Spring 2011 Newsletter members only:

Letter from the President

Happy Spring to you all, at least we hope it has finally arrived!   I was asked to report at the beginning of March. My hope was to have this President report out by the second week of March after attending the “Day on the Hill,” however, good intention fell through.  As most of us are well aware, we seem to be very busy on a tight budget and wear too many hats in our smaller hospitals thus causing my delay in  reporting.

Our annual conference is just two weeks away and I hope most of you are trying to attend or at least send someone from your program.  We have a good line up of speakers.  The planning committee has been working hard.  We have intentionally planned a round table discussion at the end of the day to  promote discussion on areas we struggle with, so hopefully we can take back ideas to improve our programs.  In addition to the speakers, we will have our annual business meeting and are looking for a President-elect and Treasurer.  I want to encourage all of you who would like to become more involved with MACVPR to consider running for these offices.  There are many members who have already held these positions and are ready to assist in anyway we can to help you succeed.

March 2 and 3, 2011,  I attended the “Day on the Hill”.  I partnered up with Jeff Redekopp, who mentored me through this whole process.  Jeff did a great job explaining the information to his Congressman from North Dakota making it look very easy!  He then was able to attend my meeting with Congressman Rothberg’s Chief of Staff.  In addition, Dr Murry Low, Karen Lue, and I met with Senator Baucus’s Financial committee staff to  discuss the same issue of “physician supervision”.  We are asking Congress to signal to Centers for Medicare & Medicaid Services (CMS) that the “physician supervision” legislative language in the Cardiac and Pulmonary Rehabilitation statutes in Public Law 110-275 (passed July, 2008) was not intended to exclude physician extenders (NPPs or non-physician practitioners, such as physician assistants and nurse practitioners) in providing that supervision. As of January 2011, CMS allows many aspects of physician supervision, within state scopes of practice, to be provided by physician extenders, but has excluded cardiac and pulmonary rehabilitation programs, for which CMS continues to require a physician (MD or DO).   The best solution is a “technical correction” to the statute that would clarify this flexibility”. (AACVPR 2011 DOH report).  The work is not complete yet!   We are currently waiting for a bill number and then I will notify you all to help us encourage our Congress to support the bill.  All of us need to help facilitate the follow-up. We may be still working on this issue as late as this fall so please be on the watch for further information.

I hope to see you all at the Conference and please bring any concerns question or ideas to help each of us improve our programs.

Debby Lee BSN, RN-BC
MACVPR President

A “Big Howdy” from the Outcomes Committee

Submitted by Mike Mcnamara

The Outcomes Project continues to grow and expand its reach.  We now have over 125 programs from 16 states that are taking part in the project.   Our last reporting period in January had a sample size of over 3200 patients – that’s quite a change from our first quarter when we had 189 patients.  Our total sample (July 2006-Sept 2010) now includes over 21,000 patients.

We’ve submitted 3 abstracts using the outcomes data to AACVPR for the annual conference in September.  The topics include: changes in depression scores that occur during CR, the Michigan group submitted an abstract looking at a QI project geared toward improving A1c testing rates and the final one is comparing MACVPR program results to all the rest of the programs – this one highlights how well you guys are doing vs. everyone else.

We are current updating the reporting spreadsheet and will have that out to everyone by April.  Some changes that you need to be aware of include:  adding ASA usage as an indicator, adding Quitline referrals as an indicator, we are also adding pre BP readings so we can compare pre to post BP readings.  There will be some other minor changes as well.  We will cover all of these changes at the conference in April.

I hope to see all of you in Helena for our annual meeting on April 7th at St. Pete’s.  Remember those programs involved with the outcomes project get one free pass to the conference.

Take care.

Committee members:
Mike McNamara – [email protected]
Cathy Lisowski – [email protected]
Casey Sheldon – [email protected]


Treasurer Report March 2011

Submitted by: Ashley Sorensen MS CES CSCS PES HFS CSSE

Hello Everyone!

The time is coming for me to step down as treasurer. It has been a great experience! We will be looking for volunteers at this year’s conference to step up and fill my position. If interested, or have questions about the responsibilities of the treasurer, please email me at [email protected] or contact one of the other officers for information.

This year’s conference will not only offer the benefit of networking with other programs and hearing a great lineup of speakers in the cardiac and pulmonary field, but your program will also receive FREE Membership for at least one person attending. Reminder: You still need to fill out and submit a membership application that can be found at:

If you are attending the conference and you have not submitted your membership application, you will not receive the discounted rate of $75 for the conference. Nonmembers need to pay $100. Yet another great reason to submit your application prior to the conference!

This year’s conference is sponsored by the Montana Department of Public Health and Human Services Cardiovascular Health Program, Cardiac Science and ScottCare.

A BIG THANK YOU to all our sponsors! This conference wouldn’t happen without you!

As I prepare to depart from treasurer of MACVPR, I would like to thank all the officers that have helped along the way. You are all one of a kind! You do an amazing job and I am happy to have been part of such a great organization.   Thank you!

Ashley Sorensen
MACVPR Treasurer

On behalf of the leadership and membership, a huge Thank You Ashley!!  You have contributed a great deal to the organization, from organizing our check book, to filing the paperwork to make us a legal non-for profit, to getting our website re-vamped.  You have so many skills, are so proficient and efficient, and, like I’ve told you many times…you need to be someone’s project manager…like maybe the President’s (of the USA)!

Good Luck to you and CONGRATULATIONS on your recent engagement!  I hope John is aware that he is one lucky man!

Reimbursement Updates:

Submitted by: Cathy Lisowski

Day On the Hill

Debby Lee is our MACVPR  representative in Washington DC this year.

Her efforts will be focused on lobbying for passage of a bill to allow the use of nurse practitioners (NP) and physician assistants (PA) for the supervision of these services. This effort is of particular importance for critical access and rural hospitals which may not have a physician on site but are required to do so for CR and PR supervision.


Billing for Sessions Beyond 36

Beginning on January 1, 2010, a patient with COPD who receives pulmonary rehab sessions beyond # 36 should have a KX modifier attached to the G0424 code that is billed to Medicare for that service. Providers (your billing office) were made aware of this through Transmittal 1966 (Change Request 6823) released on May 7, 2010 (6823.5). This holds true whether the patient is continuing one course of PR beyond 36 initial sessions or returns months or years later for further PR due to new medical necessity. The transmittal also clarifies that sessions beyond 72 will be denied regardless of whether the KX modifier is used or not (6823.5.6).


Use of HCPCS Codes

Your program should now be finding success using the HCPCS code 93797 for “CR services without continuous monitoring”. This was effective for Medicare claims with dates of service on and after January 1, 2010, per Transmittal 1974 (Change Request 6850), issued on May 21, 2010 (6850.1). Remember, CMS does not reimburse physicians for any general or direct supervisory role for CR, PR, or for other such supervisory services provided in hospital outpatient settings. Please make sure this is not erroneously occurring in your institution.

Medicare-Required Hospital Cost Reporting

Thank you for submitting verification of your hospital’s use of the nonstandard cost center to report cardiac rehabilitation on your institution’s Medicare Hospital Cost Report. This is critical information that AACVPR needs to know to determine whether there will be enough data for CMS to accurately calculate the current under-payment that is occurring for this service.


Book Review:  Prevent, Halt & Reverse Heart Disease

Authors Joseph C. Piscatella and Barry A. Franklin, Ph. D.
Copyright 2003, 2011 Workman Publishing Company

I received a complimentary copy of this book and am currently reading through it.  I must say that I’m finding it very informative and written in such a way that I think it would be a valuable resource for our cardiac rehab patients.  I am writing this review not because I’m receiving “incentives” by the authors (hint: a trip to Hawaii would be nice), but because I think our patients would benefit from it as a resource.  It is very well written, affordable—under $20 with shipping and packed with a lot of good information. The authors details “109 Life Skill Tips” that we can do to prevent, halt and reverse heart disease.  Who doesn’t want this information?  It really is a great resource for anyone interested in prevention, but I would think especially informative for someone newly diagnosed with heart disease and hungry for information.

The book is divided into four steps:

1) Assess your Cardiac Risk.  This is an in depth analysis of the 10 critical markers for cardiac risk.  I learned new information on cholesterol ( Lp(a) or lipoprotein (A), Apolipoprotein B (Apo B), Pattern A and B particles which reference the size and number of LDL particles).  All the other risk factors we know so well are comprehensively reviewed, but in addition C-reactive protein, clotting factors and new information regarding personality and behaviors that contribute to heart disease.

2) Managing daily stress.  In this section, there are 29 strategies for reducing stress as well as a thorough discussion on why stress is such a major player in cardiovascular health.

3)  Make Exercise a Habit.  This section discusses everything from the cardiovascular benefits of exercise, weight loss, reduction of the affects of aging…and nearly 30 strategies to incorporate more activity and exercise into your life.  Ideas that even the greatest resistor can manage.

4)  Balance your diet.  This section is approximately one third of the book.  It is packed full of good information such as portion sizes,  counting carbs, vitamins, antioxidants, flavinoids, fiber, soy protein, good fats/bad fats, sodium, caffeine.. much, much more.

The book ends with a section on “Prescriptions, Procedures and Programs”.  This discusses everything from aspirin, statins, and hormones; to an explanation of cardiac testing and interventional techniques and, important to us, reasons why patients benefit from participating in an outpatient cardiac rehab program.

In summary, this was a great read for me and I would highly recommend it to you, and our cardiac rehab patients. If you would like more information,  email [email protected] or visit him on facebook:

Erika Schreibeis
[email protected]


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