Embed Size (px)
Citation preview
AACVPR Program Certification
Moving Towards Program Excellence
Kim Beyer, BS, FAACVPRCo-Chair AACVPR Certification Committee
Columbia-St. Mary’sMequon, Wisconsin
DISCLOSURESThis presentation is a collaborative effort of the AACVPR Certification
Leadership Team. I have no other disclosures other
than a passion for program excellence and a strong belief in the AACVPR certification process.
Why Certify ?
• Alignment with current guidelines for appropriate and effective care
• Physicians can rely on your program as an extension of their care to the patient.
• Demonstration of excellence for state department of health or TJC surveyors.
• Insurance companies recognize that performance measures in patient care are part of the essential standards required for AACVPR certification.
• Many healthcare consumers would choose a certified over an uncertified program
• Patients and family members confidence in your program
Why Not ?
The AACVPR Cardiac and Pulmonary Rehabilitation Program Certification process
is the only peer‐reviewed accreditation process designed to review programs
based on their alignment with the latest evidence‐based medicine,
expert opinion, current regulations and measurement of
individualized patient outcomes, and to recommend certification based on that review.
Does your program HAVE to be certified?NO
But if you want to be AACVPR Certified…
A program must comply with current standards and guidelines as approved by the AACVPR
Board of Directors.
The application review team’s role is to measure your program according to these standards.
HARD WORK by AACVPR, a
team of volunteers and
YOU!!
AACVPRBoard of Directors
BOD LiaisonBonnie Anderson
Expert PanelPulmonary Chair
Trina Limberg
Expert PanelCardiac ChairJeanne Ruff
Certification Application Review Team
Co-Chair – Mark Stout
Certification Application Review Team
Co-Chair – Kim Beyer
Mentorship TeamChair – Barb Flato
Remediation TeamCo-Chairs- Barb Flato and Bob
Brown
Region 1Regional Lead
Region 2Regional Lead
Region 3Regional Lead
Region 4Regional Lead
AACVPR Program CertificationOrg Chart
Inter-Rater Reliability Testing
All applications thoroughly reviewed by a trained members of the Application Review Team
5% of ALL applications are automatically reassigned toanother member of the review team for a second independent review.
It is utilized in the certification process in order to assess the consistent evaluations of the same application. This strengthens the certification process and helps assure reliability of the review.
Application Review Process
• Programs recommended for denial are automatically reviewed by one or both of the Cert Team Co-Chairs
• Programs still recommended for denial are automatically reviewed by the BOD Liaison
• All program data is entered in a spread sheet that identifies the reason for denial for each page of the application
• Data is reviewed by the BOD for a final decision
• You are notified of the result by August 31st
• Full ApprovalApplication meets all required elements
• Eligible for Remediation Application meets most required elementsEligible for Remediation and Mentorship
• DenialApplication does not meet multiple required elements
Possible Submission Outcome
Due to the thorough review process, the availability of very clear and specific guidelines, and the availability of
numerous resources on the AACVPR website and through the Education Committee, individual programs
recommended for denial may not appeal.
• Program certification is valid for three years.
• Maintain at least one AACVPR member during the three year period to receive certification updates.
• All program certification requirements are expected to be adhered to throughout the entire period.
• The AACVPR Program Certification Committee reserves the right to perform a site inspection if indicated.
• Because you were certified does not mean that the information that you submitted last time will be automatically accepted for the next recertification. The requirements change from year to year as research and guidelines change.
Timeline
December 4, 2014: Application opens
February 28, 2015: Completed applications and payments due
March - May 2015: Program Certification Committee Review of certification and recertification applications
Aug 31, 2015: AACVPR Certification Center notifies all programs of final decision
June - Aug 2015: IRR process Co-Chair Oversight ReviewLiaison ReviewAACVPR Board of Directors reviews ProgramsCert Center prepares notifications and certificates
Sept-Oct 2015: Remediation process occurs mid-Sept through Oct
November 2015: AACVPR BOD vote on remediation results
Dec 31, 2015: AACVPR Cert Center notifies all programs of final decision
Certification is for Early Outpatient Cardiac or Pulmonary rehabilitation.
Review the application content and requirements carefully.
Certification and Recertification applications are now identical. Cardiac and Pulmonary applications are not.
Be Prepared BEFOREYou Apply
Your program must be in operation for one year prior to applying.
In order to participate in the AACVPR Program Certification process, you must have a current AACVPR member within your program and they should maintain membership for the 3-year duration of certification.
Be Prepared BEFOREYou Apply
The Time for a Self Assessment is Now
•Print a copy of the application
•Gap Analysis
•One Page at a time
Check the certification application resource page and the following available resources on the
AACVPR website www.aacvpr.org
If You’re Not SURE…
•Position Papers•Scientific Statements•Guidelines•JCRP•Cardiac and Pulmonary Rehab Fundamentals•Certification Application Resource Page
•Application Manual•Application Webcast•FAQ Section•Discussion Forum•Members Only Section•Enhanced educational opportunities
Consisting of volunteers from AACVPR Certification Committee Mentoring prior to submitting an initial application Mentor review of each application page Goal: 100% pass rate on initial certification submission Pilot Mentorship planned for 2014 to test the model
A Mentorship Team
Common Mistakes -“Tips For Success”
Fill in the program roster with all staff prior to starting the application. Be sure that you have a primary and secondary contact person or you will not be able to go further on the application.
All documentation will be requested with the initial application. No additional or newly created documentation will be allowed after the application is submitted. Don’t expect a reviewer to contact you during the review cycle to say “Could you please send me…” or “I see three of the five elements. Could you send me the rest?”
No reviewer-applicant communication
When documentation is required, there is only one option for submitting that information…. UPLOAD
UPLOAD: Simply scan required pages to upload documents directly as an attachment. The document is clearer and easier to review. If documents are unreadable or missing entirely, that page will be denied.
If you have problems with uploading documents, please contact the certification staff at 312-321-5146 Option 1 for assistance.
Application “Tips For Success”
Application “Tips For Success”
All submitted documentation must be HIPAA compliant with all patient identifiable information blacked out or removed, including patient name, date of birth, medical record number, admission number, address, phone number, spouse’s name, etc
All submitted documentation must be actual patient and/or program documentation. Blank sample forms will not be accepted. Only submit what is asked for. More is not better.
Submitted documentation should be neat and legible, with correct spelling and grammar.
There are text boxes for required narratives. Keep it brief and concise. There is a maximum number of characters allowed.
All applications must be received by the application submission deadline. No extensions will be granted.
All applications must be submitted online via AACVPR.
Application “Tips For Success”
Application “Tips For Success”
You will no longer need to anxiously read your emails waiting for a notice that the review of your application has started.
In order to uphold the consistent administration of the application requirements, reviewers will not be allowed to communicate with the applicants.
It will be the responsibility of each applicant to carefully read the application and to provide each item that is required. If the Committee Chairs or Liaison determine that clarification is warranted, you will receive an email and/or phone call and will be provided with instructions on the next steps.
Application “Tips For Success”
If you have questions while completing the application and can’t locate the answer, Certification Specialists are available Monday through Friday during business hours to assist applicants by email, live chat, or you can contact the call center 312-321-5146, option 1
Application fee for certification and recertification will be set annually by the AACVPR Board of Directors
All application fees must be paid in full by the final application submission deadline. The application will not be reviewed without payment.
Application “Tips For Success”
Printable versions of the current year’s application are currently available on the AACVPR website
When a required form or table format is required there will be a link in the application to obtain the form
Take advantage of all the available RESOURCES
The application and requirements may change every year.
Application “Tips For Success”
READ the entire application before you begin the process.
Be prepared BEFORE you apply. If in doubt… seek assistance through the Mentorship Process. Contact AACVPR for more information.
Remember that this is a CERTIFICATION process. MENTORING is a separate process that must take place before the application process begins.
From This………...To This
LIFE IS GOOD!!!
On to the Application…..
The Application
Staff Competency AACVPR defines
competency as skills, knowledge and critical thinking required to operate effectively in a Cardiac or Pulmonary program.
For the purposes of certification, must provide evidence of annual assessment of clinical/professional staff for competency and specific to CR/PR rehab
•Ways to assess competency
Check off stations Test/quizzes, Return demonstrationArticle review with post testITP Completion on a patient**BLS/ACLS counts as 1**
Staff Competency-Core Competencies
Providers of cardiac or pulmonary rehab services should possess a common core of professional and clinical competencies, regardless of their academic discipline.
For the purposes of AACVPR Program Certification programs must provide evidence of a minimum of four assessed competencies specific to the Core Competencies
Core Competencies-Cardiac
“Core Competencies for Cardiac Rehabilitation/Secondary Prevention Professionals: 2010 Update”
Journal of Cardiopulmonary Rehabilitation 2011;31:2-10
Core Competencies-Cardiac
Patient assessment Nutritional counseling Weight management Blood pressure management Lipid management Diabetes management Tobacco cessation Psychosocial management Physical activity counseling Exercise training evaluation
Core Competencies-Pulmonary
“Clinical Competency Guidelines for Pulmonary Rehabilitation Professions”
Journal of Cardiopulmonary Rehabilitation2007;27:355-358
Core Competencies-Pulmonary
Assessment:– Pathophysiology
and comorbidity– Professional
communication– Patient education
and training– Exercise– Psychosocial
Intervention:– Professional
communication– Patient education and
training– Exercise– Psychosocial– Emergency procedures
Outcome evaluation and follow-up
Staff Competency Requirements
Competencies must be assessed for all professional/clinical staff who directly report to the Cardiac or Pulmonary Rehab director or manager.
Staff listed on the submitted Staff Competency Table must match the clinical staff members listed on the Program Intake Form exactly.
You do not need to report competencies for the program medical director, ancillary or administrative staff, or consultants.
A minimum of four assessed competencies specific to the Core Components
Staff Competency Automatic Denial
DO NOT:
Submit general emergency, safety drills and in-services in the hospital facility, such as fire drills, infection control, safety inspections or health and safety reviews.
Submit documentation outside the stated date range. Submit competencies not specific to cardiac or pulmonary
rehab. Fail to submit a minimum of four core competencies.
Individual Treatment Plan (ITP) Requirements
Upload COMPLETED Cardiac or Pulmonary ITP that is HIPAA compliant
ITP must be a single document . (It does not need to be one page) EMR – Ugh!
ITP must be for an actual patient that has completed all required components
Assessment and reassessment scores must be on the ITP. Do not submit assessment tools.
ITP must be completed in the data collection period Must include physician signature and date at initial
assessment and at least 30 calendar days thereafter including discharge
NEW FOR THE 2015 APPLICATION FOR PULMONARY
• The Pulmonary Expert Panel Oxygen needs to be in a separate category on the ITP for the 2015 application.
• Starting in 2015, Oxygen will need to have a separate category with requiring Oxygen assessment, oxygen use and titration plan (goals, intervention, education) oxygen reassessment and oxygen discharge follow up.
• Oxygen Assessment• Oxygen use & titration Plan
Goals Interventions Education
• Oxygen Reassessment• Oxygen Discharge/Follow-up• Exercise Assessment • Exercise Plan
Goals Interventions
Exercise Prescription including Mode, Frequency, Duration, Intensity, Progression
Education• Exercise Reassessment • Exercise Discharge/Follow-Up• Nutrition Assessment• Nutrition Plan
Goals Interventions Education
• Nutrition Reassessment• Nutrition Discharge/Follow-Up• Psychosocial Assessment• Psychosocial Plan
Goals Interventions Education
• Psychosocial Reassessment• Psychosocial Discharge/Follow-Up• Other Core Components as appropriate (Tobacco cessation,
Environmental factors, Medications (in particular inhaler medications), and Prevention/Management of Exacerbations, etc)
• Assessment • Plan
Goals Interventions Education
Reassessment Discharge/Follow-up
• Exercise Assessment • Exercise Plan
Goals Interventions
Exercise Prescription including Mode, Frequency, Duration, Intensity, Progression
Education• Exercise Reassessment • Exercise Discharge/Follow-Up• Nutrition Assessment• Nutrition Plan
Goals Interventions Education
• Nutrition Reassessment• Nutrition Discharge/Follow-Up• Psychosocial Assessment• Psychosocial Plan
Goals Interventions Education
• Psychosocial Reassessment• Psychosocial Discharge/Follow-Up• Other Core Components as appropriate (Tobacco
cessation, Medications, Diabetes, Prevention/Management of CHF Exacerbations, etc)
• Assessment • Plan
Goals Interventions Education
Reassessment Discharge/Follow-up
So whether paper or EMR, your ITP must include:
EXERCISE PLAN
EXERCISE REASSESSMENT
EXERCISE REASSESSMENT
EXERCISE PLAN
EXERCISE DISCHARGE
PSYCHOSOCIAL PLAN
NUTRITION PLAN
OTHER PLAN
OTHER ASSESSMENT
OTHER DISCHARGE
OTHER REASSESS
Individual Treatment Plan (ITP) Automatic Denial
DO NOT: Fail to submit a completed ITP with signed physician
approval at initial assessment and every 30 days thereafter on an actual patient who completed your program within the data collection period.
Submit an ITP that does not contain all of required elements clearly labeled
Submit multiple documents i.e. assessment tools, letters to physicians/patients., progress notes, etc.
Submit check boxes only indicating something was done but no data given. Must have assessment and reassessment data
Submit ITP that is dated outside the collection period
Medical Emergencies
For the purposes of AACVPR certification/recertification, written program specific policies/protocols for the following:
Cardiopulmonary Arrest Angina Acute Dyspnea Tachycardia – Atrial &Ventricular
Bradycardia Hypertension Hypotension Hyperglycemia Hypoglycemia
Medical Emergency Requirements
A department specific policy addressing all of the medical emergency conditions. They can be in separate policies/protocols for each specific condition or in one combined policy.
Policies specific to CR/PR and specific to the role of the CR/PR staff in managing the emergency situation. .
Medical emergency policies must be detailed beyond calling 911
Medical emergency policies must address the treatment of the patient from onset of signs and symptoms until resolution of the emergency (transfer to ED, hospital admission, resolution of symptoms, discharge home, etc.
If policy refers to hospital-wide policy, submit all related policies. IE Code Blue Policy, Code White Policy
Medical EmergenciesAutomatic Denial
DO NOT:
Forget to submit all department policies that address all nine of the medical emergency conditions.
Forget to submit any referenced policy ie Code Blue, Hypoglycemia Hospital wide policies.
Submit policies that do not include specific details related to staff involvement in treatment activities.
Submit policies that are ACLS protocols/algorithmsonly.
Emergency Preparedness(Cardiac)
Defibrillator/AED Portable oxygen, tubing, mask/nasal
cannula Intubation equipment and advanced
airways Crash cart with emergency
equipment and ACLS medications.
CARDIAC REHAB: For the purpose of AACVPR certification, the following emergency equipment and supplies must be immediately available to Cardiac Rehab and documentation maintained of verification of readiness performed every day the rehab program is in operation. Calling 911/EMS alone to bring these supplies/medications is not acceptable.
Emergency Preparedness (Pulmonary)
Defibrillator or AED Oxygen source and delivery apparatus Resuscitation mask (Ambu bag) Ability to monitor oxygen saturation
(pulse oximeter) Glucose First Aid Supplies
PULMONARY REHAB: For the purpose of AACVPR certification, the following emergency equipment and supplies must be immediately available to Pulmonary Rehabilitation unit and documentation maintained of verification of readiness preformed every day the rehab program is in operation. Calling 911/EMS alone to bring these supplies/medications is not acceptable.
Emergency Preparedness Requirements
One (1) month's documentation of daily verification of readiness for each day the program is in operation. An explanation should be provided for any missing dates during that month. If you are closed, write CLOSED
Narrative description of the specific location in relation to the Cardiac or Pulmonary Rehabilitation unit for each equipment/supply listed.
Dates and brief description of four (4) different department medical emergency in-services from the NINE medical emergencies listed on Page 3 specific to Cardiac or Pulmonary Rehabilitation held during 1/1/2014 through 12/31/14.
Brief description of medical emergency in-service Submitted in-services may include mock code blues, review of
crash cart/defibrillator, critique of an actual code, etc.
Date
3/12/13
Brief description of medical emergency in-service
In anticipation of a site survey prior to our hospital's successful chest pain accreditation the cardiac rehab team performed a Cardiac Alert Mock Drill.
Situation: A patient in the outpatient department complained of pain going down his left arm not responding to NTG x2.
Actions Taken: Code White called. Dr. A notified and arrived in 2 minutes. EKG completed and confirmed STEMI. Cardiac Alert called. 02/IV started. Dr. Alexander notified patient's cardiologist. Cath Lab team arrives in the department and places patient on stretcher to take immediately to the CathLab.
Problems/Concerns: Discussion of how to get an outpatient into the system without taking to ED and losing valuable time when we are adjacent to the CathLab. We determined that the Cath Lab could "schedule" them for a procedure in order to generate an account number.
Overall Assessment: All NSTEMI's need to go through ED for full work-up and all STEMI's will go straight to Cath Lab
Medical Emergency In-service
Policies and Procedure Requirements
Documentation that policies and procedures specific to Cardiac or Pulmonary Rehabilitation have been reviewed at least every three years by the program medical director and director/coordinator/managerduring the collection period.
Example of P&PSignature Page
There is a link to download this form on
the application
Policies and Procedure Automatic Denial
DO NOT:
Fail to submit evidence that department policies are reviewed at least every three years.
Fail to submit evidence that department policies are reviewed by the medical director and program director, coordinator, manager.
Submit documentation that is not in the collection period.
Exercise Prescription - Form The exercise prescription is
individualized, approved by the physician for each CR/PR patient
It must contain all required elements; mode, frequency, duration, intensity and progression
In addition to required elements, O2 saturation and titration for pulmonary rehab patients only
The Ex Rx can be a component of the ITP but it must be submitted for both the ITP (Page 2) AND the exercise prescription (Page 6).
Exercise Prescription - Policy
A written policy must be in place that details how an exercise prescription is developed and modified for each patient. The policy must contain all required elements of the exercise prescription; mode, frequency, duration, intensity, progression plus oxygen saturation and titration for pulmonary rehabilitation.
Exercise Prescription Requirement
Individual Exercise Prescription (EX RX)
Initial exercise prescription. Physician signature approving the exercise prescription. Includes mode, duration, frequency, intensity and
progression. O2 saturation and titration for PR patients only. Intensity targets must be within AACVPR and ACSM
guidelines Progression must be more specific than “as tolerated” or “as
dictated by absence of signs and symptoms”
Exercise Prescription Requirement
Exercise Prescription Policy
Describes in detail how all required elements of the exercise prescription are developed and modified.
Pulmonary programs must have a written policy on oxygen saturation and titration.
If you submit a document called Exercise Prescription from a telemetry monitoring system it MUST include all required elements of the exercise prescription. Must be completed for an actual patient . Must be completed during the data collection period 1/1/14
– 12/31/14.
Exercise Prescription Components
Mode: – Bike, Treadmill, Elliptical, Nustep
Intensity:– How hard (heart rate range, RPE, METs) Intensity targets
must be within AACVPR and ACSM published guidelines Duration:
– How long; minutes of exercise per session Frequency:
– How often, days per week Progression: What methodology is used to advance patients?
– “As tolerated” or “as per clinical signs and symptoms” is not acceptable.
– IE: Goal: Progress activity an average of ½ Met per week Oxygen Saturation and Titration (Pulmonary only)
Exercise Prescription Automatic Denial
DO NOT Fail to submit any of the required components of the
exercise prescription. Submit blank or not for an actual patient in your
program. Fail to have evidence of physician signature. Fail to submit a policy that addresses all components
of the exercise prescription. Submit daily exercise session sheets only. Submit document outside of the data collection
period.
Outcome Assessment
Outcome measures are tests to evaluate if a desired end is met. They can be used to evaluateindividual patient progress and to determine
overall effectiveness of the program.
Cardiac outcome categories:– Clinical– Behavioral– Health– Service
Pulmonary outcome categories:– Functional status/exercise capacity– Symptoms Measurement– Quality of Life– Service
Outcome Assessment Cardiac
ClinicalClinical outcomes measure objective clinical data, such as MET level, BMI, lipid levels, (6) six minute walk results, blood pressure, DEPRESSION, etc.BehavioralBehavioral outcomes measure the patient’s ability to make changes in life style: minutes of exercise per week, dietary changes, number of cigarettes smoked per dayHealthHealth outcome measure changes in health/quality of life status: Quality of Life survey (QOL)ServiceService outcomes can measure: patient satisfaction, effectiveness of program, access or utilization of services, cost of care
Outcome Assessment Pulmonary
FunctionClinical outcomes measure objective clinical data, such as MET level,
BMI, lipid levels, (6) six minute walk results, blood pressure, etc.Symptom Management - DyspneaMeasurement for symptoms of dyspnea and fatigue, such as Borg Dyspnea Scale, MRC Scale, UCSD SOBQ, CRQ, etc.
Quality of LifeHealth outcome measure changes in health/quality of life status: Quality of Life survey (QOL)
Service – Use Cardiac Rehab Outcomes Matrix Service outcomes can measure: patient satisfaction, effectiveness of program, access or utilization of services, cost of care
**See pulmonary rehab outcomes toolkit or AACVPR Pulmonary Rehab Guidelines**
Cardiac Outcomes Requirement
Description of one clinical, behavioral, health and service outcome. Measure an outcome listed on the AACVPR Outcomes Matrix
whenever possible Document from the data collection period. Description of the assessment tool used. Report on a minimum of 30 patients (N). If less than 30 patients
completed your program during the data collection period, submit data for 100% of the patients who did complete.
Pre and Post program score Percent change between the pre-and post-program scores.
Equation = (Post Score – Pre Score) / Pre Score = Percent Change Conclusion , a summary of results of the outcome measurement on the
pre-and post program scores. Process or programming improvements made to CR program as a
result of the outcome based on the conclusion.
Pulmonary Outcomes Requirement
Description of one outcome measure for each of the following; Function, Symptoms, Quality of Life and Service.
Outcomes correspond with the Pulmonary Rehab Outcomes Tool Kit. Use the Cardiac Matrix for examples of Service Outcomes
Document from the data collection period. Description of the assessment tool used. Report on a minimum of 30 patients (N). If less than 30 patients
completed your program during the data collection period, submit data for 100% of the patients who did complete.
Pre and Post program score. Percent change between the pre-and post-program scores.
Equation = (Post Score – Pre Score) / Pre Score = Percent Change Conclusion , a summary of results of the outcome measurement on the
pre-and post program scores. Process or programming improvements made to PR program as a result
of the outcome based on the conclusion.
Outcomes Automatic Denial
DO NOT:
Submit outcome measure that does not fall into the appropriate category according to AACVPR CR outcomes matrix or PR Outcomes Tool Kit.( references found on the AACVPR web site).
Fail to meet sample size requirements. Fail to submit any of the required elements.
Service Outcome
Required Elements– One Service outcome
measured in your program during the collection period.
– Description of the assessment tool used.
– Summary of conclusions based on the outcome change found.
– Description of process or programming improvements made to the CR/PR program as a result of the outcome.
Automatic Denial– Service measured not on
AACVPR Cardiac Outcomes Matrix or Pulmonary Rehabilitation Outcomes Toolkit
– Not in collection period
Attestation Statement
You must attest that all material and information submitted with this application is true and accurately represents program operations at this facility and would welcome a site visit if randomly selected.
Submission
Here you can see a list of any pages that are incomplete. When all pages
are complete, the submit button appears.
Don’t forget to click “SUBMIT”!
OPEN UP EACH AND EVERY FILE YOU HAVE UPLOADED TO
ENSURE IT IS CORRECT AND LEGIBLE BEFORE YOU SUBMIT!!!
2015 Application
Release date April, 2014 Continue with 4 different staff competencies ITP core measures = core components – other risk
factors Unexpected event log Please review the application as it becomes available and
pay attention to emails from AACVPR‐ changes are listed in the email
OUTCOMES
Health care more outcome based. Certification application in the future. Stay tuned to the certification site www.aacvpr.org Future educational offerings
AACVPR Registry support tools
CES‐D PHQ‐9 PSRF Survey MacNew BDI‐2 Duke Activity Status Index SF36/SF12 Ferrans and Powers QLI Dartmouth COOP
Diet Habit Survey Rate Your Plate‐ Heart MEDFICTS (from ATP‐3) Block Dietary Fat Screener
Resources for all tools available on AACVPR Registry Resources SiteWWW.aacvpr.org/Resources/OutpatientDataResourceswww.aacvpr.org/PRRegistrywww.aacvpr.org/CRRegistry
How Can I Help You Be Successful?
