Northwest Cardiovascular Pulmonary Rehabilitation Association
Spring 2013 News NWCVPR President: Carol Milliron
NWCVPR News Editor: Dana Gunter
A Message from the Association Past President….
NWCVPR friends and colleagues,
Happy spring 2013!
I trust you are enjoying longer, windy days and maybe an after dinner walk. Did you celebrate CR or PR Week? If you had a special event, please share your story witheveryone on our blog, Our Spotlight Program in this newsletter, Swedish Medical Center-Edmonds Campus, Edmonds, WA had their first annual Patient Reunion, they served heart healthy snacks and encouraged former patients to come back and socialize. A fun event that they will continue for sure. This is the idea of course, to build community within your program, hospital and the surrounding population.
Here’s what’s in this newsletter: There are some very important articles regarding reimbursement which we have run multiple times to date. We have chosen to keep the topics alive because they are vital to the survival of CR and PR in the current economic and reimbursement service climates. We are running Pulmonary Rehabilitation: The Cost of Running a Program in the newsletter a final time because we want to try to reach as many clinicians as possible. We have however, moved this article as well as other current reimbursement information to a separate word document (and PDF format document) so that you can refer to them easily. You will find these documents attached to the email including the Newsletter. We still need your assistance in monitoring reimbursement concerns, if you haven’t already followed the call to action, please take action now. To further the reimbursement issues, we have included information about the recent Day on the Hill that AACVPR sponsored. Joyce Kratz-Klatt and Ivy Hollinrake attended on behalf of NWCVPR. You will findtheir stories inspiring and informative. You may even consider a trip to DC next March! Joyce has included an attachment that lists our state level Senators and Congress persons to
contact.A quick email or call to let them know your thoughts on the federal non-physician supervision issue S-382 for Cardiac Rehab would benefit our programs and patients in rural areas.
We are introducing two new sections in this newsletter, our Young Professional section and, Current Article Review. Each quarter we will review a current article related to cardiac or pulmonary rehab. This quarter we are reviewing ‘Resistance Training and Diabetes’ by Wayne L. Westcott, Ph.D. For future newsletters, if you have an article you want to review please send your idea to me at
AACVPR has recently encouraged members to ‘Instill lifelong activity habits in our youth’. See the article regarding the recent USDepartment of Health and Human Services report “Physical Activity Guidelines for Americans Midcourse Report: Strategies to Increase Physical Activity Among Youth”. You will find this information under AACVPR News along with a link to the Youth Sports Safety Alliance (YSSA). This group recently met in Washington DC to draft the “National Action Plan for Sports Safety”. Following this meeting, the information was adopted by the 113th Congress as House Resolution 72, “The Secondary School Athletes Bill of Rights”. Since March is Athletic Training month, I want to bring attention to YSSA, founded by the National Athletic Trainer’s Association and currently over 90 members strong.
Best regards,
Dana Gunter
Immediate Past President
NWCVPR
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In this edition….
Page3Pulmonary Rehab: The Cost to Run our Programs- CALL TO ACTION!
Page5NEW FEATURE: CR or PR Article Review
Page 6Reimbursement-High Co-Pay Webinar- Date TBD
Page7NWCVPR CALL TO ACTION! for High Co-Pays
Page 8Reimbursement Notes
Page8AACVPR News and More: Instilling Activity...
Page9Let’s Play-ACSM World Heart Games
Page10Youth Sports Safety Alliance
Page 11AACVPR Day on the Hill in Washington DC 2013
Page 11NWCVPR goes to Hit the Hill Day 2013
Page15Program Spotlight: Swedish Medical Center-Edmonds Campus- Edmonds, WA
Page 17FEATURE! Young Professional Spotlight: Micaela Kruckenberg
Page 18Bibliography from page 5
Pulmonary Rehab: The Cost to Run our Programs
This information was first published in our September Newsletter. We are including it again because it is so important that EVERY PULMONARY REHABILITATION PROGRAM begin to/or continue reviewing their program charges and revise them to reflect their ACTUAL COSTS to the hospital or to the private corporation managing the program. If every program throughout the United States submitted actual costs for conducting our programs then when CMS revises coding charges we will be paid reimbursement costs that are viable for sustaining programs. Please read below to find out what your program manager needs to understand.
At the end of this article we have asked that you:
1)Review the information on the AACVPR website regarding Pulmonary Rehabilitation Outcomes Resource Guide (formerly the Pulmonary Rehab Toolkit), Guidance to Calculating Appropriate Charges for G-0424 and,
2)Meet with your program/hospital billing office to find out what you currently bill for
G 0424 and, what, if anything, you could adjust to reflect actual costs to run your program.
3)Finally, we would like you to send our Reimbursement Committee an update of what you have done and your current or updated charges for your program's G-0424 billing. We want to include your information into our collection data for AACVPR to track ALL PR program efforts to effect change in CMS payments. This may be the only way to keep Pulmonary Rehab viable and continue to provide the services to our respiratory patients.
PULMONARY REHABILITATION PROGRAMS-EVALUATING G-0424
AACVPR is advising all Pulmonary Rehab programs to review their charge for CPT Code G 0424.
AACVPR is implying that most programs are not charging enough for their services based on the
current reimbursement rates. Typically, programs do not include all the services they perform in their billing to Medicare because they have been told that they are not reimbursable services. AACVPR understands we will not be reimbursed for many of the services, however, IF we provide these services we should be billing for them. The median charge submitted to Medicare in 2010 was $150 which translated to the reduced reimbursement rate of $37 for this year and will be ~$40 in 2013. (It was $63 in 2011)
The CALL TO ACTION:
- Please take the time to read through the attached “Pulmonary Rehabilitation Outcomes Resource Guide”(formerly the “Pulmonary Rehab Reimbursement Toolkit”) provided by AACVPR. Or, you can go to:
- Find out what your hospital or program charges for G 0424. Review your charges with your finance department and administrator. Determine if you need to change your charge amount and if so, to what.
Background:
CPT Code G 0424 is the required code to use for any Pulmonary Rehab session for a patient who is covered by Medicare and has a diagnosis of moderate, severe or very severe COPD (mild COPD is not covered; basis is FEV1.) This new code and regulation took effect under the new Medicare law 01/01/2010.
G 0424 is a "bundled service" code, meaning that Medicare recognizes that various services may be provided during a single visit (e.g., exercise therapy, oxygen therapy, pulse oximetry, Six minute walk, education, etc.). Consequently, Medicare had no specific data to base itsreimbursement for G 0424 in 2010 and 2011, other than an educated guess that charges submitted by hospitals for G 0424 would be significantly higher than charges for the other CPT codes (G 0239, G 0238, G 0237) used for Respiratory Services (that we call pulmonary rehab) for non-COPD Medicare patients and all other non-Medicare patients. Medicare applied its reimbursement formula to come up with ~$63 as a figure for reimbursement for G 0424 for 2010. Meanwhile, most hospitals kept their charges for G 0424 similar to their charges for G 0239. Then, when Medicare reviewed actual bills submitted by hospitals in 2010-11, it applied the same formula and decided that the reimbursement for G 0424 should be reduced to $37, effective 01/01/12.
Please let us know the outcome of your effort. This is a national effort. We need everyone to participate. A member of the Reimbursement Committee will follow-up with you.
Greg Lawson at <mailto:
Additional Note:
Starting in 2013, PR programs applying for certification or recertification must show evidence of one year of outcomes measurement. The toolkit provides key resources to assist your program in this transition to outcomes measuring; including tools to measure functional capacity, symptoms, quality of life and much more
New Feature: CR and PR:
Resistance Training and Diabetesby Wayne L. Westcott, Ph.D. in ACSM Certified News*Volume 22, Issue 3.
The following is a brief summarization of the identified article:
Decreased muscle mass directly influences the risk of developing glucose intolerance and diabetes because muscle tissue is the primary site of glucose deposit and utilization. Age related muscle loss may begin around age 30 and can reach up to a 10% loss per decade after age 50. Numerous studies have shown that resistance training is associated with gains in lean weight, which in turn results in greater glucose tolerance in adults with type 2 diabetes. This has been shown for adults, older adults, men and women, all with type 2 diabetes. In addition to glucose intolerance, Flack et al. found improved insulin resistance with resistance training in these groups.
More than one study has shown that resistance training alone may reduce abdominal and visceral fat, known to increase with age and negatively influence insulin resistance. Part of the explanation for this may be in the post-training muscle tissue remodeling processes which are believed responsible for increasing resting energy expenditure.
The American Diabetes Association supports resistance training exercise for people with type 2 diabetes, and recommends a training protocol consistent with the ACSM guidelines.
- ACSM general recommendations: 8 to 10 exercises per session, performing 2-4 sets of exercise for each muscle group, using a resistance that permits 8 to 12 repetitions. Emphasis should be on a complete movement range for the involved joint and controlled movement speed, and training 2-3 non-consecutive days a week.
- ACSM recommendations for older adults are similar, but recommend beginning with a resistance that permits 10 to 15 repetitions at a lower effort level.
Improvements in glycemic control have been reported to result from a range of training volumes (4-9 exercise sets per muscle group per week) and training intensities (50% to 85% maximum resistance).
*References included from the article are listed on the last page of this newsletter.
NEW IN 2013! Co-pay Workshop/Webinar:
From AACVPR:
Title: Co-Pays with Medicare Advantage (see below for details)
Webinar Title:Co-pays with Medicare Advantage: Learn strategies for addressing one of the common barriers to accessing rehabilitation – co-paysAACVPR Health Policy & Reimbursement Update:
AACVPR Presents:Medicare Advantage and Commercial Co-pay Workshop Date and Time: TBD
This workshop was supposed to make its debut at DOTH in Washington DC but was cancelled due to weather. It will be run as a Webinar at a future date and through AACVPR for members. Look for it in your in-box or check in at
The traditional Medicare fee-for-service program sets beneficiary co-pays for cardiac and pulmonary rehabilitation at a specific, modest level, but in Medicare Advantage programs and commercial plans, there is wide variation in co-pays. In fact, Medicare Advantage co-pays may exceed the amount that is reimbursed. High co-payments are a well-documented barrier to patient enrollment and participation in cardiac and pulmonary rehabilitation.
This Co-pay Workshop will present strategies to address payers when rehabilitation is clinically indicated. Join speakers from the Centers for Medicare and Medicaid Services (CMS) and commercial insurance to learn how to negotiate solutions.
In preparation for the workshop and potential discussion with Congressional members, and since it is again the first of the year for meeting deductibles, now would be a good time for programs to track Medicare Advantage and commercial co-payments. The more documentation AACVPR has of the co-payment problem, the more accurately we can address the issue with CMS and private payers. You can send your information to .
Copyright 2012 American Association of Cardiovascular and Pulmonary Rehabilitation
NWCVPR – A CALL TO ACTION!
for Cardiac and Pulmonary Programs:High Patient Co-Pays:
Regarding the complaints recently over the relatively high co-pays for both Pulmonary and Cardiac Rehabilitation assessed on Medicare patients who are Medicare Advantage members:
Over the past 1 ½ years, there has been an increasing amount of referred patients who have high co-pays per visit ($30+). These co-pays are a potential financial threat to many programs if they become the norm and if most patients choose not to participate because of them. Most of these patients chose the Medicare Advantage plans that are managed by companies such as Humana, SoundPath, Regence, and many others. Most of these companies offer several tiers of coverage. The plan with the lowest per month fee has the highest co-pay per visit, and vice-versa. Most subscribing patients choose the lower priced monthly plan. Cardiac and Pulmonary rehab, while “covered” by most of these plans, are lumped in with “specialists” and thus have the high co-pay per visit. AACVPR is aware of this issue. The issue is more or less significant in different parts of the country. For example, apparently the co-pays in Florida are no higher than $15 since Florida Medicare Advantage plans receive more funding per capita than we do in the Northwest.
The CALL TO ACTION:
- Collect and submit the following data to NWCVPR Reimbursement Committee ( and include Co-Pays in subject line) in as much detail as you can for 3-6 months.
How many referred patients chose not to participate because of high co-pays?
How many participating patients reduced their LOS or dropped out because of these high co-pays?
What percentage do these numbers represent in terms of total participation in your program?
What is the name of the company and the plan?
Greg Lawson is the committee chair for NWCVPR’s Reimbursement Committee. He can be reached at <mailto:
Reimbursement Update on MAC-J-F (formerly J2+J3)
Please refer to and click ‘reimbursement’.
AACVPR Reimbursement Chairperson:
Joyce Kratz-Klatt
CARDIAC REHABILITATION WASHINGTON LIASON:
Greg Lawson
PULMONARY REHABILITATION WASHINGTON LIASON:
Heidi Jibby
AACVPR Announces CMS decisions for 2013
Please refer to and click ‘reimbursement’.
AACVPR News……and More
Instilling lifelong activity habits
Taken from a recent emailing from AACVPR to itsmembers:
In an effort to further the AACVPR mission of reducing morbidity, mortality, and disability from cardiovascular and pulmonary disease through education, prevention, rehabilitation, research, and disease management, we urge you to read the recently released U.S. Department of Health and Human Services (HHS) report Physical Activity Guidelines for Americans Midcourse Report:
Strategies to Increase Physical Activity Among Youth.
The report recommends implementation strategies to help young Americans increase physical activity in a variety of settings, as well as strategies to use these recommendations to inform policies and procedures in both the federal government and communities.
Key findings from the study include:
1. School settings hold a realistic and evidence-based opportunity to increase physical activity among youth and should be a key part of a national strategy to increase physical activity.
2. Preschools and Childcare Centers that serve young children are an important setting in which to enhance physical activity.
3. Changes involving the Built Environment (community) and multiple sectors are promising.
4. To advance efforts to increase physical activity among youth, key research gaps should be addressed.
Instilling lifelong physical activity habits in our youth is critical to investing in the long-term well-being of our nation. We hope that you will share this guide with your peers in a united effort to increase physical activity in our nation’s youth and ultimately reduce the effects of cardiopulmonary disease in years to come.
Please find the full study, key messages, and report overview on the AACVPR Web site.
Sincerely,
AACVPR President Anne Gavic, MPA, FAACVPR
2013 ACSM World Heart Games – Reclaiming the Joy of Sports
Let’s Play!
2013 ACSM World Heart Games
The American College of Sports Medicine is hosting an Olympic-style competition for those with cardiovascular disease or related risk factors. The 2013 ACSM World Heart Games will be held May 17-18, in Decatur, Georgia.
ACSM invites anyone working in the CR profession as well as CR patients to compete in a variety of challenging but safe activities and go for the gold! Register now and discover what it means to “reclaim the joy of sports.”
Copyright 2013 American Association of Cardiovascular and Pulmonary Rehabilitation
Youth Sports Safety Alliance
The Youth Sports Safety Alliance (YSSA) comprises more than 100 health care and sport organizations and parent activists. The YSSA has a single goal: To make America’s sports programs safer for young athletes. Recently the group convened in Washington DC at the 4th Youth Sports Safety Summit. TheNational Action Plan for Sports Safety
was created toreduce the risks to student athletes while playing sports.Current exercise recommendations for youth; from the CDC, ACSM and other groups; are for children and adolescents to spend about 60 minutes a day engaged in physical activity, most of which should be aerobic. Physical inactivity increases the risk for heart disease, diabetes, colon cancer, high blood pressure and premature death. But physical activity is not without risk. Brain injury, sudden cardiac death, exertional heat stroke, exertional sickling, cervical spine fractures and other illnesses or injuries are all serious and potentially life-threatening. According to the National Athletic Trainer’s Association, as many as 50 youth athletes die each year, the majority from sudden cardiac arrest. And, it’s not just football;risk is involved in almost every extra-curricular activity such as cheerleading and marching band.