016 11:43 AM | Julie Feirer (Administrator)

    Cardiac Rehab Week: February 14-20, 2016

    Pulmonary Rehab Week: March 13-19th, 2016

    • Host an open house inviting the public and hospital staff to the CR and/or PR department to see facility and what programs offer- provide healthy snacks, give out t-shirts, pens?
    • Provide heart healthy snacks (with recipes)
    • Cooking demonstration by program dietician, can be done with each class or can also be done for the public 
    • Heart trivia questions with prizes for patients and/or staff
    • Bulletin board outside of the cafeteria about Heart Month- placed during Cardiac Rehab week
    • Host a breakfast on a Saturday for current and past patients with a speaker or game with prizes 
    • Potluck for previous year’s patients
    • Give talks on radio/TV spots during Heart Month
    • Presentations: CPR demonstrations, Nitro use, Health- for public, staff, patients 
    • “Did you know…” poster with stats related to rehab and heart/lungs
    • Fill a jar with something (candy, buttons, etc) have patients guess how many are in the jar- closest wins a gift bag with pulmonary or cardiac rehab week gear from Jim Coleman
    • Have a drawing for a free month membership to the maintenance exercise program
  • 4 Jan 2016 11:45 AM | Julie Feirer (Administrator)

    Southwest Regional Meeting

    When: 1/7/16, 9:30-1:00

    Where: Clarinda Regional Health Center

    823 S. 17th ST 

    Clarinda, IA 51632

    Please contact Karie Martin with questions

  • 12 Sep 2015 12:47 PM | Julie Feirer (Administrator)

    2015 IACPR Fall Regional Meeting Schedule

    Northeast Regional Meeting

    Where: Okoboji Grill

                    1749 Golf Course Blvd

                    Independence, IA 50644

    When:  Tuesday, October 27th, 12-2pm

    Please contact Aleshia Bloker with questions.

    **Information about other regional meetings will be posted as available**

  • 25 May 2015 12:50 PM | Julie Feirer (Administrator)

    Winner:  Peg King,  Boone County Hospital

    Peg is one of those quiet behind the scenes people that keeps IACPR running smoothly.  She is incredibly knowledgeable about the workings of our organization and offers guidance based on her long history as secretary.  I have always appreciated her questions which I think she often posed as gentle reminders of tasks or meetings that needed to be scheduled.  We are blessed to have someone who meticulously records our meeting minutes.  It cannot be easy to determine what is imperative to record from our teleconferences, but Peg manages to do an outstanding job.

    Claire Shannon, IACPR Past-President

  • 17 Feb 2015 1:45 PM | Julie Feirer (Administrator)

    The Lung Transplant Program at the University of Iowa Hospitals and Clinics (UIHC) is almost 8 years old!  There have been 110 lung transplants performed in that time.  Many of you have cared for these patients in your pulmonary rehabilitation programs, both before and after transplant.  Thank you for that!  I often receive emails with questions about the care of these patients, so would like to take this opportunity to review the care of these patients in pulmonary rehab.

    Pre-Lung Transplant

    Patients seeking lung transplant at the UIHC must participate in pulmonary rehab (PR) prior to being listed for transplant.  This assists the patient in achieving a more optimal level of physical function, with improved surgical outcomes; and also shows motivation on the part of the patient.  The UIHC Lung Transplant Medical Director requires that all patients seeking lung transplant be able to complete a minimum of 30 minutes of aerobic exercise, preferably on a treadmill.  Ideally, this should be 30 minutes of continuous exercise at a minimum speed of 1.0 mph. Of course, not all patients can accomplish this initially, but with close supervision and support from the PR staff, most patients are able to achieve this goal.  However, if it is not physically possible for the patient, then 30 minutes of continuous exercise on the NuStep may be acceptable.  Keep in mind that some patients may require titration of supplemental oxygen to a level that maintains their SpO2 >88% while exercising.  Please make sure your program’s policy allows you to titrate oxygen as needed. 

    Pre-lung transplant patients are billed for these services with the same codes as any other PR patient, based on diagnosis.  Patients with a diagnosis of moderate to very severe COPD are billed with CPT code G0424.  Patients with a diagnosis of chronic respiratory disease other than COPD are billed with Respiratory Therapeutic Services codes, G0237, G0238 and/or G0239.  Pre-lung transplant patients should be discharged from the program within 36 sessions or less (for COPD patients), or in a similarly reasonable time period for patients with a diagnosis of chronic respiratory disease other than COPD.  They must then transition into a maintenance exercise program, or be able to provide documentation of daily aerobic exercise to the UIHC Lung Transplant Team.  It is important to keep in mind that patients with a diagnosis of COPD tend to remain on the lung transplant list longer than patients with some other chronic respiratory diagnosis.  Therefore, use caution in the number of pulmonary rehab sessions provided these patients.  Pre-lung transplant patients are end-stage and are at high risk for exacerbation and hospitalization.  Each hospitalization may require a few sessions of PR to help the patient get back on track with exercise.  That won’t be possible if they have used all of their “lifetime” sessions.  Please find a way for these patients to participate in your maintenance programs, assisting them in any way possible if the patient has financial constraints or transportation issues.

    Note:  Patients who are noncompliant with attendance at PR will likely not be considered for lung transplantation, as this suggests a lack of interest in taking responsibility for their health.

    Post-Lung Transplant

    All post-lung transplant patients are required to participate in PR following discharge from the hospital.  They spend the first 4 weeks post-transplant in the Iowa City area, staying in a hotel after discharge.  They attend PR 5 days per week at the UIHC Pulmonary Rehab Program.  When the Lung Transplant Team determines the patient is ready to be discharged to home, they will be referred to a pulmonary rehab program in their local community.  The UIHC Pulmonary Rehab Team will provide a detailed treatment plan for that patient.  Please follow it!  The following is a list of the key points to remember when working with a post-lung transplant patient:

    1.  Protect the patient from potential infection:  Do NOT mainstream these patients into your regular PR classes.  These patients are very immunocompromised from their transplant medications.  The patient is required to wear a mask at all times when in public places, but it is difficult to exercise wearing a mask.  Ideally, attempt to schedule a time when the patient can exercise alone or far enough away from other patients that they can remove the mask.  Do not allow a staff member to work with the patient if they are or have been ill recently.  Make sure all exercise and monitoring equipment has been cleaned prior to use by the post-transplant patient.  Remind the patient and all staff to use good hand hygiene.

    2.  Education:  The patient and their support person(s) have received extensive education from the Lung Transplant Team.  This can be reinforced by the PR staff if it is consistent with what has been taught.  Each patient has a notebook containing the education material, as well as medication, vital sign, and exercise diaries.  The UIHC PR Program staff has outlined the key education to reinforce in the individualized treatment plan for the patient.  Post-lung transplant patients no longer have lung disease; therefore, teaching them about chronic lung disease is NOT appropriate.  Even if the patient receives only a single lung transplant, the new lung typically takes over the majority of function, overshadowing the remaining diseased lung.

    3.  Exercise:  Post-lung transplant patients must not have an interruption in their pulmonary rehab.  They are often discharged from the UIHC PR Program on a Wednesday and should begin PR in your program by Friday, or Monday at the latest.  The UIHC PR Program staff will fax the information you need to allow smooth transition into your program.  This patient does not need a complete PR evaluation prior to beginning the program.  If this must be done, please complete the evaluation when the patient attends exercise sessions, rather than delaying their start date until there is an opening in your new evaluation schedule.  Post-lung transplant patients have 6-12 months to achieve maximal function from their new lungs.  The best way to achieve maximal function is to challenge the new lungs with the deep breathing that occurs with exercise! 

    a.  PR Frequency:  Minimum of 3 times/week for 24-36 sessions.  However, the patient will travel to Iowa City every Wednesday for first few months for an appointment in the Lung Transplant Clinic.  Many of them choose to exercise in the UIHC PR Program that day.  Therefore, they should participate in at least 2 sessions of PR/week in the local program.  The patient should exercise independently the other days of the week.

    b. Exercise Prescription:  The UIHC PR Program will provide the local PR program with the most current exercise prescription for the patient.  Please begin the patient’s exercise according to that prescription; however do progress the exercise program on a regular basis, using the guidelines provided in the Exercise section of the ITP provided you.  There should be no reason to exercise the patient at a lower workload, unless the patient has had a change in physical health.  In that situation, the UIHC Lung Transplant Team should be notified immediately.

    c.  A lifelong commitment to exercise should be encouraged in all transplant patients.

    4.  Billing:  This patient no longer has lung disease; therefore their therapy should be billed with the Respiratory Therapeutic Services codes (G0237, G0238, or G0239) using the Lung Transplant ICD-9 code V42.6.

  • 18 Dec 2014 1:48 PM | Julie Feirer (Administrator)

    The European Respiratory Society and American Thoracic Society have recently published new standards for field walking tests, including the six minute walk test (6MWT).  The 6MWT is a standardized test therefore, specific guidelines should be followed when administering the test.  Find this new important information here:  Holland AE, Spruit MA, Troosters T, Puhan MA, et.al. An official European Respiratory Society/American Thoracic Society technical standard:  field walking tests in chronic respiratory disease.  Eur Respir J 2014; 44:1428-1446.  Click on this link to find the article: http://www.thoracic.org/statements/pages/copd.php

  • 23 Jul 2014 2:50 PM | Julie Feirer (Administrator)

    Links to these documents are below and are also posted for members in the AACVPR Regulatory & Legislative Resources section of the AACVPR web site which contains extremely helpful and informative resources.

    As the final Medicare policy states, coverage of cardiac rehabilitation for beneficiaries with stable, chronic heart failure was effective for dates of service on and after February 18, 2014. This was previously discussed in the AACVPR Reimbursement Update on February 19, 2014.

    The implementation date is August 18, 2014. This means that all WPS must have completed changes to their claims processing software so that appropriate heart failure diagnoses (ICD-9 codes) are not denied. For CR programs that received denials for CR services provided to heart failure patients as of February 18th or later, re-submission after August 18th will most likely be necessary for reimbursement. Please work with your billing departments to be sure inappropriate denials are tracked and corrected. 

    Medicare now covers CR services to patients with stable, chronic heart failure defined as: 

    1.     Patients with left ventricular ejection fraction of 35% or less, and

    2.     NYHA class II-IV symptoms despite being on optimal heart failure therapy for at least 6 weeks.

    Are an AACVPR member? They have provided members with excellent webinars and FAQs to help programs interpret appropriate HF candidates for CR, based on the above eligibility criteria. This will continue to be discussed in depth at a heart failure session at the AACVPR Annual Conference in Denver: "How to Implement a Heart Failure Rehabilitation Program" - Randal J. Thomas, MD, MS, FAACVPR; Ray Squires, PhD, MAACVPR, Steven Keteyian, PhD, FAACVPR; Karen Lui, RN, MS, MAACVPR, on September 5, 2014 from 8:00 am - 9:30 am. For more information on how to register, please click here. CR Program staff, in conjunction with CR medical directors and referring physicians, should develop department policies that are consistent with the Medicare qualifying criteria with the goal of enrolling patients who will benefit from CR and are appropriately eligible.

    Some CR programs have been enrolling HF patients in CR since the effective date with successful Medicare reimbursement using diagnosis (ICD-9) code 428.22 (chronic systolic heart failure). You are advised to work with your billing dept. to find the most descriptive and appropriate ICD-9 code for each patient, given that patient's clinical diagnosis. It would be best practice to utilize the patient's medical record/Plan of Care to clearly document all the elements/conditions that qualify this patient for CR. 

  • 23 Oct 2013 2:53 PM | Julie Feirer (Administrator)

    The next Heartland Conference  will be March 28-29th, 2014 at La Vista Conference Center in La Vista, NE.

    We will update the conference details as they become available.

  • 15 Oct 2013 3:05 PM | Julie Feirer (Administrator)

    Northeast Region

    October 15, 2013

    1.  AACVPR is urging all PR programs strongly to please review the Pulmonary Rehab toolkit and present to your financial department to adjust charges for G0424.  PR programs cannot continue to offer services when they are only being reimbursed for $39.  This is our own fault and we have the power to fix it.  If you have any questions or you need help convincing your CFO, please contact Jane Knipper.

    2.  The AACVPR will be offering a Certified Cardiac Rehab Professional Certification exam next year at the National conference.  See the AACVPR website for more information.

    3.  The AACVPR conference is in Denver Sept. 4-6, 2014.

    4.  Day on the Hill is March 13 & 14, 2014.  We will continue to lobby about S.382, the technical correction to allow NPP’s to supervise rehab.

    5.  The 5th Edition of the the Guidelines for Cardiac Rehab are out.  Everyone should have this in their department says Karen Lui.

    6.  We will have an opening for President Elect this year.  Please consider the position and let Claire know if you have any questions.

    7.  AACVPR urged all rehab programs to join the CR and PR national AACVPR registry.  Many sessions at the conference urged tracking outcomes.  Our programs will become value based with the coming healthcare changes and we need to prove our worth!  At the Northwest meeting, some departments mentioned having issues with the registry.  Please let AACVPR know.  Give them an opportunity to improve what is a work in progress. 

    8.  AACVPR has a new initiative to support the state affiliates and their leadership. They have formed regional groups and Iowa is with Wisconsin, Minnesota and Missouri and the other one I think is Kansas.  An AACVPR volunteer will coordinate a conference call 4/yr for us to network.  This is a great opportunity as Wisconsin was the affiliate of the year and they have a strong organization so we can learn great things from them.  Additionally, AACVPR will sponsor a leadership conference yearly in Chicago and will foot the bill for a hotel room for each affiliate (Pres and Pres elect can go).  This year it will be in June, but they do not have a set date as yet.

    9.  Regarding several presentations on the potential healthcare changes in our future.  Here is what they said we should be doing to prepare:

         a.  Outcomes have to be presented?

         b.  Know your cost per case in rehab.  You made to know that to negotiate with insurance companies.

         c.  We need the ability for predictive modeling of outcomes with fixed costs.  We need a moneyball guy.  For example, does a late referral increase our cost and more.  An empty hospital will be better than a hospital with full beds because we will get cost per member per month from payers. 

         d.  When patients come into the hospital we will need to:  Assess risk, implement longitudinal care, and develop network of care providers.  This is where they predict homehealth will increase and our programs can make a difference. 

    10.  G0424 will likely change to a new APC.  Jane Knipper is following this and will let us know when there are changes.

    11.  We are hoping S382 can get pushed through the senate.  Many senators have not signed on.  Both Iowa senators are signed on.  The other states were urged to launch serious campaigns to get it done!

    12.  Big news!  In June of this year CMS accepted a formal request for CHF to be a covered diagnosis.  In December, CMS is expected to post a proposed National coverage determination with a public comment period.  Karen Lui seemed very positive about the possibility that this could become affective in Spring 2014. 

    13.  Lisa (Moeller), ARNP DNP with Dr. Sundaram’s office has started a local chapter of the PCNA (Preventative Cardiovascular Nurses Association) and is encouraging healthcare professionals (nurses, exercise physiologists, dieticians, etc) to join and support a local chapter.  Meetings will be held twice a year.  Benefits include:  webinars, CEU opportunities, local networking, and patient educational tools.  For more information, contact Erika Leonard at Allen Cardiac Rehab at 235-3911 or go to www.pcna.net and sign up under the Cedar Valley chapter.

    Northwest Region

    Thursday Oct. 17th

    Held at the Pocahontas Community Hospital, with 26 people attending!!

    It was a great day of networking and great to have so many people come. A big thank you to Clarie Shannon for presenting us with information from the annual meeting and a copy of her balance assessment and exercises. Thank you too Jean Cipperly for informing us on some new statistics on diets and the use of fats making diets more successful.

    Discussion about the amount everyone charges for each session of CR and PR. With higher prices it is difficult as we can miss some people that can not afford the co-pay but we also have to look at do we want to loose our whole program.

    There is a new professional certification coming next September with the first exam being in Denver. Certified Cardiac Rehabilitation Professions (CCRP)

    This year the Day on the Hill will be March 13 &14th with the big issue being Dr. supervision. Please send any issues you have to Claire. Claire touched on the Physician in proximate distance of CR and told us there really was no change.

    The 5th addition of CR guidelines is out and can be ordered through AACVPR.

    IACPR is in need of a president elect. Clarie talked about the responsibilities and how rewarding it has been for her. There are only 4 meetings with 3 being held by teleconference and the other meeting at the Heartland Conference.

    We talked about the Registry and many voiced the problems they have had. Claire stressed that we need programs to join as we need outcomes. With Obama Care we will need to prove that we are cost effective. We talked about the nutrition survey programs use. Many use the Rate your Plate as it is easy and free. You can google it. We also talked about certification. Claire did mention that now once you complete your application they will no longer be sending things back for you to fix. If things are not done completely as they instruct you, you will not get certified.

    Jean than shared some information that she had gotten at an AADE webinar; Healthy fats, Heart Disease and Type 2 Diabetes. She reviewed how the world’s top 12 health problems have changed from 1990 to 2010. Heart disease and stroke were 4th and 5th and now have moved up to 1st and 3rd. We all chuckled at the top risk factor in 1990 being low body weight and were reminded that this is world wide (in 2010 it was 8th). In 2010 High blood pressure, smoking and alcohol are the top three with inactivity now on the charts at #10. Modified fat diets (decreasing saturated fats with unsaturated fats) have a better effect on major CV risk factors than reduced fat diets. Other points made were that no diet is better than the other and we need to individualize our plans and help our patients find what diet works for them and encourage them. Most people plateau in weight loss at 6 months and after that they don’t loose much, try help them learn to maintain. Pre-diabetics are more successful at loosing weight and we need to try help them than. More saturated fats will also increase insulin resistance. Monounsaturated fats will help boost the HDL some. It is more important to be fit than thin we were reminded.

    Discussion about changes in health care coming with Obama Care, and that CR might be used on CHF pts. to help keep them out of the hospital, and/or there might be CR Home Health programs. There are some new plans for pts being discharged from the hospital called “See you in 7”. It has been shown that for every day a pt. is home and there is no contact with healthcare their attendance to CR decreases by 1% and their ER visits increase.  There is hope that CHF will be a covered diagnosis for CR. WATCH EMAILS, is could happen as early as spring 2014.

    There was discussion about what programs were doing for competencies and how that sometimes is difficult for the one person department. We talked about referrals and how to keep clinic, ER’s, Home Care personnel informed so if a person gets missed they might catch it and make the referral.

    Claire than presented us with her balance assessment and said we really should use this on any high risk pts. Those that have fallen in the last 6 months, feel unsteady, use a walker or cane etc. We than all did some of the balance exercises, some of us did not do as well as others J

    Thanks to all for a great meeting

    Mary Brandt RN, Coordinator of Pocahontas Community Hospital Cardiac rehab.

    IACPR Spring 2013 Regional Meeting Summaries

    Northeast Region

    Tuesday, April 16th in Independence at the Okoboji grill.  Deb Recker from Independence coordinated this one.  We had 13 in attendance.  Many had attended the Heartland conference so we rehashed for the other members the high points.  All Heartland attendees were complimentary of the pertinent information shared at the conference. 

    1.        I shared handouts on the staff competencies that we use.  A discussion took place on how departments complete their competencies.  Some do a skills day and other do them monthly with their staff meetings.

    2.      All departments have had a Takosubo patients and we shared our experiences.

    3.      We discussed how each department is seeing CHF patients.  Some filter them into Phase II with a stable angina dx (mindful that it is truly angina), others incorporate them into their Phase III with a free consult to start. 

    4.      We discussed billing two sessions in one day and what scenarios this will work in such as the long intake process on the first day.

    5.      We shared how we manage tobacco cessation.  Some departments have RT to help and others do it on their own.  We all agreed that we do not have the expertise that the presenter at the conference has. 

    6.      Attendees were encouraged to contact Senator Harkin and lobby for S.382.

    7.      Claire let the group know that there is a BOD position open on IACPR.

    8.      Participants that are not IACPR members were strongly encouraged to join the organization.

    9.      Claire shared information on the new AACVPR membership option.

    Our next meeting will be in mid- October and will be organized by Erika Leonard from Allen Memorial.


    Fall 2012 IACPR Regional Meetings

    Southeast Region

    Sept 18, 2012

    Newton, Iowa

    Attendees: Lisa Reece, Susan Flack, Gwen Weghorst, Claire Shannon, Denise Sheston, Kari Hatfield, Jennifer Hoopes, Kim Boyd, Renee Edgar, Rick Terpstra, Stephanie Cooper, Nancy Steingreaber, Rose Groteluschen, Linda Groenendyk

    Thank you to Nancy Steingreaber and Skiff Medical Center in Newton for hosting, and to Claire Shannon (IACPR President) for driving all the way from West Union to attend our meeting.                         

    Claire Shannon introduced herself to the attendees and shared basic AACVPR information as well as information from the recent AACVPR National Conference in Orlando. Some of the highlights:

    ·        Rocky Mountain affiliate is disbanding due to lack of interest from its members. This highlights the importance of IACPR members becoming involved in the state association – we would hate for this to happen to us!

    ·        Claire reminded us that we are still looking for a President-elect for IACPR. Contact Claire C.Shannon@palmerlutheran.org or Susan flacksk@ihs.org for information about IACPR positions.

    ·        2013 Heartland Conference is scheduled for Apr 12/13 in West Des Moines

    ·        2013 AACVPR Annual Conference is scheduled for Oct 3-5 in Nashville

    ·        All Pulmonary Rehab programs should have worked with their revenue/billing departments by now to determine an appropriate amount to charge for PR services. If you are not familiar with the Pulmonary Rehab Toolkit, please check it out on the AACVPR website www.aacvpr.org. You may also contact Janie Knipper with questions at jane-knipper@uiowa.edu.

    ·        Discussed the Cardiac Rehab Registry. Several programs are currently enrolled and/or using the Registry, which is an excellent tool to assist with outcomes. It also helps you “compare” your outcomes with others to help determine where to focus your improvement initiatives.

    ·        Claire summarized a few of her favorite breakouts from the national conference.

    ·        Nationally, <20% of eligible patients participate in Cardiac Rehab. Nebraska has the highest participation at 53%; Iowa is 2nd at 46%.

    One topic that was discussed in the group involved monitoring/non-monitoring patients and “mixing” various diagnoses for rehab. Several programs were hi-lighted at the AACVPR conference who telemetry monitor their patients infrequently or not at all; we’re encouraged to use risk stratification to determine our patient care. Reminder: “monitoring” to CMS doesn’t necessarily mean “telemetry” – it refers to all monitoring techniques (pulse ox, HR, BP, etc). Both codes (93797 – non-monitored CR session and 93798 – monitored CR session) are reimbursed the same amount. Claire is currently non-monitoring patients in her program, so feel free to contact her if you want more information.

    Claire presented information about Motivational Interviewing with the group, and we all had time to practice. *Claire shared a handout that she has found useful – see attachment.

    Steph Cooper told the group about an American Medical Association video that also gives good information. The link is http://www.youtube.com/watch?v+cGtTZ_vxjyA You may need to copy and paste this in your browser. If your hospital blocks your access to You Tube, you may need to watch at home…

    Question came up about valvuloplasty and whether this was a reimbursable procedure. Susan checked with Candy Steele and Claire reviewed a PowerPoint from Karen Lui. Valsuloplasties (Valve Repair) and Transcatheter Valve Replacements (Valve Replacement) would both be covered. Remember that CMS reimburses for “heart valve repair or replacement” without specifying method. For specific questions about Cardiac Rehab reimbursement, contact Candy Steele at candace.steele@wfhc.org

     The next meeting of the IACPR SE Quadrant is scheduled for Tues, Apr 23 at 10am, hosted by Renee Edgar in Oskaloosa.

    Respectfully submitted by Susan Flack

    Northeast Region

    Leadership:  Looking for a President elect.  Job Description handout.  North Carolina exceptional affiliate increased Physician involvement, improved finances of their org.  legislation to bill for Ex Phys. license.  Rocky Mountain (3states) folded due to lack of leadership.

    Heartland Conference Dates:  April 12,13 at Marriott in Des Moine.  Next National AACVPR conference in Nashville Oct 3,4,5

    PR Tool kit:  Contact Janie Knipper if you have taken the tool kit to your financial department to realign you charges for G0424.  Contact Janie if you need help.

    Cardiac Rehab Registry:

    • 383 applied
    • 160 currently active programs
    • 69% male, 31 % female
    • 30% MI, 29% PCI, 21%, CABG
    • 30% diabetic
    • 43% high risk, 34%, Intermediate, 15% low
    • Mean program length 13 weeks.

    Do not foresee that Registry will be a requirement for certification.

    The registry is how we measure our work: Motivation, strategy, culture.  Can compare to all programs in state, hospital size and all programs in registry.  Participation agreement, pay subscription fee, view registry webinar (1 hour), complete data entry training (20 min)

    Pulmonary Registry coming:  Next June.  Possible to be early adopter and pay only $50. 

    Nutrition:  What is the right diet?  DASH, Very Low fat vegan, Mediterranean, The New American Plate,  “Expect different strokes for different folks.”  “The plan that works is the plan that is followed.”  “Nutrition counseling to get the right fit and get support.

    Key Messages on Physical Activity:  1.  Its not just for wt. control. 2. Can be 10-15 min blocks. 3.  Limit TV/Screen time.  4.  Find ways to add small bits of movement throughout the day.

    Extreme Endurance Exercise:  There are 6 heart attacks each year during marations and 4 are fatal.  Is more better?  14 deaths last year during triathlons – mean age 43.  11male – 3female.  13 of deaths were in swimming part of race.  Location of death is usually during last quarter of event so after 20 miles in marathon.  50% happen at last mile.  .54 deaths per 100,000 participants.  Possible presentation for Heartland conference.

    Cardiac Rehab referrals:  19% eligible medicare patients currently participate in rehab.  53% in Nebraska (#1), 46% Iowa (#3). Too many not attending, dropping out, and don’t continue compliance.   Research tells us that the maximum outcome is achieved at 38 weeks.  To modify: enhance self-efficacy, increase long term adherence, (maintenance programs) increase accessibility (modify hours for those that work, increase program capacity with open gym model, maximize outcomes, reduce costs.

    Innovation in Rehab model:  Goal to get patient into rehab within 5-7 days.

    Mark Lui:  Think out of the box. Our core business is changing behavior.  Participants knowledge that they can change behavior.  His rec:  1.  Take off monitors. 2.  Individual does active warm-up and cool-down on own. 3.  Open gym model.  4.  Could use heart rate monitors.  5.  Patients self record data.  6.  Perceived exertion and enjoyment.  7.  Self prescribed exercise by session 10-18.  8.  Motivational interviewing.

    Zack Clint;  Rehab Ed;  Group vs. Individual

    Lecture Pros: efficient, shared experience, easy to document

    Cons:  hard to meet individuals needs, confrontational        

    Atmosphere (forced to attend class), retention

    Coach approach: Train our staff, collaborate with pts in a change process, listening, asking, reflecting, evocative (pt doing the participating)

    5 to thrive:  Emotional Well Being, Smoking cessation, Healthy nutrition, medication adherence, exercise and physical activity. 

    Evaluate 1st visit, pt drive ship, help set goals.  Coach every session, revisit goals, exploring successes, and failures.

    We reviewed Legislative and Regulatory Issues presented by Karen Lui at the National conference.

    Erika Leonard from Allen Hospital in Waterloo brought flyer encouraging nurses to join newly formed local PCNA chapter coordinated by Lisa Moellers NP from Cedar Valley Medical clinic in Waterloo. 

    IACPR membership:  Many of you have forgotten to renew your membership or are not a current member of IACPR.  I urge you to remedy this soon.  We need paid members in order to continue to be a strong, viable, financially sound affiliate. 

    The next meeting is tentatively set for Tuesday, April 23rd in Waterloo.  The Allen Hospital program will pick a meeting place. 

     Spring 2012 IACPR Regional Meetings

    Northwest Region 

    The Northwest Iowa Regional Cardiac and Pulmonary Rehab Spring  Meeting was held Thursday March 8th at

    PocahontasCommunityHospital. We started about 9:30 am with 16 people in attendance.

    Susan Flack gave us interesting information about the AACVPR day at the hill. She enlightened us on the upcoming bills and the interpretation of them. She gave us nice background information and the need for a call to action. Our rehabs undercharge and are under utilized, but it is very cost effective and there is lots of evidenced based information.

    We had nice discussion about phase III in our departments and communities and phase IV in some areas. Some were seeing Humana pts. under their supervised fitness programs

    We discussed briefly about the AACVPR registry and Susan made a good point. We can think our programs are the best, but if we don’t compare it to anything how do we know they are good and could it be better. 

    A nice discussion was targeted to teaching and health coaching, with several ideas going around. A few people had been to the health coaching classes and thought it was very helpful. We need to focus on the pts. goals not ours. Sometimes they are so overwhelmed they can’t think of anything. We need to be understanding and compassionate with our pts. and help them see what they can do. PR and CR need to document progression.

    A light lunch was served and than a tour of the PCH cardiac rehab department was given for those who could stay. Of course our discussion continued through lunch and after.

    Mary Brandt RN

    Cardiac Rehab Coordinator

    Pocahontas CommunityHospital

    Southeast Region

    Pella, IA

    May 8, 2012

    Attendees: Ruth Gassman (Des Moines); Sherrilyn Nikkel (Pella); Kim Boyd (Anamosa); Jennifer Hoopes (Muscatine); Rose Groteluschen (Marshalltown); Renee Edgar (Oskaloosa); Nancy Steingreaber (Newton); Susan Huff (Keosauqua); Sigrid Vogelpohl (Keosauqua); Wanda Coleman (Pella); Linda Groenendyk (Pella); Susan Flack (Des Moines

    Thank you to Sherrilyn Nikkel and Pella Regional Hospital for hosting the SE Quadrant IACPR meeting on Tuesday, May 8, 2012.

    The meeting started with sign-in and introductions. Meeting participants varied greatly in Cardiac and Pulmonary Rehab experience. Discussion topics included:

    ü      AACVPR

    §         Number of members, programs, certifications

    §         Importance of AACVPR membership dues – support legislation, assist with program certification and outcomes, education, etc (21% of AACVPR dues support legislative activites which directly help our programs)

    §         “Possible” that CHF will be added to a list of reimbursable diagnoses for CR (should hear by 2013)

    ü      Heartland Cardiopulmonary Rehabilitation Network Conference

    §         2012 conference recently held in Omaha – presenters included Steven Lichtman (current AACVPR president) and Jody Hereford (Past AACVPR President, and current consultant for ICCC, who spoke on Health Coaching)

    §         2013 Conference is scheduled for April 12 and 13 – West Des Moines Marriott, West Des Moines, Iowa

    ü      AACVPR Annual Meeting is scheduled for Sept 6-8, 2012 in Orlando, Florida

    ü      Certification / Recertification – discussion held and questions answered

    ü      Core Competencies for Cardiac Rehabilitation / Secondary Prevention (2010 Update) – can find on www.aacvpr.org  

    ü      Pulmonary Rehabilitation Toolkit: Guidance to Calculating Appropriate Charges for G0424 – can find on www.aacvpr.org

    ü      Outcomes – discussed a variety of assessment tools

    ü      AACVPR Outcomes Registry – Cardiac launch June 2012; Pulmonary launch in 2013

    ü      Outpatient monitoring technology (interfacing with EMR)

    ü      Shared and discussed ITPs

    The next meeting of the IACPR SE Quadrant is scheduled for Tues, Sept 18, 2012 with site and time TBD. Watch your email and check the IACPR website for details.

    Northeast Region

     It was held March 27th in New Hampton.  I reviewed the PR toolkit with the attendees.  I reviewed some of the highlights of the Heartland conference.  Attendees brought ideas for some of the extracurricular activities their departments are involved in in the community including:  

    Allen Hospital, Waterloo:  Annual Heart Walk.  They are involved in Heart Aware.  They participate in health fairs, and do cholesterol checks.

    Central Community Hospital, Elkader:  During heart month, they go into schools to present on heart health.

    Other ideas from other northeast Iowa CR’s: Go Red Friday contests and raise money for donations to AHA, wearing red hair extensions on Go Red day, articles on patients published in papers, Cardiac Rehab Christmas party inviting all participants from previous year, Heart Risk Appraisal that includes Framingham questionnaire, Cholesterol, Glucose, Sleep apnea questionnaire, blood pressure, BMI, activity level and then results reviewed with participant by RN rehab staff.  

    Fall 2011 Regional Meetings 

    Southwest Region

    The Southwest Regional IACPR meeting was held on September 29, 2011, at 10:00 AM at MontgomeryCountyMemorialHospital in Red Oak.  Special guest was IACPR President, Susan Flack, who had recently attended the AACVPR Annual Meeting.  She reported on several topics of interest from the meeting including the upcoming AACVPR Outcomes Registry project, Supervising Physicians, and the possibility of cardiac and pulmonary rehab services being a part of a bundled payment for a hospitalization instead of getting paid per session as it is now. 

    Benefits of membership to IACPR and AACVPR were reviewed. 

    Discussion was held about how and when to hold southwest regional meetings.  It was recommended to try to meet at least twice a year and that the best attendance would require hospitals in the center of the region to host most often.  It was agreed that it would be beneficial to have the president or a board member who had attended the national meeting come and give a report at the fall meeting. 

    The attendees took a tour of the Cardiopulmonary Rehab Department, which was followed with lunch. 

    Peggy Dunbar is planning to host the next meeting in Atlantic, possibly in February.   

    Diane McGrew

    Northeast Region


    16 people attended including:

    Deb Reiker – Buchanan CountyHealth, Independence

    Karen Wahls – Central Community Hosp., Elkader

    Pat Swenka – MercyHospital, Oelwein

    Michelle Litterer – WaverlyhealthCenter, Waverly

    Maggie Pearson – Franklin General Hosp, Hampton

    Stacy Gooder – Franklin General Hosp, Hampton

    Betty Meighan – CommunityMemorialHospital, Sumner

    Kim Wilmes – WinneshiekHospital, Decorah

    Claire Shannon-PalmerLutheranHealthCenter, West Union (big group came from my hosp)

    I sent the info below to 3 rehabs that were hoping to attend, but could not make it that day.

    In addition to networking and getting to know each other, I reviewed some of the information acquired from the National conference.  Susan Flack unable to attend.

    1.        Coaching tips:

    a.        Listen until you don’t exist.

    b.      Affirm strengths

    c.       Balance open ended questions with reflections

    d.      Use few words, ask one question at a time

    e.      Have client speak more than you do

    f.        Get permission before you give advice

    g.       Show empathy, non-judgmental acceptance

    2.        Impact of CR on ability of elderly DHF patient to perform common household tasks:

    a.       ‘Bottom line, findings strongly support a role for muscle strength in determining the physiological capacity to perform activities of daily living.  From a clinical perspective, our results suggest that interventions designed to lessen physical disability in CHF patients should consider improving muscle strength as one of their goals.”  Resistance/strength training should be part of CR/PR programs.

    3.        Sleep Apnea:  CPAP can help CHF patients diagnosed with OSA.  Must have titration study for CPAP pressure. 

    4.       National Registry Update for CR and PR discussed.

    AACVPR site recommended for further details.

    5.        It sounds like NE rehabs are running into the insurances that have high co-pays.

    6.       Most NE rehabs have had LVAD patients in the past year.  Policy and Procedures discussed.

    7.        Most NE rehabs doing some type of Phase III and charging $5 per session.

    The rest of the time we ate and visited informally.  The consensus was that we would like to continue to do this every six months, Spring and Fall. 

    Southeast Region

    Ottumwa, IA

    October 13, 2011

    Attendees: Kim Boyd, Jones Regional Medical Center, Anamosa; Steph Cooper, Mercy, Cedar Rapids; Wanda Coleman, Pella Regional Hospital; Renee Edgar, Mahaska Health, Oskaloosa; Susan Flack, Iowa Health-Des Moines; Ruth Gassman, Mercy Medical Center, Des Moines; Kari Hatfield, Keokuk County Health Center, Sigourney; Diane Hunt, Marshalltown Medical Surgical Center; Leslie Heemsbergen, Ottumwa Regional Health Center; Sherrilyn Nikkel, Pella Regional Health Center; Cathy Packard, Fort Madison Community Hospital; Pam Poulos, Trinity Medical Center, Moline, IL; Sigrid Vogelpohl, Van Buren County Hospital, Keosauqua

    Thank you to Leslie Heemsbergen and OttumwaRegionalHealthCenter for hosting the SE Quadrant IACPR meeting on Thursday, Oct 13, 2011. Attendees introduced themselves and gave a bit of background on their rehab and association experience.

    Current IACPR President Susan Flack presented highlights from the recent AACVPR Annual Meeting in Anaheim.

    ü      National Cardiac Rehabilitation Registry is targeted for release in June, 2012. A few programs in Iowa have already registered to be a part of this project, and it sounds very exciting. The United States’ first nationwide registry of its kind, it will give programs an efficient means to track, document and communicate patient outcomes and program performance. Subscribers will be allowed access to high-quality data in real time via the Internet. In addition, programs will be able to see how their clinical, behavioral, health and service outcomes compare to aggregate data from other programs (in their state or nationally).  The Registry will most certainly prove to be an important and effective tool in program promotion. More information can be found on the AACVPR website at www.aacvpr.org

    ü      In a breakout given by Karen Lui, EOCs (Episodes of Care) were discussed. The Affordable Care Act includes provisions for bundled payments, clearing the way for more “global fees”. This could significantly impact reimbursement for our services, as cardiac rehab could be “bundled” with the cardiac event (MI, CABG, etc). Instead of billing for each session of care, CMS would make a global payment to the medical institution, intended to cover virtually all services received. There is certain to be more communication on this topic from the AACVPR, but in the meantime, Karen encouraged us to streamline our care and make our programs as efficient as possible, as the current billing practices may disappear.

    ü      CMS has proposed to cut reimbursement for hospital-based pulmonary rehabilitation from $63 per session (national average) to $38 (national average). Actual Iowa reimbursement would be lower. Unfortunately, this decision was reached due to hospital “charges” being too low. CMS uses a formula to determine payments, and the data reported to them by hospitals regarding charges for pulmonary rehab resulted in this decline in payment. Pulmonary Rehab programs are encouraged to discuss session charge rates with their Business or Reimbursement Office to make sure they are submitting appropriate charge amounts.

    In addition, there was discussion about the importance of “patient progression” while participating in Cardiac Rehab. Although CMS allows up to 36 sessions over 36 weeks, the average patient does not require this many sessions. There has been at least one instance where CMS visited a Cardiac Rehab program (in our area) and reviewed medical records to check on patient progression. The hospital was forced to reimburse CMS a substantial amount of money because patients had continued to participate in Cardiac Rehab after plateauing with their exercise. Cardiac Rehab needs to be individualized for each patient: this includes education as well as MET level (functional) goals. Patients are to be discharged when they are no longer showing progression.

    The next meeting of the IACPR SE Quadrant is scheduled for Tues, May 8, 2012 in Pella. Details will be posted at a later date.

    Northwest Region

    Representatives from 12 hospitals attended the district meeting at St. Anthony Regional Hospital on Thursday, September 15, 2011.  Susan Flack, IACPR President was unable to attend.  The meeting dealt with networking and sharing of information.  Some topics of discussion included:

    1. CEUs through AACPR/Academy Medical—AACVPR webinars are more expensive than Academy Medical.  Academy Medical educational programs are $49 through IACPR membership.
    2. State surveys of hospitals—Surveyors were looking for locked up patient records, outdated medications or syringes, MSDS sheets on hand sanitizer gel.
    3. Resistance training—One program starts resistance training 4 to 5 weeks into Cardiac Rehab with 1,3,5, and 10 pound weights for 5 minutes using 10 reps.
    4. Patient education—Some programs are using Krames “Living with Heart Disease”.  Others are using Active Partnership which includes a CD (cost of $20).  
    5. Program administration issues—Pulmonary Rehab participants need documentation of “face to face” contact with their physician.  One program pages their medical director for documentation of response time.
    6. Patient outcomes—Some programs are using Duke Activity Status Index (DASI), Depression forms PH Q2 and Q9, Montana Outcomes.
    7. Patient knowledge assessment—American Heart Association diet quiz (dated 1996).
    8. Staff competencies—Programs shared examples of their staff competencies which included ACLS protocols, ACLS meds, rhythm strips, department-specific emergency protocols. 


    CommunityHospital will host the next NW district meeting sometime in early spring 2012. 

    (Submitted by Darlene Rueter, RN from St. Anthony Regional Hospital in Carroll.)

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