Texas Association of Cardiovascular and Pulmonary Rehabilitation

Summer 2007 Newsletter www.tacvpr.org

Texas Association of Cardiovascular and Pulmonary Texas Association of Cardiovascular and Pulmonary Rehabilitation Rehabilitation

A Message From A Message From Your New PresidentYour New President

Do You Know Anyone Who May Be Interested in Joining TACVPR?To join or renew your TACVPR membership you may sign up online or download a printable membership application at www.tacvpr.org

Annual dues are $40/person

Thanks to all who attended this year’s TACVPR conference in Austin. I was able to speak to many of you and from your comments “Jammin’ in Austin: A Capitol Idea for Rehab” was a great conference. There were many great speakers who gave information and ideas on how to improve your program and overall patient care. A great time was had by all at the social event on Friday night. I would also like to send a big thanks to all our vendors for their amazing support of our organization year after year. I hope you all enjoyed the conference as much as I did and we are happy to announce that the 2008 TACVPR conference will be held in Dallas on April 24th & 25th.

The 2007 conference also marked the end of Lorri Lee’s year serving as our TACVPR President. She has done a wonderful job leading our association over the last year and has been key in keeping us in touch with the national issues and updates as well as promoting our letter writing campaigns to key legislative congressmen and women. Thanks for all your hard work and dedication and we appreciate your ongoing efforts with the grassroots campaign.

Our annual TACVPR Board elections were held at the conference and brought back some old as well as new faces. Marilyn Burwitz was reelected to the board for another term. Barbara Flato, who served as one of the original TACVPR board members, was elected to serve on the board again. Danielle Strauss was elected and will be serving her first term serving on the board. We also welcome Dean Diersing to the board who was appointed after the resignation of one of our board members.

As most of you know, this is a very critical time and much work is still left to be done to pass Cardiac & Pulmonary Rehab programs into law. See Twyla Selvidge’s reimbursement update article in this newsletter for more information and how you can get involved. It is extremely important that every program gets onboard and participates in calling and writing their senators and congressmen. We will not be able to get the results we need without each and everyone of you doing your part.

If you’re feeling confused or lost with the Cardiac and Pulmonary Rehab changes & legislative issues we are referring to, you should really consider becoming an AACVPR member. They offer numerous benefits, but the most helpful are the quarterly newsletters and email updates of legislative changes that revolve around Cardiac and Pulmonary Rehab. Go to www.aacvpr.org for more membership information.

Please remember that the state board members are available to help so please don’t hesitate to contact any of us. Names and contact info can be found on the website at www.tavcpr.org, or email your questions and comments to [email protected].

Julie Hartman, MS TACVPR President


Reimbursement Updates By: Twyla Selvidge, MS

CARDIAC REHAB On May 17, 2007, TrailBlazer, the current Medicare fiscal intermediary for most of Texas, issued the revised LCD for Cardiac Rehabilitation. This LCD for Cardiac Rehab is in effect and gives you the guidelines for designing your program for optimal operations and reimbursement.

If you were not able to attend the TACVPR state conference in Austin, May 4 & 5, here are a few highlights from the presentation on this LCD.

Diagnoses Acute MI begin CR within 12 months CABG begin CR within 6 months PTCA/Stent begin CR within 6 months Stable Angina proof of ischemia per stress test Valve repair or replacement begin CR within 6 months Heart or heart-lung transplant begin CR within 12 months

Facility Hospital outpatient department Physician directed clinic

Timeline 2-3 times/week, 1 time per week is considered “not medically necessary” unless there is an illness or hospitalization and this must be documented. 12-18 weeks, additional series of 36 sessions (up to 36-week total) must meet medical necessity criteria

Exit criteria (includes, but not restricted to): Stable level of exercise tolerance w/o ischemia or dysrhythmia Resting BP & HR within normal limits Negative stress test 36 sessions only for valve repair or replacement VO2 >90% predicted for transplant

Group services I: Continuous EKG rhythm strip with interpretation and physician’s exercise

prescription revision; limited examination for physician follow-ups II: New patient comprehensive evaluation, E & M code allowed one at the

beginning of CR by supervising physician; EKG stress test at beginning and completion of program

You can find the Cardiac Rehab LCD at www.trailblazerhealth.com


Reimbursement Updates (Cont.)

PULMONARY REHAB

BIG NEWS! Revised LCD from TrailBlazer effective for 5/30/2007 for Outpatient Pulmonary Rehabilitation. If you currently provide this service, it will benefit you to go to Trailblazerhealth.com, search Outpatient Pulmonary Rehabilitation. However, on 6/27/07, CMS released a decision memo on pulmonary rehabilitation. This can be found at: www.cms.hhs.gov/mcd/viewdraftdecisionmemo The CMS decision was to NOT issue a National Coverage Determination (NCD) for outpatient pulmonary rehabilitation services. The reason for not issuing an NCD is that the Social Security Act does not define a comprehensive pulmonary rehabilitation as a part B benefit. ie, CMS claims it does not have the statutory authority to cover pulmonary rehabilitation. These respiratory care services are considered reasonable and necessary only in a CORF-Comprehensive Outpatient Rehabilitation Facility.

STOP! What does this mean for both Cardiac Rehab and Pulmonary Rehab??? Both service lines have an LCD which gives us the authority to provide our services. Cardiac Rehab has an NCD, Pulmonary Rehab does not. Not having an NCD leaves Pulmonary Rehab more vulnerable than Cardiac Rehab. TrailBlazer can decide not to provide reimbursement for PR since CMS decided not to issue a NCD.

BUT! It doesn’t stop there! Due to the lack of a specific statue (law) that mandates coverage of both services, the medical necessity and coverage of incident-to services such as Cardiac and Pulmonary Rehab are extremely vulnerable to interpretation by CMS. This is why the TACVPR is urging each of you to promote the Pulmonary and Cardiac Rehabilitation Act of 2007. We need to make sure our 2 US Senators, John Cornyn & Kay Bailey-Hutchison sign on as co-sponsors. If this act passes, it will become law that Medicare has to provide coverage for both service lines. What’s That???What’s That???

CMS - The Centers for Medicare and Medicaid Services

NCD - National Coverage Determination

FI - Fiscal Intermediary

LCD - Local Coverage Determination


2007 TACVPR 172007 TACVPR 17thth Annual Annual ConferenceConference

By: Lorri Lee, BS, RCEP, TACVPR Past President

Congratulations goes to JoAnn Garcia from Valley Baptist Medical Center for visiting all the exhibitors

and winning the drawing for a FREE TACVPR Conference and Membership for next year!!!!

Thank you to all who attended the TACVPR Conference on May 4th and 5th at the Doubletree in Austin. We had a great line up of speakers and were pleased to offer 8 continuing education credits, as well as, a unique opportunity to network with other Cardiac & Pulmonary Rehab professionals.

The board was pleased to receive lots of great feedback from those who attended. Some of the comments were as follows:

Great Speakers!Good opportunities to networkLoved Joe, social, buffets, popcorn!Better schedule, not so rushed

Of course we love to hear those compliments, but some of the complaints help us to better serve you the next year. Some of the “could do better” comments were:

Too coldNeed more coffee at breakfastAsk everyone to turn off cell phones

Overall, it was a successful event and we’re excited to have plans underway for the 2008 Conference. Mark your calendars for next year’s conference which will be held on Friday, April 25th and Saturday, April 26th, 2008 at the Doubletree Campbell Centre in Dallas. More information will be available as we get closer to the date.

A special thank-you to Austin Smith for designing the

wonderful “Jammin’ in Austin: A Capitol Idea for Rehab” logo

for this years conference.


Meet Your 2007-2008 TACVPR Meet Your 2007-2008 TACVPR BoardBoard

Julie Hartman, MSPresident

Baylor Heart & Vascular Hospital/THE HEART HOSPITAL Baylor Plano

Lorri Lee, BS, RCEP

Immediate Past PresidentMcKenna Memorial

Hospital

Twyla Selvidge, MS

TreasurerOutcomes Committee

East Texas Medical Center

Nita Pack, RRTSecretary

Charlton Methodist Hospital

Marilyn Burwitz, RN

President ElectEast Texas Medical

Center Fairfield

Poppy Patterson, RNPast President

Hillcrest Health System Getterman Wellness Center

Dean Diersing, MSUniversity Medical Center

Health Point Fitness & Cardiac Rehab

Mary Hart, RRTBaylor University Medical Center

LorriLorri

Not Pictured: Mary Hart

PoppyPoppy

DeanDeanJulieJulie

TwylaTwylaBarbarBarbaraa

NitaNita

Kitty Collins, RRTConference Chair

Seton Medical Center

If you are interested in serving on the TACVPR Board of Directors, please contact Julie Hartman at

[email protected]

Danielle Strauss, BSN, RN-BC, BS

Baylor Heart & Vascular Hospital

DanielleDanielle

MarilynMarilyn

KittyKitty

Barbara Flato, MSN, RN-BC, FAACVPR

CHRISTUS Spohn Cardiac Rehab


New Evidence-Based Clinical Practice Guidelines for Pulmonary

Rehabilitation By Kitty Collins, RRT

At a time when we are all being pro-active and writing our congress to get legislative support for our programs, a new document has been published this May in Chest that offers substantial new evidence that pulmonary rehabilitation is beneficial for patients with COPD and other chronic lung conditions. This document updates the previous guidelines that were published in 1997 by the American College of Chest Physicians (ACCP) and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR).

The new guidelines are based on literature review and development of evidence tables gathered by a panel of physicians and other health care professionals and chaired by Andrew Ries, MD, MPH, FCCP. The panel systematically reviewed published literature from 1996 to 2004 and established a scaled process that determined the strength of evidence in 24 areas that included previous recommended guidelines as well as recommendations for new areas of research relevant to pulmonary rehabilitation.

The system uses a 3-point scale with recommendations grouped on the following two levels: strong (grade 1); and weak (grade 2). Issues that were considered when classifying were quality of the evidence that supports estimates of benefit, risks, and costs; the importance of the outcomes of the intervention; the magnitude and precision of estimate of the treatment effect; the risks and burdens of an intended therapy; the risk of the target event; and varying patient values.

The strength of the evidence is classified, based on the quality of the data, into the following three categories: high (grade A); moderate (grade B); and low (grade C).

To summarize, the new evidence supports the earlier guidelines that recommend lower and upper extremity exercise training (1A) and documents improvements in dyspnea (1A) and health-related quality of life (1A). Additional evidence does support improvements in psychosocial outcomes and healthcare utilization (2B); however, there is little evidence regarding survival.

Based on evidence at this time the use of inspiratory muscle training routinely is not recommended (1B), as well as the use of anabolic drugs, or nutritional supplementation (2C).

The use of supplemental oxygen therapy is proven beneficial at rest and with exercise for patients with severe hypoxemia (1C), and new evidence supports oxygen use with exercise in patients without hypoxemia (2C). For selected patients with advanced COPD noninvasive ventilation may produce better outcomes when used with exercise or nocturnally (2B). The guidelines also report that pulmonary rehabilitation appears to help patients with chronic lung disease other than COPD (1B).

Program length has always been up for discussion and research is needed in this area to help determine optimal effectiveness. There have been some studies that show that longer pulmonary rehabilitation programs (greater than 12 weeks) produce greater sustained benefits than shorter programs (2C).

These are the highlights of this document and I encourage everyone working in pulmonary rehabilitation to review it completely. The evidence documents many things we already know working with patients with pulmonary disease; however, as we aim to produce the best outcomes, we need to constantly reassess our treatment strategies.

This document can be accessed at http://www.chestjournal.org/cgi/content/full/1315_suppl/4S?ck=nck.


Broken Heart or Heart Attack?

by Danielle Strauss, BSN, RN-BC, BSMrs. Smith’s husband died two days ago. She was 74 years old and they were married for 50 years. Last night, she was rushed to the emergency room with complaints of severe chest pain. Lab tests revealed a mild elevation in her cardiac biomarkers. Diffuse T-wave inversion with a prolonged QT interval was present on the EKG. Echocardiography results showed akinesis of the apical one-half to two-thirds of the left ventricle, with an LVEF of 30%. The patient was sent to the cath lab for angiography and the coronary arteries were free of blockages.

This phenomenon is called Broken Heart Syndrome (BHS) and is also referred to as “stress cardiomyopathy”. This condition may appear when intense emotional stress causes a surge in the body’s circulating stress hormones which ultimately stuns the heart. The clinical features of broken heart syndrome as described above usually resolve within a few days. Furthermore, left ventricular dysfunction is reversible and there is no permanent damage to the heart. Most patients who suffer from BHS make a quick and complete recovery.

Broken Heart Syndrome often occurs in the postmenopausal female population. Prior to hospital admission, patients experience a severe emotional stressor and often report chest pain and dyspnea as their chief complaint. Although BHS improves quickly, it can be life threatening in certain cases. Therefore, it is important for the multi-disciplinary cardiac rehab team to be able to identify BHS in order to provide patients optimal care and treatment.

TACVPR Members Only SectionTACVPR Members Only SectionHave you had the chance to check out the “Members Only” section of the TACVPR website? If you answered “no” to this question, take a minute to log on to www.tacvpr.org to see what it

has to offer. You can access TACVPR newsletters, the Texas Program Directory and more!

For log-in questions, please e-mail Dean Diersing at [email protected].


ATTEND THE UPCOMING NTACVPR MEETING

All cardiac & pulmonary rehab professionals are welcome to attend the next meeting which will be held on Tuesday, July 17th

at Methodist Charlton Medical Center in Dallas.

Location: 3500 W Wheatland Road, Dallas, TX 75237

Cardiopulmonary Rehab Education Room (3rd floor outpatient center building)

Speaker: Jon Aldama, RN, Cath Lab Supervisor

Topic: Elution of Drug Coated Stents

Schedule: 6:00-6:30pm Tour of facility 6:30-7:00pm Dinner, brief meeting

7:00-8:00pm Speaker 8:00-8:30pm Tour of Cath lab

Please RSVP to Mike Crayton at 214-947-0671

IN OTHER NEWS…IN OTHER NEWS…

JOB OPENING

Parkland Hospital in Dallas is looking for a Cardiac Rehab Nurse, cardiac rehab experience preferred. For more information or to apply please call 214-

590-8236.

Is Your AACVPR Membership Up to Date?Is Your AACVPR Membership Up to Date?AACVPR membership dues expired June 30th – Don’t forget to renew!

Membership fees: $185 Member/Associate Member; $75 Student

Go to www.aacvpr.org to join or renew your membership.

Documents

Texas Association of Cardiovascular and Pulmonary Rehabilitation