Winter 2011 Newsletter members only:

Letter from the President

In September, the MACVPR board met on a teleconference call to gear up for a new year,  transitioning new officers and begin  planning for our 2012 spring conference.  On that call, Susie Mathis, our President for the up coming term, reported that she had just been diagnosed with breast cancer.  She will be undergoing treatment with surgery, chemo and radiation likely to follow.  As this was a shock to all of us on the call, I spoke up and offered to continue the roll of president.  The board members felt this was a good decision as we certainly wanted to free Susi from this responsibility.  However, in reviewing the bylaws, the directive is that should the president not be able to fulfill their responsibility, the president elect should fill the position.  As a board, we discussed this on a teleconference in October and asked Casey Sheldon how he would feel stepping into the role of president.  The original idea was that as he served a term as president-elect, he would be mentored by Susi for the role as president , as they work together in Missoula.  Casey, understandable, was uncomfortable assuming the role as president at this time.  As a board, we feel it is best for the organization and the individuals impacted, that I assume the role of president again.  We do need to amend the bylaws and Erika will be sending out a ballot for the membership to respond to.  It will be a simple change to state “If the president is absent or unable to perform all the duties of the President, the president elect or past president, by direction of the Executive Board, will perform all the duties of the President.”  There are other small changes that need to be added to the bylaws.  These will be presented at our next annual meeting, discussed and approved at that time.  We did want the membership to be aware of the situation with the presidency at this time and give opportunity for comment.  The ballot will be forthcoming.

At the time of writing this, I have spoken with Susie who gave me permission to share this personal information.  We all need to keep her in our thoughts and prayers as she progresses through the treatment options.

Bylaw change:  Article V-Officers—Section 2 A.  President.  Add an ending sentence.  “In the absence or disability of the president, either immediate post president or president elect can fulfill the term.  This will be under the direction of the Executive Board, and to serve the best interests of the organization for continuity of leadership.”

Please give this some thought, and if you have any concerns, please let me know.

The ballot will be coming out in January.

Have a great Holiday!

Debby Lee BSN, RN-BC
MACVPR President

A “Big Howdy” from the Outcomes Committee

Submitted by Mike Mcnamara
I just finished sending out the Apr-June feedback reports. I received data from 138 programs representing 20 states and our sample was nearly 4,000 patients. This is the first quarter since we started tracking pre and post BPs, aspirin usage and smoking cessation referrals. Overall we saw a small drop in both SBP and DBP pre to post rehab. Ninety-four percent of the patients were taking ASA or other anti-platelet/anti-coagulant meds and our smoking cessation referral rate was 63%. Smoking cessation referral looks like a good QI project for our affiliate. MACVPR programs reported 63% referral rate which was higher than the national average of 56%. Even though MACVPR beat that national referral average, I think we can do better. I encourage all of you to provide Quit Line info to all patients entering your program that are or have recently quit smoking/chewing. Click here for more information on the Quit Line

The Montana Outcomes Project is still growing but I suspect that when AACVPR’s National Registry kicks-off in June of 2012 we will lose some programs. Not to worry though, the Montana Outcomes Project will continue to exist as long as we have funding and there are programs that submit data to us.

If you have any questions about AACVPR’s National Registry Project please contact me.

Take care.
Committee members:
Mike McNamara – [email protected]
Cathy Lisowski – [email protected]
Casey Shelden – [email protected]

Reimbursement Updates:

Submitted by Jeff Redekopp and Cathy Lisowski—Reimbursement Committee

Pulmonary Reimbursement

At the beginning of this month CMS rolled out their final ruling on Pulmonary Rehab reimbursement using the code GO424. Unfortunately the news was not good; reimbursement is being cut from an average of $63 per session to $37 starting 1/1/2012. From our AACVPR President Steve Lichtman “The reason for the payment reduction primarily lies with hospital “charges” that are reported by hospitals to CMS on their claims data.” AACVPR is developing a strategy for responding to these cuts. As soon as information is available , I will send out an e-mail with the details on how programs will be asked to get involved with this effort. Please forward this to all programs in your state. Sorry for the bad news before the holidays.

Cardiac Reimbursement

The ‘pass’ for Clinical Access Hospital’s (CAH’s) on physician coverage has been extended through calendar year 2012. This means that CAH’s will be able to continue to operate CR/PR programs with a NPP (Non Physician Practitioner) on-site in the event that they are not able to have a physician on-site. The NPP legislative push is on hold due to the budget crisis. However, a champion for the legislation has been identified: Megan Teran, senior health staffer for Chuck Shurmer.

Treasures’s Report

Submitted by Shannon Isakson

As of November 17, 2011, the balance in the MACVPR account is $9835.5. The last transaction ($250 withdrawal) was a donation to sponsor a table at the national AACVPR conference.

Montana Continues Growing

Debby Lee, MACVPR President

The Montana Association Cardiovascular and Pulmonary Rehabilitation (MACVPR) held our annual conference April 7 in Helena. We had 45 participants from around the state. Our featured speaker was Dr. John Porcari, who spoke on exercise physiology for the non-exercise physiologist and exercise prescription. Other presentations included pulmonary hypertension by Dr. Anderson from Great Falls, and diagnostic test for the cardiac patient by Dr. Kinsley from Helena. We also had our annual report on the Montana Outcomes Project, in which Mike McNamara reported that we are currently growing and doing well with the outcomes project! Our evaluations for the conference were highly marked, and we look forward to planning our next conference.

MACVPR also participated in the AACVPR Day on the Hill. MACVPR President Debby Lee represented us and was able to meet with a team from Senator Baucus’s Senate Finance committee, along with Dr Murray Low and Karen Lui. In addition, Jeff Redekopp assisted Debby by allowing her to team up with him to meet with Congressman Rehberg and the Congressman from North Dakota. As reported from AACVPR, the reception was well received, with the comment, “It makes sense.” DOTH was a great experience, and we encourage anyone who wants to get involved with the future of Cardiac and Pulmonary Rehab to attend this great event! For information on our association, check out

Mark Your Calendar

The annual MACVPR Conference is in April 12, 2012 at the Billings Clinic.  This is the day before the Summit which will also be held in Billings on April 13 (Yes, Friday the 13, I hope the  speakers make it and it’s not a blizzard) at the Holiday Inn.  This year we have already asked for speakers to speak on topics of leadership coaching, managing the business of Cardiac Rehab, interesting cardiac cases and are close to having a well experienced speaker in pulmonary rehab come to talk on the nuts and bolts of pulmonary rehab.  Many of us in Montana are just starting pulmonary rehab and the planning committee felt this may be helpful to those of us starting our program and a good reviewed who have their programs up and running.  We will try to keep up posted on the conference.

Lastly, we sponsored the AACVPR conference again this year which I was able to attend.  The conference, as usual, was excellent, full of information, and updates on the national movement in both areas of Cardiac and Pulmonary rehab.  Reimbursement in cardiac and pulmonary rehab seems to be a never ending battle and I am glad we have such strong leadership at the national level that has such compassion to see things through.

Please vote on the bylaw changes ASAP and remember to mark your calendars for annual conference!

Happy Thanksgiving
Debby Lee

Latest JAMA Study on New Drug to Increase HDL

Submitted by Erika Schreibeis

Did you know this?  A recent new study demonstrated that the “good” cholesterol, HDL, is increased, and so-called “bad” cholesterol, LDL, is decreased by a new, as yet unreleased drug, Evacetrapib.   Published last month in the Journal of the American Medical Association (JAMA– November 16th issue), the study demonstrated that HDL can more than double when  compared with placebo and LDL was decreased up to one-third.   ScienceDaily (Nov. 15, 2011) — Among patients with sub-optimal low-density lipoprotein cholesterol (LDL-C) or high-density lipoprotein cholesterol (HDL-C) levels, use of the drug Evacetrapib alone or in combination with statin medications was associated with significant increases in HDL-C levels and decreases in LDL-C levels.  The study is being released early online to coincide with its presentation at the American Heart Association Scientific Sessions

 The study, titled “Effects of the CETP Inhibitor Evacetrapib Administered as Monotherapy or in Combination With Statins on HDL and LDL Cholesterol“ (JAMA November 16th issue), was both double-blind and placebo-controlled.  The 398 subjects were people with low HDL or high LDL cholesterol levels, but who were also considered to be at low risk of developing heart disease within ten years.  The study’s purpose was to see if HDL levels would increase, and LDL and triglyceride levels would decrease. They did, and to a significant degree.  The Evacetrapib trial was a success, with HDL increased as much as 126.1% – more than doubling, LDL decreased as much as 51.4%, and triglycerides decreased by more than a quarter.

This could have a dramatic impact on our cardiac rehab patients in the future.  Of course, wouldn’t you know that just when Lipitor becomes affordable, a new and probably very expensive, drug will take its place.

Butte Christmas Party

St. James Healthcare is having a Christmas party for our 20 medical exercise phase III patients on December 15, 2011 at 5:30 PM at the Montana Club in Butte, MT. Some of the patients who are attending the dinner have exercised in our program for as long as 9 years. They are past Cardiac Rehab patients who have chosen to remain exercising and over the years have become 2nd grandparents to myself. The party will be the first one put together from our Cardiac Rehab Staff and Medical Director Sharon Hecker. The idea came from the Wisconsin Lacrosse’s program for Cardiac Rehabilitation, which I had the wonderful opportunity of visiting last September. They have done a Christmas party for their patients for several years as a way of bringing patients together to socialize and build long lived friendships. Each patient pays for their own dinner and the hospital sponsors those that cannot afford a dinner and hors d’oeuvres. The dinner will have a remembrance for those patients who have passed away this year and will be in our memory always. We are in hopes of a great turn out and a fun gathering.

Shannon Isakson RN
St. James Healthcare Cardiac Rehab.
Butte, MT


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