Texas Association of Cardiovascular and Pulmonary Rehabilitation
A Message From
Your New President
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 tacvpr_2005@yahoo.com.
Julie Hartman, MS
TACVPR 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
Summer 2007 Newsletter
www.tacvpr.org
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
CABG
PTCA/Stent
Stable Angina
Valve repair or replacement
Heart or heart-lung transplant
begin CR within 12 months
begin CR within 6 months
begin CR within 6 months
proof of ischemia per stress test
begin CR within 6 months
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
Summer 2007 Newsletter
www.tacvpr.org
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???
CMS - The Centers for Medicare and Medicaid Services
NCD - National Coverage Determination
FI - Fiscal Intermediary
LCD - Local Coverage Determination
Summer 2007 Newsletter
www.tacvpr.org
2007 TACVPR 17th Annual
Conference
By: Lorri Lee, BS, RCEP, TACVPR Past President
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 network
Loved 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 cold
Need more coffee at breakfast
Ask 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.
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!!!!
Summer 2007 Newsletter
www.tacvpr.org
Meet Your 2007-2008 TACVPR Board
Dean
Lorri
Poppy
Marilyn
Julie
Kitty
Barbara
Danielle
Nita
Twyla
Not Pictured:
Mary Hart
Julie Hartman, MS
President
Baylor Heart & Vascular Hospital/THE HEART
HOSPITAL Baylor Plano
Lorri Lee, BS, RCEP
Immediate Past President
McKenna Memorial Hospital
Twyla Selvidge, MS
Treasurer
Outcomes Committee
East Texas Medical Center
Kitty Collins, RRT
Conference Chair
Seton Medical Center
Barbara Flato, MSN, RN-BC,
FAACVPR
CHRISTUS Spohn Cardiac Rehab
Mary Hart, RRT
Baylor University Medical Center
Nita Pack, RRT
Secretary
Charlton Methodist
Hospital
Marilyn Burwitz, RN
President Elect
East Texas Medical Center
Fairfield
Poppy Patterson, RN
Past President
Hillcrest Health System
Getterman Wellness Center
Dean Diersing, MS
University Medical Center
Health Point Fitness & Cardiac Rehab
Danielle Strauss, BSN, RN-BC, BS
Baylor Heart & Vascular Hospital
If you are interested in serving on the TACVPR Board of Directors,
please contact Julie Hartman at julieob@baylorhealth.edu
Summer 2007 Newsletter
www.tacvpr.org
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.
Summer 2007 Newsletter
www.tacvpr.org
Broken Heart
or Heart Attack?
by Danielle Strauss, BSN, RN-BC, BS
Mrs. 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 Section
Have 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 mdiersing@teamumc.com.
Summer 2007 Newsletter
www.tacvpr.org
IN OTHER NEWS…
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
6:30-7:00pm
7:00-8:00pm
8:00-8:30pm
Tour of facility
Dinner, brief meeting
Speaker
Tour of Cath lab
Please RSVP to Mike Crayton at 214-947-0671
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?
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.
Summer 2007 Newsletter
www.tacvpr.org