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4/5/17
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Cardiac and Pulmonary Rehab Legisla6ve Update 2017
Janie Knipper, RN, MA, AE-‐C, FAACVPR AACVPR MAC Liaison, J5 & J8
IACPR April 7, 2017
jane-‐[email protected]
I have no disclosures.
Any opinions expressed are my own.
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ObjecPves AQendees will be familiar with:
Ø The role of the AACVPR MAC Liaison Task Force and the MAC Resource Group (MRG).
Ø Cardiac and Pulmonary Rehab billing and coding rules in current Medicare regulaPons.
Ø Medicare expectaPons for cardiac and pulmonary rehab documentaPon, including specific expectaPons of the J5 Medicare Contractor, Wisconsin Physician Services (WPS).
Ø Current issues related to cardiac and pulmonary rehab, including Nonphysician Provider supervision, off-‐campus services, Medicare Advantage Plans, and the Episode Payment Model & Cardiac Rehab IncenPve Payment Model.
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AACVPR MAC Liaison Task Force Ø Purpose: to develop, foster, & maintain a relaPonship with
each MAC (Medicare AdministraPve Contractor) Medical Director(s)
Ø Goals: 1. Provide a channel for two-‐way communicaPon on all issues
perPnent to cardiac/pulmonary rehabilitaPon (CR/PR) between providers of these services and the MAC
2. Serve as resource to MAC MD(s) to provide current evidence, best pracPce, clinical experPse and expert opinion on these services with both naPonal and local input
3. Assist MAC in ensuring quality CR/PR services through on-‐going educaPon of providers regarding MAC expectaPons/ regulaPons
4. Serve as resource to programs with regulatory quesPons/issues 4
Role of MAC Liaison for J5, J8
Ø Work closely with the Task Force (TF) team on determining best strategies specific to each MAC
Ø Have AACVPR/GRQ resources & support* available to foster the MAC MD relaPonship & address issues as they occur.
Ø Share progress & challenges with other TF members Ø Form a MAC Resource Group or MRG Ø Work closely with each state affiliate’s leadership for
opPmal funcPonality and producPvity of this TF
5 *Effective use of AACVPR dues
MAC Resource Group -‐ MRG Ø MRG in J5
Karen Hardy, RN, BSN (NE) Susan Flack, RN-‐BC, BSN (IA) Phone: (402) 717-‐9914 Phone: (515) 263-‐5422 [email protected] [email protected]
Debbie Dorshorst (MO, KS) Phone: (417) 830-‐4145
Ø ROLE: – Responsible for maintaining an effecPve communicaPon process from AACVPR to CR/PR programs in the MAC
– Maintain strong collaboraPon between affiliates within a MAC for successful outcomes
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Medicare Administrative Contractors (MACs) in Jurisdictions 5, 6, 8 and 15 will not be further consolidated.
Medicare AdministraPve Contractors
www.cms.gov
2016 Goal – MAC Liaison
Ø Meet face-‐to-‐face with MAC Medical Director(s) Ø Goal met?
Ø No – J5 MAC MD refused a face-‐to-‐face meePng Ø Dr. Cheryl Ray – “All communicaPon b/w providers and WPS must go through the Provider Outreach and EducaPon Office or POE”
Ø POE finally agreed to web-‐based call, but it would only include an RN from POE & representaPves from claims department
Ø June 2, 2016: Claims dept reps – no red flags seen in claims from J5 CR & PR providers
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Audits OIG, CERT, RAC, MAC Probe Medical Review
Ø OIG: Office of Inspector General Ø Congressional mandate to audit & invesPgate government branches
Ø CERT: Comprehensive Error Rate TesPng Ø Looks for errors in payments made by MACs
Ø RAC: Recovery Audit Contractor Ø Looks for errors made by providers
Ø BoQom Line: Hospitals can be financially responsible for refunding Medicare payments
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OIG Audit of CR and PR Ø Reviewed 100 random claims in one hospital Ø Findings:
Ø 46 of 100 claims were out of compliance with Medicare requirements
Ø 30 of the 46 claims related to the individualized treatment plan (ITP) Ø The ITP was signed aoer the iniPal date of service Ø There was NO ITP for a date of service Ø The ITP was not dated Ø PR did not meet psychosocial assessment requirements Ø CR session duraPon did not meet billable requirements Ø CR – no documentaPon of educaPon was provided Ø Lack of policies and procedures
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CGS Probe Medical Review
Ø OutpaPent CR with ConPnuous ECG Monitoring (HCPCS Code 93798) Ø Reviewed 100 claims in Ohio & Kentucky Ø ADR (AddiPonal DocumentaPon Request) – must be returned within 45 days
Ø BoQom Line: Make sure your business office makes you aware of any ADRs or denials for CR or PR Ø YOU know best what informaPon is important to include in the ADR – The ITP
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Medicare CondiPons for Coverage: Code of Federal Regula6ons
Cardiac Rehab: 42 CFR 410.49 Pulmonary Rehab: 42 CFR 410.47 Ø Each “provision” is 1.5 pages in length -‐ broadly wriQen
intenPonally Ø MACs are allowed some degree of interpretaPon in
compliance with these regulaPons
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Individualized Treatment Plan
The ITP is the only form of documentaPon discussed in the Medicare provision.
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EducaPon/Training DocumentaPon
Ø SuggesPon: Ø Brief narraPves
– Check box is not sufficient – Copious narraPve and repePPve data/
documentaPon not required or necessary – CMS cares about the ITP; not so much about daily
notes – Example of daily note: See ITP for
documentaPon of non-‐exercise components
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The ITP
SuggesPon: Ø If narraPves (including educaPon documentaPon) are
included in monthly summary (reassessment) in ITP, auditor is guaranteed to find necessary narraPve
Ø If narraPves are on another “form”, will an auditor find all required informaPon?
Ø ITP is the documentaPon (other than MD order) an auditor may use to assess compliance
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CMS Requirements for the ITP
Ø Individualized treatment plan = a wriQen plan tailored to each individual pa6ent
Ø Goals must be set for the individual under the plan Ø Outcomes assessment = an evaluaPon of progress as it relates
to the individual’s rehab Ø Exercise…as determined to be appropriate for individual
pa6ents Ø EmoPonal funcPoning as it relates to the individual’s rehab Ø CR: Cardiac risk factor modificaPon, including educaPon,
counseling, and behavioral intervenPon, tailored to the pa6ents’ individual needs
Ø ITP details how components are u9lized for each pa9ent
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Psychosocial Assessment 42 CFR 410.47: Ø Psychosocial evalua6on of the individual’s response to and rate of progress under the ITP
Ø WriQen evaluaPon of psychosocial assessment Ø What does the score mean? Ø What is the plan for the paPent based on score?
Ø Periodic re-‐evaluaPon, every 30 days vs beginning & end evaluaPons Ø Example: PHQ-‐9 score pre-‐rehab = 10 (<5=no depression) – repeat PHQ-‐9 at 30-‐day reassessment and discharge; include narraPve of acPons taken to decrease the score.
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Psychosocial Assessment AddiPonal assessment Ø Anxiety, Panic Ø Depression Ø Perceived social isolaPon Ø PercepPon of exisPng social support Ø TransportaPon: self; significant other; public transportaPon; Medicaid-‐provided transportaPon; etc.
Ø Lives alone or with another adult Ø Living situaPon: independent; assisted living; nursing home; stairs in home; bedroom located on ____ floor; bathroom located on ____ floor
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Medicare Compliance: ClarificaPon from WPS (J5MAC)
Physician Signature on the ITP: Ø ITP must be signed prior to paPent’s first exercise rehab treatment session
Ø WPS: “The iniPal assessment is for evaluaPon, and should not be a treatment session as well”
Ø MD signature comes aoer the evaluaPon, but prior to the first treatment session.
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CMS Medicare Benefit Policy Pub 100-02, Transmittal 124
Medicare Compliance: ClarificaPon from WPS (J5MAC)
Pulmonary Rehab ONLY: Ø Supervising physician must have iniPal, direct
contact w/paPent prior to subsequent treatment
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CMS Medicare Benefit Policy Pub 100-02, Transmittal 124
Medicare Compliance ClarificaPon from WPS (J5MAC)
“If the plan is developed by the referring physician or the PR physician…PR physician must also review and sign the plan prior to ini6a6on of the PR program.”
-‐CMS Medicare Benefit Policy Pub 100-‐02, TransmiQal 124 -‐Federal Register, Nov 25, 2009, pg 61883
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Medicare Compliance ClarificaPon from WPS (J5MAC)
Ø Supervising physician must have at least one direct contact in each 30-‐day period.
Ø WPS: “If a paPent is not present on the day the physician is present, it is necessary to reschedule the day for the direct contact with-‐in that 30 days”
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NOTE: MD cannot bill for direct patient contact
Initial evaluation of the PR patient is completed
The individualized treatment plan is developed based on the assessment findings
Medical Director/PR Physician signs the ITP
Patient begins the PR Program - Session 1
Medical Director initial, direct contact
Medical Director
initial, direct contact
Individualized Treatment Plan ITP must include -‐ Ø “a descrip6on of the individual’s diagnosis”
Ø Pulmonary Rehab = GOLD moderate to very severe COPD Ø Defined as chronic bronchiPs and/or emphysema in Federal Register, November 25, 2009
Ø GOLD 2017: “COPD is caused by a mixture of small airways disease (e.g., obstrucPve bronchioliPs) and parenchymal destrucPon (emphysema)”
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Federal Register, Vol. 74, No. 226, Wednesday, November 25, 2009, Rules and Regulations. Section 144.
Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report.
www.atsjournals.org/doi/pdf/10.1164/rccm.201204-0596PP.
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COPD Diagnoses with ICD-‐10 Codes
Ø BronchiPs, not specified as acute or chronic: J40 Ø Simple chronic bronchiPs: J41.0 Ø Mucopurulent chronic bronchiPs: J41.1 Ø Mixed simple and mucopurulent chronic bronchiPs: J41.8 Ø Unspecified chronic bronchiPs: J42 Ø Chronic obstrucPve pulmonary disease, unspecified: J44.9 Ø Unilateral pulmonary emphysema: J43.0 Ø Panlobular emphysema: J43.1 Ø Centrilobular emphysema: J43.2 Ø Other emphysema: J43.8 Ø Emphysema, unspecified: J43.9
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GOLD ClassificaPon of COPD
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Stage FEV1/FVC FEV1
I -‐ Mild COPD < 0.70 FEV1 >80% predicted
II -‐ Moderate COPD < 0.70 FEV1 50% -‐79% predicted
III -‐ Severe COPD < 0.70 FEV1 30% -‐ 49%
IV -‐ Very Severe COPD < 0.70
FEV1 <30% OR <50% with signs of
chronic respiratory failure
GOLD = Global Strategy for the Diagnosis, Management, and Prevention of COPD – GOLD Update 2017
Timeframe for PFTs prior to PR Ø 42 CFR 410.47 – No 9meline Ø WPS: “No Wmeline requirements to complete PFTs prior to
starPng a PR program, only that the GOLD classificaPon requirements must be met.”
Ø WPS: “No regulaPon that state PFTs need to conPnue on a yearly basis.”
Ø WPS: “Will only cover services that are reasonable & necessary for the treatment of a paPent at the Pme of service.
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*If you have a policy that states otherwise, change it! It is not based on any regulations.
Billing for CR and/or PR: Ø Exercise:
Ø PR (G0424): PaPent must have some exercise every session. Ø CR (93797 and/or 93798): PaPent must have some exercise every day.
Ø Session duraWon (BOTH CR and PR): Ø One session must be at least 31 minutes in duraPon. Ø Two sessions must be at least 91 minutes in duraPon.
Ø Not required to bill for two sessions if > 91 min. Ø KX modifier: MUST be used for any CR and/or PR sessions
beyond 36 in paPent’s Medicare lifePme. Ø This indicates to Medicare that addiPonal documentaPon should be requested to determine medical necessity
Ø PR services exceeding 72 session will be denied!
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Billing for CR and/or PR:
Ø Time limit: Ø PR: No Pme limit to complete PR sessions Ø CR: 36 weeks to complete up to 36 sessions
Ø Modifier 59: Ø Applies when one 93798 code and one 93797 code are used on the same day
Ø Does not apply to PR
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HIPAA Eligibility TransacPon System (HETS) HETS indicates the # of sessions of PR remaining for that paPent’s lifePme, but indicates the # of CR sessions used:
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HIPAA Eligibility TransacPon System
Ø Sessions were not tracked prior to 2010 Ø Any sessions completed prior to January 1, 2010 do
not count as part of the PR 72 session limit Ø HETS is ONLY for Medicare paPents Ø Private insurance companies may or may not have
session limits; even so, they DO NOT COUNT toward the Medicare lifePme limit
Ø Access to HETS: Ø www.wpsgha.com Ø Requires authorizaPon for use
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ClarificaPon from WPS – DocumentaPon of Physician Supervision
Ø WPS: Daily physician supervision log/record “is acceptable” Ø Log MUST accompany medical record
documentaPon if audited Ø WPS 2016: “DocumentaPon of physician supervision
should be somewhere in the paPent’s medical record for each day of service”
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RESPIRATORY SERVICES
For Chronic Lung disease other than COPD
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Respiratory Services (non-‐COPD)
Ø J5 MAC does NOT have a Local Coverage Decision (LCD) for Respiratory Services
Ø WPS: There is no plan to develop an LCD for Respiratory Services Ø NO list of approved diagnoses Ø No PFT guidelines
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SuggesPon: Ø Review PFTs for presence of chronic lung disease Ø Does the paPent have persistent symptoms despite medical therapy?
Ø Does the paPent have funcPonal limitaPons related to chronic lung disease symptoms?
Ø Does the paPent perceive impaired quality of life? Ø Has the paPent had increased health care uPlizaPon?
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Respiratory Services:
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Ø G0237: Respiratory therapeuPc procedure to increase strength & endurance of the respiratory muscles, each 15 minutes, 1:1, includes monitoring Ø G0238: Respiratory therapeuPc procedure to improve respiratory funcPon other than described by G0237, each 15 minutes, 1:1, includes monitoring Ø G0239: Respiratory therapeuPc procedure, group (2 or more individuals), includes monitoring – billed once per session Ø Plus other perPnent services provided with Respiratory Services
– 94664: IniPal Aerosol/Inhaler training – billed once per session
Federal Register, Vol. 66, No. 212, November 1, 2001
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Medicare Compliance ClarificaPon from WPS (J5MAC)
Use of 1:1 codes, G0237 and G0238 Ø WPS: 1:1 supervision must be medically necessary, or indicated or it should not be billed to Medicare.
Ø WPS: The same is true with a group session or class – if only one pa9ent aCends, this may not be billed as individual or 1:1 care unless medically necessary.
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CURRENT ISSUES FACING CR AND PR
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Nonphysician Providers ClarificaPon from WPS (J5MAC)
Can Nonphysician Providers (NPPs) independently order CR & PR?
Ø WPS: Nonphysician pracPPoners (NP, PA, CNS) are NOT allowed to independently order CR & PR services. There must be an MD co-‐signature on order/referral.
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Nonphysician Providers S.488/H.R.3355
Ø LegislaPon would allow qualified NPPs (PA, NP, CNS) to supervise CR and PR programs on a day-‐to-‐day basis Ø ALL Iowa Senators and member of House signed previous bill, but S.488 and HR3355 no longer exist
Ø New bill #s: H.R.1155; sPll waiPng for bill # for Senate
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DOTH 2017 Claire Shannon & Janie Knipper
Ø Senator Ernst Ø Senator Grassley Ø Congressman Blum – District 1 Ø Congressman Loebsack – District 2 Ø Congressman Young – District 3 Ø Congressman King – District 4
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*All Legislative Aides/Assistants/Health Policy Advisors verbally agreed to co-sponsor the legislation again!
New Off-‐Campus Program LocaPon MaQers!
Ø BiparWsan Budget Act of 2015: Aoer 11-‐2-‐2015, new off-‐campus hospital outpaPent departments will be reimbursed according to the Physician Fee Schedule (PFS), NOT according to the OutpaPent ProspecPve Payment System (OPPD). Began 1-‐1-‐2017.
Ø Bofom Line: Reimbursement is significantly less! Ø About 50% less for PR Ø About 2/3 less for CR
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Medicare Advantage Plans, Private Insurance and State
Medicaid Programs
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Medicare Advantage Ø All Plans don’t necessarily follow Medicare rules Ø A plan may or may not have a 72 session lifePme limit for PR
Ø Plans don’t track sessions in the HETS file – contact each plan directly
Ø Contact individual MA Plan to determine their rules
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Medicare Advantage (MA) Co-‐payments
Ø AACVPR/GRQ have been collaboraPng with CMS MA Plans Office since December 2014 Ø CMS established a cap on co-‐payment (with a few excepPons) Ø $50 for CR Ø $30 for PR – on average $20 copay but some higher
Ø Report excessive co-‐pays to J5 MRG or MAC Liaison Ø Co-‐pay may be a result of the hospital’s “insurance contract negoPator” w/the plan
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Medicare Advantage (MA) Co-‐payments
Ø PaPents should call Medicare to report any co-‐payment that is a barrier to parPcipaPon in CR or PR
1-‐800-‐Medicare
Ø Educate your hospital administraPon AND Insurance NegoPator AND physicians AND paPents on the value of CR and PR
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Private Insurance
Ø May or may not have session limits for PR Ø May only pay for 1:1 services, not group Ø Must contact each insurance company for each pa6ent
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State Medicaid Plans
Ø Ooen have session limits, e.g. 25 visits/year Ø May only pay for 1:1 services Ø May require prior authorizaPon aoer an iniPal visit
Ø Must contact the Plan regarding each pa6ent
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Pre-‐AuthorizaPon for Services
Ø See Pre-‐Auth template in handout Ø Also found on AACVPR website: hQps://www.aacvpr.org/Member-‐Center/AACVPR-‐Member-‐Resources
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R2R, Bundles & Best PracPce
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Regulatory Terms Ø EPM or “Episode”: episode payment model Ø 90-‐day episode (or care period): from hospital admission to
90 days aoer hospital discharge Ø ParPcipant: hospital in MSA (Metropolitan Service Area)
selected for EPM Ø AMI or CABG EPM: parPcipant & beneficiaries in the episode Ø FFS: Fee-‐for-‐Service Ø CMMI: Centers for Medicare & Medicaid InnovaPon Office @
CMS Ø EPM-‐CR parPcipant: hospital in EPM & CR IncenPve Model Ø FFS-‐CR parPcipant: hospital in CR incenPve, but not EPM
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Services included over the 90-‐day episode:
Ø MD services Ø In-‐paPent services Ø In-‐paPent rehab facility (IRF) Ø Skilled nursing facility (SNF) Ø Long-‐term care Ø Home Health Ø Out-‐paPent services: CR, PT, labs, DME, Part B drugs
Ø Hospice
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Iowa Hospitals in the CR IncenPve Payment Model
Ø Waverly Municipal Hospital
Ø Genesis Medical Center Ø CHI Health Mercy –
Council Bluffs Ø Methodist Jennie
Edmundson Ø St. Lukes – Davenport Ø Grundy County Memorial
Hospital Ø Community Memorial -‐
Sumner
Ø Covenant Medical Center – Waterloo
Ø Covenant Medical Center – Schoitz
Ø Sartori Memorial Ø Trinity – BeQendorf Ø Allen Hospital Ø Alegent Health Community
Memorial – Missouri Valley Ø Select Specialty Hospital –
Quad CiPes 54 www.cms.gov
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Rules and RegulaPons for Episode Payment Model
Ø Federal Register/Vol. 82, No. 1/ Tuesday, January 3, 2017/Rules and Regula6ons
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Episode Payment Model
Ø Episode Payment Model (EPM) without CR IncenPve Payment Ø ParPcipate in the EPM for AMI/CABG Ø Will NOT receive addiPonal incenPve funds
Ø EPM with CR IncenPve Payment 1. IniPal payment = $25 per CR service for first 11 services paid 2. Aoer 11 services, payment = $175 per service paid
Ø 12 CR/ICR services provides strong incenPve to increase referrals Ø 12 CR/ICR services increases likelihood that beneficiaries complete a clinically meaningful # of CR services
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Hammel, et. al. Circulation 2010; 121:63-70
CR IncenPve Payment
Ø CR IncenPve payment is not a payment for CR/ICR services . . . It is for CR parPcipant (hospital) work to coordinate & increase uPlizaPon of beneficiary’s parPcipaPon (pg 579 Federal Register)
Ø CR incenPve pay is separate & disPnct from reconciliaPon payments & repayments for EPM-‐CR parPcipants
Ø CR incenPve pay is separate from reimbursement based on submiQed claims data Ø Reimbursement for delivery of CR services is included in
episode costs – no ma\er where it is received 57
Episode Payment Model
Ø Payment is structured around a paPent’s total experience of care Ø MI or CABG: Bundle begins with hospital admission to
90 days aoer discharge Ø ParPcipaPng hospitals would be paid a target price for
each episode of care, NOT fee for service Ø Referral to another program: incenPve payment
stays with parPcipaPng hospital, NOT the hospital that provides the CR
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Episode Payment Model -‐ Payment
Ø Services conPnue to be paid by FFS Ø EPM is retrospec6ve payment methodology Ø At end of performance year, Medicare payment from submiQed claims for all services furnished in the episode are combine to calculate an actual episode payment
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Episode Payment Model
Ø At end of year, Medicare claims payments for all services furnished in episode are combined to calculate an actual episode payment
Ø Actual payment is reconciled against quality-‐adjusted target price Ø Hospital re-‐pays Medicare if actual payment exceeds
target & quality score is not acceptable Ø Financial risk begins at end of performance year 3
(years 1 & 2 are learning years)
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CR INCENTIVE PAYMENT MODEL
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Proposed Bundling of CR
Ø CMS recognizes benefits of CR & wants to expand use of CR 1. Provide CR incenPve payment models for AMI &
CABG 2. Cardiovascular bundled payment system
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Episode Payment Model
Ø Delay in CR Enrollment Ø Delay in enrollment will be tracked Ø SuscepPble to financial penalty by CMS
Ø Sessions: Maximum of two 1-‐hour sessions/day for up to 36 weeks; opPon of addiPonal 36 sessions over extended period if approved by MAC Ø If care is delivered under quality-‐adjusted target price,
achieved savings are received Ø Hospitals with costs exceeding target price will repay
Medicare.
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CMS Goals Ø CR/ICR achieves significant improvements in long-‐term paPent outcomes Ø Cardiovascular mortality Ø Improved health-‐related QOL Ø Reduced risk of hospital admission
Ø CR is underuPlized; has potenPal to lead care coordinaPon
Ø CR has dose-‐dependent effect on mortality Ø Timely referral & early enrollment post-‐dc improve uPlizaPon
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CR IncenPve Payment Model
Ø CR incenPve pay is separate & disPnct from reconciliaPon payments & repayments for EPM-‐CR parPcipants
Ø CR incenPve pay is separate from reimbursement based on submiQed claims data
Ø CR incenPve pay is unrelated to comparison of actual EPM episode payment to quality-‐adjusted target price
CR IncenPve Payment Model
Ø IncenPve payments stop at end of 90-‐day period Ø Fee For Service (FFS) reimbursement for CR/ICR conPnue per statute: Ø Up to 36 CR sessions within 36 weeks Ø Up to 72 ICR sessions within 18 weeks
Ø IncenPve is only for parPcipants in CR incenPve payment model
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Waiver of Physician DefiniPon for EPM-‐CR & FFS-‐CR ParPcipants
Ø Qualified NPP (NP, PA, CNS) may: Ø Serve as daily supervising MD/NPP for beneficiaries in EPM or care period
Ø Prescribe exercise Ø Establish, sign, review ITPs
Ø Consider extending hours to enroll more par6cipants and enroll earlier with NPP immediately available
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Beneficiary Engagement IncenPves
Ø Technology: Ø Not to exceed $1000/beneficiary per EPM/care period
Ø Must be minimum necessary to advance toal Ø Exceeding $100 must:
Ø Remain property of EPM/FFS parPcipant (hospital)
Ø Be returned at end of EPM/care period
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Beneficiary Engagement IncenPves
Ø TransportaPon: Ø Provided directly by & under control of FFE-‐CR or EPM-‐CR parPcipant
Ø Not Ped to receipt of items/services other than CR/ICR during 90-‐day period
Ø Not Ped to parPcular program (i.e., provider or supplier) Ø Not adverPsed or promoted other than beneficiary is made aware of availability
Ø Strategies, educaPonal materials, advance training opportuniPes
69 Slide courtesy of Dr. Rich Josephson
Slide courtesy of Karen Lui and the AACVPR
Your Roadmap
Increasing Cardiac Rehabilita6on Par6cipa6on From 20% to 70%: A Road Map From the Million Hearts Cardiac Rehabilita6on Collabora6ve
Philip A. Ades, MD; Steven J. Keteyian, PhD; Janet S. Wright, MD; Larry F. Hamm, PhD; Karen Lui, RN, MS; Kimberly Newlin, ANP; Donald S. Shepard, PhD; & Randal J. Thomas, MD, MS.
Mayo Clinic Proceedings. 2017:92(2):234-‐242
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AACVPR R2R Strategies: www.aacvpr.org/R2R
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BoQom Line
Ø Expect and prepare for increased referrals Ø Implement R2R strategies Ø Market your CR program to referring “par6cipants” Ø We can get your pa6ent in fast; no wait 6me
Ø This is the coordina6on in “care coordina6on”
References 1. Centers for Medicare and Medicaid Services: www.cms.gov 2. Code of Federal Regula6ons, 42 CFR 410.49 3. Code of Federal Regula6ons, 42 CFR 410.47 4. CMS Medicare Benefit Policy, Pub 100-02, Transmittal 124,
Change Request 6823: Pulmonary Rehabilitation Services. 5. Federal Register, Vol. 74, No. 226, Wednesday, November 25,
2009, Rules and Regulations. Section 144. 6. Executive Summary of the Global Strategy for the Diagnosis,
Management, and Prevention of COPD (GOLD) 2017 Report. www.atsjournals.org/doi/pdf/10.1164/rccm.201204-0596PP.
7. Federal Register/Vol. 82, No. 1/ Tuesday, January 3, 2017/Rules and Regula6ons: Medicare program; Advancing care coordinaPon through episode payment models (EPMs); cardiac rehabilitaPon incenPve payment model; and changes to the comprehensive care for joint replacement model (CJR).
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References ConPnued
8. Hammill BG, CurPs LH, Schulman KA, Whellan DJ. RelaPonship between cardiac rehabilitaPon and long-‐term risks of death and myocardial infarcPon among elderly Medicare beneficiaries. Circula6on 2010; 121:63-‐70.
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Ques6ons?
Thank you! jane-‐[email protected]
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