Texas Association of Cardiovascular and Pulmonary Rehabilitation

1. A Message From Your President Happy New Year! I hope everyone had a good holiday and came back to work refreshed and ready to go for the new year. This is the winter edition of the TACVPR newsletter, a quarterly newsletter dedicated to delivering the latest information benefiting cardiac and pulmonary rehabilitation professionals. This newsletter contains a lot of great information including information about the upcoming 2008 TACVPR Conference, Legislative & Reimbursement Updates, Review of the New AACVPR/AHA/ACC Performance Measures, CMS Competitive Bidding and What this Means for O2 Dependent Patients, as well as information about Cardiac & Pulmonary Rehab Weeks and our AACVPR Certification Corner.In November, I had the opportunity to represent the Texas affiliate (TACVPR) at the 2nd Annual AACVPR Leadership Forum in Chicago. It was an extremely beneficial meeting for the leaders of each affiliate society. I not only got to network with other states and learn how their associations function, but also developed relationships with key leaders from the national association. We were also educated about the numerous resources that are available to the state societies and I plan on utilizing them to help our state continue to grow and stay strong as an affiliate association. The board is also working with the AACVPR on an ongoing basis to develop our plans for the next legislative push for the cardiac and pulmonary rehab bills. Continue to check your emails because at any time we could need your assistance to help contact key congressmen when AACVPR contacts us to do so. I hope you find this newsletter helpful and educational. If there is additional information you would like to have included or if you’re interested in writing an article for the next newsletter, please email Dean Diersing at mdiersing@teamumc.com. See you in Dallas in April!Julie Hartman, MS, CESTACVPR President Texas Association of Cardiovascular and Pulmonary Rehabilitation It’s Time to Renew Your TACVPR Membership! Membership dues expired Dec 31st. To join or renew your TACVPR membership for 2008 you may sign up online or download a printable membership application at www.tacvpr.org Annual dues are $30/person if paid before February 14th ($40 after Feb 14th)

2. Update Your Information for the 2008 TACVPR Program Directory We are currently updating the statewide program directory which is available to all current TACVPR members. In order to make sure your facility’s information is included and accurate, please answer the following questions and return this form as soon as possible by email or fax. Hospital/Facility Name:_______________________________________________________ Hospital/Facility Address:_____________________________________________________ __________________________________________________________________________ City:_____________________________________ Zip Code:_______________________ Department (Cardiac, Pulmonary or both): ________________________________________ Department Phone Number: ___________________________________________________ Department Fax Number: _____________________________________________________ Program Director/Coordinator’s Name: ___________________________________________ Program Director/Coordinator’s Email: ___________________________________________ Cardiac Rehab Program AACVPR Certified? Yes No Pulmonary Rehab Program AACVPR Certified? Yes No There is no cost to have your program listed in the directory, but if you do not want your program listed, please let us know. We will let you know when the 2008 directory is completed and available. TACVPR members can view the current directory online at www.tacvpr.org in the “member’s only” section. Upon completion, please email to llee@mckenna.org, fax to 830-606-3657or mail to: Lorri Lee 750 Landa Street, Suite A New Braunfels, TX 78130 Go Red For Women Day is Friday, February 1st, 2008 Going red in your own fashion is about finding a personal way to take part in the fight against heart disease in women.  Whether it’s visiting your healthcare provider, eating a healthier diet, increasing your exercise, purchasing products that support the cause, supporting the HEART for Women Act or wearing red on Feb. 1st for National Wear Red Day, you can do something special to love your heart.

3. TACVPR Conference 2008 Rodeo, Ropin’ & Rehab: Deep in the Heart of Texas It’s time to start making plans to attend the 2008 TACVPR annual conference. This year’s meeting will take place on April 25-26th in Dallas, TX. The conference will be located at the Doubletree Hotel Campbell Centre located off US 75 andCaruth Haven.It is a short 6-mile drive from Dallas Love Field Airport (18 miles from DFW Airport) and close to many popular shopping and dining spots in town. We have a great venue set up for the meeting and are fortunate to have some wonderful speakers lined up including Dr. John Foreyt, Dr. Richard Casaburi and coming back to speak again this year will be Kathy Oppenheim who was highly requested after last year. The breakout sessions will offer educational updates on topics of interest for those working in cardiac and pulmonary rehabilitation, whether you’re a nurse, respiratory therapist, exercise physiologist, physical therapist, occupational therapist, or dietitian. As in years past, we will once again host an evening social after the first day of lectures which is always a lot of fun for all who attend. It is a great time to relax, catch up with old friends as well as meet new some new ones. Plus the food and music is always a hit! Look for the conference brochure in the mail around mid-February and mark your calendars with the dates. Attending the annual TACVPR conferenceis one of the best waysto network with your colleagues and keep up to date with all of the important issues happening in the field of cardiac & pulmonary rehabilitation. Call for Abstracts & Posters Do you have a quality improvement project you would like to share with other professionals in the field? Are you working on a research protocol to improve care for your patients? We would like to share your knowledge with other professionals at the TACVPR Conference in April. For more information about how to submit a poster at the conference please contact Poppy Patterson at ppatterson@hillcrest.net. Submissions are due before March 28th, 2008.

4. Many of you may have heard that CMS recently proposed a change in the 2008 OPPS to the current process for billing cardiac rehabilitation services. CMS proposed to replace the current per session CPT codes, 93797& 93798 with new per hour G codes. This would effect both the physician provider and the hospital provider. Many health provider commenters to this proposed change expressed concern that the use of the term “Physician Services” and “MD Services” in the G-code descriptors could be misinterpreted by Medicare contractors (Texas is TrailBlazer) as requiring a physician to directly deliver the care or be in attendance during each service episode and requested the code descriptor be revised. CMS responded that “we are aware of several intensive cardiac rehabilitation programs that provide multiple sessions in a day, lasting several hours.” CMS further stated that the NCD does not distinguish between different approaches to the delivery of cardiac rehabilitation services, whether the common practice of three sessions per week or the more intensive programs of several sessions per day. Based on the comments received and further review of this issue, CMS decision was to keep the current CPT codes, 93797 and 93798 in the OPPS for CY 2008, From this information it appears that hospitals will be allowed to report more than one unit of service per day if more than one cardiac rehabilitation session lasting at least one hour is provided on the same day. Please be advised the precise rules for distinguishing between traditional cardiac rehabilitation programs and “intensive” programs have yet to be announced by CMS or its contractors (TrailBlazer). The TACVPR will keep you updated on this new information as it is released by the AACVPR and CMS. The federal payment rate for cardiac rehab is increasing modestly for CY 2008. On the physician fee schedule, $36. 21 is the total payment from Medicare and the patient. Reimbursement rates vary slightly around the country. As you are aware, CMS declined to write a NCD for Outpatient Pulmonary Rehabilitation. Currently, there is an LCD for pulmonary rehab under our MAC contractor, TrailBlazer Health Enterprises. According to the AACVPR reimbursement contact source, if CMS does provide an NCD for a type of service, the MAC contractor is not obligated to provide reimbursement for the service. The TACVPR will keep you updated on this new information as it is released by the AACVPR and CMS. What’s New on the Reimbursement FrontBy: Twyla Selvidge, MS East Texas Medical Center Regional HealthCare System What’s That? CMS: Centers for Medicare and Medicaid Services LCD: Local coverage Determination NCD: National Coverage Determination MAC: Medicare Administrative Contractor OPPS: Outpatient Prospective Payment System AACVPR: American Association of Cardiovascular & Pulmonary Rehabilitation

5. New ACC/AHA/AACVPR 2007 PERFORMANCE MEASURES ON CARDIAC REHABILITATION By: Laura Raymond, RN; St. David’s Medical Center • If you are a person driven by “quality” you should have read these at least 3-5 times by now. • If your program has been around for at least 3-5 years and you have been doing your homework, • you may not be surprised by any of the recommended performance measures and you are probably • wondering what took so long. • If you have the Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs 4th • Edition and have implemented the guidelines into your program, you are one step ahead of the • performance measures. • If you have a program certified by AACVPR and you have read the performance measures you are • pretty much confirming that your program has all the components in place but may need some fine • tuning. • If you have embraced the AHA/ACC Secondary Prevention Goals for Patients with Coronary and • Other Vascular Diseases and have a copy of the Core Components of Secondary Prevention • Programs 2007 Update… you are a step ahead and should be not too far off from following the • recommended performance measures. Are you with me? • I am sure by now all of you have heard by attending the AACVPR annual conference in Salt Lake • City, or via email from a college or co-worker or…. by reading your Journal of Cardiopulmonary • Rehabilitation and Prevention or the Journal of the American Collage of Cardiology or Circulation • or even reading it in the Los Angeles Times that… Performance Measures have been released • for Cardiac Rehabilitation/Secondary Prevention Programs. PERFORMANCE MEASURES, • WHAT’S THAT? • Over the past 4 decades, cardiac rehabilitation/secondary prevention (CR) services have become • recognized as a significant component in the continuum of care for persons with cardiovascular • disease (CVD). The role of CR services in the comprehensive secondary prevention of CVD events • is well documented and has been promoted by various healthcare organizations and position • statements. Just recently, October 2007, the ACC, the AHA, and the AACVPR formalized • and released 2 sets of performance measures for CR services to include: Set A) referral of • eligible patients to a CR program and Set B) delivery of CR services through multidisciplinary CR • programs. • The ultimate purpose of these performance measure sets is to help improve the delivery of • CR in order to reduce cardiovascular mortality and morbidity and optimize health in persons • with CVD. “Set A” seeks to improve referral of eligible CVD patients and “Set B” establishes • standards of excellence for CR programs. • Cardiac Rehab/Secondary Prevention Performance Measure “Set A” is based on 2 criteria • for the appropriate referral of patients to an early OP CR program. • All hospitalized patients with a qualifying CVD event are referred early to an outpatient CR program prior to hospital discharge; and • All outpatients with a qualifying diagnosis within the past year who have not already participated in an early OP CR program are referred to an outpatient CR program by their healthcare provider. CONTINUED

6. It should be noted that the Health Care System and its providers who care for patients during and/or after CVD events are accountable for these performance measures. “Only a minority of eligible patients receive the full benefits provided by cardiac rehabilitation/secondary prevention programs today. We hope that healthcare providers, healthcare systems, and health insurance carriers will work together to help eligible patients participate in such programs. Perhaps this performance measurement will make referral to Cardiac Rehab as automatic as giving aspirin during an MI.” The second set of performance measures included in the Cardiac Rehab/Secondary Prevention Performance Measurements is “Set B.” These relate to the Optimal Structure and Processes of care for CR programs themselves. Structural measures include: A physician medical director is responsible for the program An emergency response team with appropriate emergency equipment and trained staff is available during patient care hours Process measures include: Assessment and documentation of each patient’s risk for adverse events during exercise A process to assess patients for intercurrent changes in symptoms Individualized assessment and evaluation of modifiable CVD risk factors Development of individualized risk reduction interventions for identified conditions and coordination of care with other health care providers Evidence of a plan to monitor response and document program effectiveness through ongoing analysis of aggregate data. This includes 1) a plan to assess completion of the prescribed course of CR, and 2) a standardized plan to reassess patient outcomes at the completion of CR Methodology to document program effectiveness and initiate quality improvement strategies. This performance set is to ensure safety and excellence of cardiac rehab programs. To obtain a full comprehensive copy of the Performance Measures click on this link. http://www.acc.org/qualityandscience/clinical/pdfs/CardiacRehab_PM_sept20.pdf For those of you who are a member of TACVPR and have not read the performance measures, I suggest you do so ASAP. For those of you who have read them, I am hoping that you have started the process of doing everything in your power with the help of your staff, co-workers, colleges, medical director and other healthcare team members to spread the word and make Cardiac Rehab/Secondary Prevention Programs available to all eligible CVD patients so that they may receive the positive outcomes they deserve. AACVPR is working on available resources to assist programs in ensuring that evidence based standards and performance measures for secondary prevention programs are in place to improve the outcomes of patients with CVD. New ACC/AHA/AACVPR 2007 PERFORMANCE MEASURES ON CARDIAC REHABILITATION (CONTINUED)

7. CMS-Competitive Bidding & What This Means to Oxygen Dependent Patients By: Kitty Collins, RRT The Medicare Modernization Act (MMA) of 2003 has changed the way HME companies can bill and receive payment for oxygen supplies and equipment. Although this was passed four years ago many providers of care for oxygen dependent patients as well as the patients themselves are unaware of the consequences. Most of us are aware that in spite of strong opposition from a variety of home care interests, including respiratory therapists and patients Congress enacted a provision included in the Deficit Reduction Act (DRA) that required Medicare beneficiaries to assume responsibility and ownership of their oxygen equipment after 36 months of rental. This leaves the patient responsible for maintaining their equipment, and having it serviced. A pretty scary prospect for many patients .Effective January 1st, 2006 patients that are currently on oxygen or newly ordered receiving the Medicare oxygen benefit will have the patient-provider relationship for home oxygen therapy severed after the 36 month rental period is over. Medicare payment for equipment rental will be discontinued regardless of the patient’s ongoing medical need for home oxygen therapy. Medicare will continue to make payments to the provider for delivery of portable oxygen to a beneficiary and for non-routine equipment maintenance. Keep in mind that none of the specifics of how that reimbursement will occur have been developed at this time. Currently a limited payment of $30 per month provides access to unlimited refills and delivery of portable canisters. This modest payment is subsidized by payments for other oxygen equipment. Without ongoing payments to subsidize portable oxygen use, the ability to provide portability service will be jeopardized. Liquid oxygen systems may not have a place after 2009 due to the increased cost of supplying this. The new competitive bidding program for certain durable medical equipment that includes oxygen supplies and equipment, CPAP devices, respiratory devices, and related supplies and accessories will replace the current payment amounts. Suppliers that wish to furnish competitively bid items in a competitive bidding area (CBA) will be required to submit bids to furnish those items. Contracts will be awarded to a sufficient number of winning bidders in each CBA to ensure access to and service for high-quality DME items. Medicare payments would be the median of the winning bids. Starting in 2008, the competitive bidding will operate in CBAs within 10 of the largest metropolitan statistical areas (MSAs), one of which is the Dallas-Fort Worth-Arlington, Texas area. The program will be expanded into 70 additional MSAs in 2009. After 2009, CMS will expand the program to additional areas. When fully implemented in 2010, it is projected that these savings to Medicare will amount to $1 billion annually. For our patients that depend on oxygen for survival and whose link to staying active is easy access to portable oxygen it is small comfort. Oxygen providers that survive the bidding process may need to cut back on services as well as decrease the amount of licensed personnel to provide services. With fewer HMEs providing oxygen delivery, their patient volume and area covered will increase which may make it more difficult for patients to receive services and supplies in a timely manner. We need to learn as much as we can and stay informed as these changes start to go into effect so that we can help our oxygen dependent patients survive. Legislation in Congress has been re-introduced to repeal the 36 month oxygen equipment ownership provision. HR 621 and S.1484 would if enacted legally repeal that section of the Social Security Act. Encourage your patients and their family members to contact their Senators and Representatives and be advocates for this bill.

8. Certification Corner By Barbara Flato MSN, RN-BC, FAACVPR For those of us who have recently completed and sent certification documentation to AACVPR…… CONGRATULATIONS!!! The first step towards national certification is complete. Those who are working diligently on their recertification documentation to send in by February 15th, keep working! You still have a little over a month to complete it. Most importantly, know that there are resources available to help you. A few best practices have been posted on the website at www.aacvpr.org. Also, committee members are happy to review tabs if you have questions or concerns. State Committee ChairNational Committee Laura Raymond, RN Poppy Patterson, RN Austin Waco Phone: 512-544-4017  Phone: 254-202-3800 Fax: 512-544-5014 Fax: 254-202-3802 Email: Laura.Raymond@stdavids.com Email: ppatterson@hillcrest.net National CommitteeNational Committee Barbara Flato, RN Stacy Dramiga, MS Corpus Christi San Antonio Phone: 361-881-3633 Phone: 210-916-3551 Fax: 361-881-6383 Fax: 201-916-2964 Email: barabara.flato@christushealth.org Email: Stacey.dramiga@amedd.army.mil A few words to the wise as you put the finishing touches on your recertification document: ♥You know how your program works. The committee does not. Be clear and concise in your narratives. ♥Ask a colleague in a different department to read your narratives. If they have a clear picture of your process then most likely, so will we. ♥Fairly new to the Outcomes Tab in the application is the requirement that you include in your narrative a discussion on how each of your outcome results were used. Did you change a process, add a new education topic, adjust a goal for the following year? For instance, you set a goal of increasing patients Rate Your Plate score by 10% during the Phase 2 program. As a group your patients increased their score by 7%. As a result you increase the frequency of discussing dietary choices with patients and solicit a local celebrity to help with a “healthy choices” seminar. ♥Another fairly new requirement in the Individualized Care Plan Tab is that you label your care plan so that assessment, intervention, goal and follow-up are clearly marked for each of the four domains necessary for every care plan. They are nutrition, psychosocial, education and exercise. They can be in one document or multiple documents but if you can’t identify where you document your assessment, interventions and evaluation of each of these four domains we probably won’t be able to either. ♥ If you get asked for additional documentation, DON’T PANIC!! It is quite common and usually can be addressed quickly. Your letter will include your reviewer’s contact information. Call or email that person so you know without a doubt what they are looking for. Most of the time that same person will be doing the final review in July. ♥Look for more updates and information in our next newsletter. If you have specific questions don’t hesitate to contact any of us.

9. Top 10 Countdown: Ideas to Celebrate Cardiac & Pulmonary Rehab Week By: Lorri Lee, BS, RCEP; McKenna Memorial Hospital The holidays are just behind us which means it’s time to start planning how your program’s going to celebrate Cardiac & Pulmonary Rehab Weeks. Top 10 Ideas to Celebrate Cardiac & Pulmonary Rehab Week: 10. Be sure to order your official celebration paraphernalia from www.JimColemanLtd.com/aacvpr. 9. Decorate your gym in festive balloons, streamers, Cardiac & Pulmonary Rehab Week posters, etc. 8. Donate Cardiac Rehab or Pulmonary Rehab t-shirts to local referring physicians and their office staff to wear on “casual Friday”. 7. Take lunch to your program’s top referring physicians and staff to express your appreciation. 6. Don’t forget your own staff! Treat them to lunch, a field trip, or an off site get together of some sort. 5. Stock up on and give out some great, inexpensive giveaways to your patients like pens, pill boxes, message buttons, tote bags, t-shirts, drinking cups or water bottles. 4. Host a “Heart Healthy Living” or COPD Awareness” seminar for the community. Use your knowledgeable staff to teach it, market it in your local community papers and doctors offices. This can be a great way to educate the community on the services your program offers! 3. Don’t forget your hospital employees. Set-up a booth with blood pressure checks in the hospital or clinic cafeteria and take that opportunity to make sure your hospital knows your services as well. 2. Be a guest on your local radio station. Sounds crazy, right! Many stations offer “health awareness” segments and are often looking for people who have new topics to speak on. Grab your favorite physician advocate and share your message! 1. Throw a PARTY! Invite other healthcare professionals, administrators, etc and take a moment to show off your program and bring some well deserved recognition to your “neck of the woods”. The theme this year for Cardiac Rehab is: “Celebrate Cardiac Rehab: A Smart Start to a Healthy Heart”. The dates for celebration will be February 10-16, 2008. The theme this year for Pulmonary Rehab is: “Pulmonary Rehab: Inspiration, Respiration & Perspiration”. The dates for celebration will be March 16-22, 2008.

10. TACVPR Recruit–A–Pal (RAP) Program What is the RAP Program? The Recruit–A–Pal program was initiated in time for the conference in 2007. This program starts on January 1st each year and continues to the start of TACVPR annual conference. For each new person you recruit to join the TACVPR or to attend the conference you earn points. You may also earn points for an approved poster presentation. (A new person is someone who was not a member over the past year nor attended the previous conference). The Point System: 1 point: Each new member recruited between Jan 1st and the conference 2 points: Each new person brought to conference 1 point: An approved poster presentation The AWARDS: 5 points: Earns a free membership for a year 7 points: Earns a free conference fee for the following year IMPORTANT: Make sure to have your name filled in the “RAP Program Referral” section as the referring person on the membership form and the conference registration form. • 2007 RAP Candidates and Winners: • Kori Rich =  8 points (Free registration for 2008 conference) • Dean Diersing = 8 points (Free registration for 2008 conference) • Katy Kennedy = 6 points (Free membership dues for 2008) • Anita Gaddis = 4 points • Valerie Arizmendi = 4 points • Marilyn Burwitz = 2 points • Julie Hartman = 2 points • Clint Rivers = 2 points

11. IN OTHER NEWS… • Want to Serve as a TACVPR Board Member? • Board members are elected for a two-year term. When you agree to run for the • position, you must be able to participate on the board by meeting the following • expectations: • Must be an active and participating TACVPR member, must be in good standing with all dues paid in full at the time of election. • Must serve on a committee and/or hold office on the board (it is preferable to hold an office in the second year on the board). • Attendance at board meetings is mandatory (5/year). Failure to attend meetings • regularly may result in dismissal from the board. • All reports and communication should be forwarded to a board member, if you are unable to attend the board meeting. • Members will represent the membership and communicate with members of the association to bring issues and concerns to the board meetings. • Members will be expected to contribute articles and/or information for publication in the quarterly newsletter. • Members of board will receive a complimentary membership to the TACVPR. • Commitment/Confidentiality/Conflict of Interest Form will be signed by all board members upon election. • Complete the form on the next page to run for the 2008 Board of Directors. Job Openings If you have a job you would like posted in the quarterly newsletter, please email Julie Hartman at julieob@baylorhealth.edu Is Your AACVPR Membership Up to Date? AACVPR membership dues expired June 30th – Don’t forget to renew if yours expired! Annual membership fees: $185 Member/Associate Member; $75 Student (AACVPR is running a special right now for an 18-mth membership for $250) Go to www.aacvpr.org to join or renew your membership.

12. Texas Association of Cardiovascular and Pulmonary RehabilitationBoard Nomination FormIf you are interested in running for the TACVPR board, please complete the form below and send it to Lorri Lee at llee@mckenna.org. You will also need to mail a picture (3x5 or 4x6) of yourself for us to post on a board near conference registration. No scandalous photos please! Our Question Your Info I am interested in serving on and working for the Board of the Texas Association of Cardiovascular and Pulmonary Rehabilitation. I understand the construct and requirements of this Board position and submit my information as nomination for the April 26, 2008, election.    Printed Name: ___________________________________________ Signature: ___________________________________________ (Email will suffice for signature if sent electronically)