April 2013
Volume 2, Issue 1
MNACVPR
Newsletter
Meet the 2013 MNACVPR Board
MNACVPR Board
 President:
Teresa Fietek
 President Elect:
Marc Arndt
 Past President:
Kari Weber
• Treasurer: Chad Gundry
Dennis Angellotti, MS, RN: Mercy Hospital, Coon Rapids, MN
Marc Arndt, MA: Unity Hospital, Fridley, MN
Barb Darsow, COTA, CES: Fairview Southdale Hospital, Edina, MN
Teresa Fietek, BA, RCEP: Fairview Ridges Hospital, Burnsville, MN
Chad Gundry, MA, RCEP: Mercy Hospital, Coon Rapids, MN
John Inkster, MS, CES: St. Cloud Hospital, St. Cloud, MN
 Secretary: Kathy Zarling
 Membership Co-Chairs:
Aaron Pergolski
Dennis Angellotti
 Outcomes Co-Chair:
John Inkster
Jessica Oman
 Disease Management
Co-Chairs:
Dennis Angellotti
Kari Weber
Whiteny Quast
 Reimbursement Chairs:
Cardiac: John Inkster
Pulm. Jessica Oman
 Region Co-Directors
North Central:
Nancy Nubson
Jessica Oman
North:
Kevin Welsh
South:
Monica Senden
Kari Weber
Metro:
Marc Arndt
Barb Darsow
Anita La Haye RN, CES: HCMC, Minneapolis, MN
Nancy Nubson, RN: Lake Region Health Care, Fergus Falls, MN
Jessica Oman, CRT, RCP: St. Cloud Hospital, St. Cloud, MN
Aaron Pergolski, MA, RCEP: Fairview Southdale Hopsital, Edina, MN
Whitney Quast, MS, CES: Fairview Red Wing, Red Wing, MN
Monica Senden, RN: Avera Regional Medical Center, Marshall, MN
Paul Spilde, PT: Methodist Hospital, St. Louis Park, MN
Kari Weber, MS, RRT, RCP: Austin Medical Center, Austin, MN
Kevin Welsh: SMDC, Duluth, MN
Kathy Zarling, MS, RN, FAACVPR: St. Mary’s Hospital, Rochester, MN
MNACVPR
Congratulations
We would like to congratulate the following:
Anita La Haye for being elected into the secretary role starting in 2013
Aaron Pergolski for being elected as President Elect starting in 2013
Ruth Rinker for receiving the MNACVPR 2012 Award of Excellence
Cardiac Reimbursement Report:
1. S.2057 – Technical Correction to allow NPP’s to supervise CR/PR
a. Senator Franken has just signed on as a cosponsor!
b. Thank you Carla Theusch for being persistent with Franken’s aide!!
c. We should now forward this on to Senator Klobuchar
2. New AACVPR MAC Liaison
a. Holly Bright, Mayo Clinic Arizona
3. MAC Award
a. Nothing new. Award to NGS still being contested. So we still have Noridian as our
legacy Fiscal Intermediary.
4. CR Proposed Payment Rate (AACVPR Reimbursement Report 7.13.12.)
a. CMS’ Proposed HOPPS and PFS regulations for 2013. Final regulations expected in
November 2012.
b. Hospital outpatient (hospital-owned) setting reimbursement rate for both CPT 93797 and
93798 proposed payment of $80.06
i. This is a national average and will vary based on geographic location due to
adjustments related to labor costs.
c. Co-payment amount (secondary insurance or patient portion) is $16.02.
d. The higher cardiac rehabilitation reimbursement rate may be due in part to the increased
use by hospitals of the cardiac rehabilitation nonstandard cost center on the Medicare
Cost Report Form 2552-10. This option was implemented in October, 2009. Please see
details here if your institution has not yet made this shift.
5. Cardiac Rehabilitation Referral Performance Measure
a. CMS continues to consider patient referral to cardiac rehabilitation performance
measures (inpatient and outpatient settings) for various future CMS performance
measures programs. For example, the Cardiac Rehabilitation Patient Referral from an
Outpatient Setting measure was included in the PQRS Qualified Registry as an individual
MNACVPR
quality measure for reporting in 2012 and is included for use in 2013. As another
example, the Hospital Outpatient Quality Reporting (OQR) Program will begin data
collection for this measure for CY 2015 payment determination. This program incentivizes
physicians for the use of certain performance measures. Meanwhile, AACVPR is working
closely with the American College of Cardiology (ACC) to complete measure
specifications so that CMS is able to utilize the inpatient referral measure in an EMR
application.
6. Transcatheter Aortic Valve Replacement (TAVR) now covered by Medicare
a. MLN Matters Number: MM7897. Related Change Request CR): CR7897.
Implementation date January 7, 2013.
FYI: Home Care and Rehab – It is OK to have pt. in rehab and receive Home Care at the same time
as rehab is a health care treatment. However, is it appropriate for that patient? Are they ready to come
to rehab yet?
“Medicare Benefit Policy Manual
Chapter 7 - Home Health Services
30.1.1 - Patient Confined to the Home
(Rev. 1, 10-01-03)
A3-3117.1.A, HHA-204.1.A, A-01-21
In order for a patient to be eligible to receive covered home health services under both Part A and Part
B, the law requires that a physician certify in all cases that the patient is confined to his/her home. An
individual does not have to be bedridden to be considered confined to the home. However, the
condition of these patients should be such that there exists a normal inability to leave home and,
consequently, leaving home would require a considerable and taxing effort.
If the patient does in fact leave the home, the patient may nevertheless be considered homebound if
the absences from the home are infrequent or for periods of relatively short duration, or are attributable
to the need to receive health care treatment. Absences attributable to the need to receive health care
treatment include, but are not limited to:
 Attendance at adult day centers to receive medical care;
 Ongoing receipt of outpatient kidney dialysis; or
 The receipt of outpatient chemotherapy or radiation therapy.
Any absence of an individual from the home attributable to the need to receive health care treatment,
including regular absences for the purpose of participating in therapeutic, psychosocial, or medical
treatment in an adult day-care program that is licensed or certified by a State, or accredited to furnish
adult day-care services in a State, shall not disqualify an individual from being considered to be
confined to his home. Any other absence of an individual from the home shall not so disqualify an
individual if the absence is of an infrequent or of relatively short duration. For purposes of the preceding
MNACVPR
sentence, any absence for the purpose of attending a religious service shall be deemed to be an
absence of infrequent or short duration. It is expected that in most instances, absences from the home
that occur will be for the purpose of receiving health care treatment. However, occasional absences
from the home for nonmedical purposes, e.g., an occasional trip to the barber, a walk around the block
or a drive, attendance at a family reunion, funeral, graduation, or other infrequent or unique event
would not necessitate a finding that the patient is not homebound if the absences are undertaken on an
infrequent basis or are of relatively short duration and do not indicate that the patient has the capacity
to obtain the health care provided outside rather than in the home.
Generally speaking, a patient will be considered to be homebound if they have a condition due to an
illness or injury that restricts their ability to leave their place of residence except with the aid of:
supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special
transportation; or the assistance of another person; or if leaving home is medically contraindicated.”
Respectfully submitted in absentia: John Inkster
Pulmonary Rehabilitation Payment 2013
Pulmonary rehabilitation received a modest increase to $39.58 (2012 $37) for HCPCS code G0424. Co-payment
amount is $7.92.
Respiratory services (what those in the field refer to as “pulmonary rehab” for patients with a non-COPD
respiratory disease) also received an increase to $35.12 per 15 minutes for the timed procedure codes, G0237 and
G0238 and the un-timed group exercise therapy code, G0239. The co-payment is proposed to be $7.03.
Working on language fix for PR (very severe was omitted) a request to resubmit article, no action from
members at this time.
Pulmonary tool kit- do not share cost/billing charges with others
Bundled billing with different services/codes, manage care/charge master need to be involved.
Nordian update to training workshop February 25, 2010 link:
https://www.noridianmedicare.com/pmeda/train/workshops/qa/pulmonary_rehab_program_services.html
this is current to 6/8/2012
MNACVPR
Outcomes Report
1. AACVPR CR Registry
(https://www.aacvpr.org/Resources/OutpatientDataRegistries/OutpatientCardiacRehabDataRegi
stry/tabid/422/Default.aspx)
a. Now available. Requirements to get started:
i. Submit registry subscription fee
1. <100 pt.’s/year
= $100
2. 100-200
= $125
3. >200
= $150
ii. Submit signed participation agreement
iii. Watch webcast about registry
iv. Complete online training exercise
v. Start entering data
b. Anything new from the AACVPR meeting? Anyone submitting data yet?
2. MNACVPR Outcomes Committee Survey
a. Survey email sent to members and MNACVPR@yahoogroups.com on 9/13/12.
b. Website link: https://qtrial.qualtrics.com/SE/?SID=SV_d1dY4ZUIbFlkp0M
c. Can be added to our Facebook page, website, newsletter, email signature tag, etc.
Respectfully submitted in absentia: John Inkster
Discussion ensued about the AACVPR CR Registry. Teresa shared that, currently there are no dietary
tools offering assistance in the nutrition assessment. The AACVPR registry group told the
membership, at the annual meeting, that they have not found an ideal nutritional assessment tool, to
utilize for the ITP. Kathy Zarling shared that Karen Collins and Georgia Kosta, two dietitians, who
spoke at the annual meeting will assist AACVPR to find a reliable and relevant tool for use for the ITPs
and registries. Non-COPD would be therapeutic respiratory services. Then Teresa asked if the same
staff may work with all diagnoses, and both ways are used, within Minnesota organizations.
MNACVPR
Disease Management
The American Lung website is acceptable for the Austin Mayo Health System Program use. The
Disease Management Committee will talk further about what websites and tools to use and share with
the MNACVPR membership.
Whitney, Kari, and Dennis have been working on the Heart Failure clinical tool. Whitney has been
previewing the AHA Heart Failure website program. She and Kari will compare the tools used for all
diagnoses, to make sure all are consistent.
The disease management committee hopes to role out the new CHF guidelines at the beginning of
2013. Please continue to look in the members only section.
Website
Members are currently using the website more frequently. Many members have been logging on to the
Form section. We encourage you all to start to use the form as a great way to communicate with other
members in the state. Remember to log into the forum section using you member number and the
password : MNACVPR.
Please E-mail apergol1@fairview.org with any questions.
Membership
Membership is being done throught ZapEvents. Membership card are now being sent to via e-mail. If
you have signed up for a 2013 membership and have not receive your membership card please email
tfietek1@fairview.org
MNACVPR
Award of Excellence
Help us honor people in the field of cardiac and pulmonary rehabilitation with the MNACVPR Award of
Excellence. We will be accepting nominations for the MNACVPR Award of Excellence from now till the end of
August of 2013. Please submit the name and why they should be considered for the award . Please submit
nominations to Teresa Fietek at tfietek1@fairview.org The winner of the MNACVPR Award of Excellence will
be reconized at the fall conference each year.
Past recipeints:
2012 Ruth Rinker: Regions Hospital (retired), Past MNACVPR board member and secretary.
2011 John Inkster: 2006 MNACVPR past president, current cardiac outcomes and rembusment co-chair, cardiac
rehab Supervisor at St. Cloud Hosital.
2010 Peg Bear: 2003 MNACVPR past president, Former (retired) clinical cordinator at Mercy Hospital cardiac
rehab.
2009 Kathy Zarling: Current AACVPR Education committee member, 2005 MNACVPR past president
The award is given annually to an individual for outstanding contributions and leadership in the MNACVPR and
the practice of cardiopulmonary rehabilitation.
Criteria:
Nominee(s) will be a current MNACVPR member or, if retired, was a current MNACVPR member at the
time of retirement.
Nominee(s) will have earned prominence within the state in the field of cardiopulmonary rehabilitation.
Please complete the nomination form below, and write a compelling paragraph in support of your nominee.
Suggestions include:
how this individual influenced the practice of cardiac/pulmonary rehab
what was the most important thing you learned from this individual
what you would like us to know about this individual
Nominations will be accepted until 08/24/13.
Send nomination letters to: Marc Arndt
e-mail: Marc.Arndt@allina.com
Nominations will be voted on by the Board of Directors and announced at the state meeting in October.
MNACVPR
Site Spotlight
Mayo Clinic Health System – Red Wing, MN
What programs do offer?
We offer Phase II Cardiac Rehab, Outpatient Pulmonary Rehab, and Wellness for Life. We are part of
the Rehab Services department, which also includes physical therapy, occupational therapy, and
speech therapy. Wellness for Life is an exercise program for graduates of cardiac rehab (Phase III),
graduates of pulmonary rehab, CHF patients, and patients with other chronic diseases. Since primary
prevention is key, those without chronic health issues are also encouraged to participate, especially if
they are new to exercise. We work closely with Behavioral Health, Nutrition, Respiratory Therapy,
Yoga Therapy, the Heart Failure Clinic, and Partners in Aging to provide well-rounded patient care.
What times do you have groups and how many patients to do you see in a group and per day?
Phase II Cardiac Rehab is offered Monday, Wednesday, and Friday at 9:00, 10:30, 12:30, 2:00, and
3:30. Each group has 1-4 patients (usually 2 or 3). We see up to 15 patients per day. Pulmonary
Rehab is offered Tuesday and Thursday at 10:30am. Wellness for Life is Tuesday and Thursday 9:0010:30am and 3:30-5:00pm. All first visits are done on Tuesday and Thursday.
What are your patients to staff ratios?
Cardiac Rehab = 3:1, Pulmonary Rehab = 4:2 (RT always present), Wellness for Life = 4:1
What are your therapists credentials?
One full-time Exercise Physiologist has a Master’s degree in Exercise Science. One casual Exercise
Physiologist has a Bachelor’s degree in Cardiopulmonary Rehabilitation. Both have ACSM Clinical
Exercise Specialist certifications and ACLS.
Do you have education classes for your patients?
Since our patient-to-staff ratios are so small, we are able to offer thorough education as they exercise.
Individual referrals are made to Nutrition and Behavioral Health. Through our Heart Failure Clinic, any
patient can attend A&P/Pathophysiology, Medication Management, Cardiac Nutrition, and Energy
Management classes.
What is your facility layout, equipment, square feet?
We have a gym (1750 sq ft), 6 exam/consult rooms, and 2 office areas for all the rehab services. We
have 2 treadmills, 2 NuSteps, 1 ergometer, and 1 Airdyne for cardio equipment. For resistance
training, we have leg press and lat pull-down machines and dumbbells.
Anything else you would like people to know about your program? New ideas different programs…
Our cardiac rehab program has been continuously certified since 2006. We have been actively using
the AACVPR Registry since July 2012. We are working on a structured transition process for Wellness
for Life patients to the Red Wing YMCA. Since we do not have enough equipment to support a large
maintenance program, this transition will include detailed exercise recommendations from our Exercise
Physiologists and regular check-ins with the YMCA staff.
MNACVPR