1. Glenn A. Feltz, Psy.D., FAACVPR Past President, AACVPR
AACVPR Update for
Glenn A. Feltz, Psy.D., FAACVPR Past President, AACVPR

2. Mission
To reduce morbidity, mortality, and disability from cardiovascular and pulmonary disease through education, prevention, rehabilitation, research, and disease management.
Founded in 1985, AACVPR is a multidisciplinary organization focused on a mission, not preservation of a discipline.
Central to our mission is the improvement in quality of life for our patients and their families
We accomplish this by
Providing educational resources and networking opportunities to enhance the knowledge and performance of our members and their programs
Advocating on both national and regional levels to enhance third-party payment for cardiovascular and pulmonary rehabilitation and prevention services

3. Membership Membership 3,300+ State Affiliates: 40+
Joint Affiliates: 15
Masters & Fellows: 400+

4. 2016-2017 Board of Directors Tom Draper President Todd Brown
President-Elect
Dean Diersing
Treasurer
Kate Traynor
Secretary
Steve Keteyian
Director
Tracy Herrewig
Director
Alison Bailey
Director
Charlotte Teneback
Director
Bob Brown
Director
Trina Limberg
Director
Cathie Biga
Director at Large
Adam deJong
Immed. Past President

5. Board of Directors DOC Health & Public Policy HCRC
Executive Director
&
Headquarters Staff
Executive
Committee
Publications
Advocacy/
Innovation
Clinical Quality
Recruitment &
Engagement
Professional
Advancement
DOC
Health & Public
Policy
HCRC
Professional Certification
Program Certification
Quality of Care
Clinical Affairs
Registry
Affiliate Relations
Professional Liaison
Program Planning
International
Finance
Awards and
Nominating
CR Experts Panel
PR Experts Panel
“Scientific”
Quality
Research
Education
JCRP
News & Views
This chart shows the structure through which volunteers, AACVPR staff and committees lead and contribute to the fulfillment of AACVPR’s mission. We are fortunate to have a dedicated group of volunteers who represent the same wide range of disciplines our members do.
As you can see, this structure provides many opportunities to serve the organization and a host of programs and benefits for members and the field

6. Education Virtual and in-person on: Exercise Prescription
Behavior Change
Cardiovascular Rehab and Clinical Cardiology
Leadership & Innovation
Nutrition
Program Management
Pulmonary Rehab & Medicine
Through its Annual Meeting, Virtual Annual Meeting, regular webcasts, workshops and virtual workshops and similar online and in-person resources, AACVPR provides relevant education to help our members and their colleagues enhance patient care and elevate the knowledge of everyone in a CR or PR program. CME is available for Annual Meeting virtual and in-person sessions.
Topics for AACVPR’s education include the ones listed here.

7. Pre-Exercise Assessment Developing the Exercise Prescription The Exercise Session Telemetry

8. Discounted member pricing & bundles at aacvpr.org
Four new modules
Diabetes Management NEW
Cardiac Exercise Training
Tobacco Cessation NEW
Pulmonary Exercise Training
Psychosocial Management NEW
Patient Assessment
Weight Management NEW
Discounted member pricing & bundles at aacvpr.org

9. JCRP Guidelines & Resources (aacvpr.org) News & Views
Publications
JCRP
Guidelines & Resources (aacvpr.org)
News & Views
AACVPR publishes and maintains a number of peer-reviewed journals, guidelines and similar publications to provide essential information to help practitioners promote healthy lifestyles and lessen the impact of disease on quality of life, morbidity and mortality. These include the Guidelines for CR and Secondary Prevention Programs, Guidelines for PR Programs, and the Cardiac Resource Manual.
Additionally, our members-only News & Views, provides association and affiliate news and updates, as well as trends and other insights from our volunteers.

10. SAVE THE DATE
AACVPR Day on the Hill
March 13-14, 2017

11. AACVPR Program Certification
Identify your program as a leader. Learn more at

12. Visit www.aacvpr.org/Registry
IMPROVE YOUR PRACTICE
Visit
Founding Sponsor
Supported by:

13. Registries Subscribed Programs: 478 Subscribed Programs: 220
Within the last three years, AACVPR has launched registries for both CR and PR programs. Here is a look at the data collected to date.
Individual programs benefit through being able to view outcomes data on enrolled patients in real time, Track and quantify progress of the program in meeting performance goals
And Produce individual and grouped outcomes reports
By assisting in the collection, management, and interpretation of outcomes data, the registry will help all programs:
Compare outcomes and processes to evidence-based goals and national benchmarks
Implement quality improvement projects based on real data
Enhance documentation and communication with the program’s key audiences, such as hospital administrators and referring physicians
Promote the role of cardiac & pulmonary rehabilitation.
Increase support from physicians
Improve 3rd-party payer coverage and reimbursement rates

14. Professional Certification
The only professional certification specific to cardiac rehabilitation. Earning this certification demonstrates mastery of the core components essential in providing quality cardiac rehabilitation.
Computer-based testing through Pearson Vue, and paper exam only at the Annual Meeting.
To sit for the exam you must have:
1,200 clinical hours in CR/secondary prevention
Minimum of a Bachelor’s degree or higher in a health-related field from an accredited college or university or current RN licensure. Current RN licensure does not necessitate minimum academic requirement.

15. Comprehensive Cardiac Rehab Workshop
April 24-27, 2017
Registration Fee: $595 (AACVPR or Affiliate Society members receive $25 discount)
Similarly, UW La Crosse hosts a great workshop every spring dedicated to Cardiac Rehabilitation. You will receive a broad, up-to-date overview of the theory and practice of Phase I (inpatient), Phase II (outpatient), Phase III (supervised), and Phase IV (maintenance) cardiac rehabilitation with emphasis on exercise physiology, pathophysiology, administrative considerations, and patient education. The course is worth about 25 CEUs as well.

17. Health Care Reform is a constant evolution and changes are occurring rapidly and often.
The most drastic reforms have been the shifts from fee-for-service payment models to value-based payment models and now payment models designed at reimbursing for episodes across the care continuum.
These changes can be confusing and difficult to understand what the impact may be on your program.
AACVPR is positioned to help you navigate it all.
aacvpr.org/R2R

18. Episode Payment Models/Bundled Payments
This is a call to action. The Cardiology Episode Payment Model/Bundled Payment Model implementation date is right around the corner
Prepare now

19. Continuum of Payment Models
Economic and social factors are driving this need for healthcare reform and this push towards episodic payment models.
The aging population is increasing the demand for acute and post-acute care services.
Traditional fee-for-service payment models are not sustainable with the aging population demand for healthcare services
Growth in post acute care spending makes controlling post-acute spending a focus for Medicare
Additionally, appropriate care and, in particular, hospital readmission rates are being targeted as an area to promote efficiency and quality in health care.
Payment for episodes of care are seen as a solution to combating these healthcare trends
The care for a cardiovascular patient can be complex, expensive and, at times, un-coordinated
The coordination of care from an acute hospital episode to long-term recovery and risk factor reduction must be done without the presence of silos
The acute hospital team must coordinate with the outpatient providers who must coordinate with the cardiac rehabilitation teams.
Not only is this effective and efficient care for the patient, new payment models are demanding this level of coordination

20. Discharge Disposition
CV Continuum of Care
CV Event
Acute Hospital Stay
Discharge Disposition
Cardiac Rehab
Long Term Follow-up
CV Care is no longer provided in silos – Shifting to episodic continuum of care
infographic on the outline of typical patient.
Patient presents signs and symptoms to ED Cath Lab hours observation----discharge-----follow up with Cardiologist
Patient has scheduled CABG-----On Floor for x amount of time-----Discharge---Follow up with Cardiologist

21. Bundled Payment Overview
In July 2017, CMS will institute “Episode Payment Models” (EPM) - bundled payments - for AMI and CABG that will cover the period from hospital admission through and including 90 days after discharge.
The bundled payments will be for “fee for service” Medicare patients (not Medicare Advantage plans) with these diagnoses and will be implemented in 98 Metropolitan Service Areas (MSAs) across the country.
Together with this change in reimbursement is an exciting incentive program to increase referral to, and participation in, cardiac rehabilitation programs for patients with these same diagnoses.
The “incentive” includes a $25 bonus (in addition to the customary payment for the CR service) for sessions 1-11 and then the incentive bonus increases to an additional $175 per session for sessions within the 90-day post discharge period. 
Very Important – this incentive payment goes to the hospital that discharged the patient – so it is incredibly important that you have or build strong relationships with your referring hospitals
There are 90 MSAs included in this particular incentive program - 45 of which will come from the “bundled payment “ MSAs and 45 from all other eligible MSAs not chosen to participate in the bundled payment model. This graphic illustrates the breakdown of MSAs
Your program may be in an MSA that is part of the bundled payments, the incentives, both, or neither. AACVPR can help you determine which group your program falls in to, if you don’t already know. 21

22. AMI & CABG EPMs - Payment
Target price CMS will reimburse is set on blend of hospital-specific & regional historical data
If care provided is below quality-adjusted target price, participant hospital receives savings
Hospitals with costs exceeding target price will repay Medicare

23. Cardiac Rehab Incentive (CRI) Payment
Exciting incentive program intended to increase referral to and participation in cardiac rehabilitation programs for patients with AMI and CABG.
The “incentive” includes a $25 bonus (in addition to the customary payment for the CR service) for sessions 1-11 and then the incentive bonus increases to an additional $175 per session for sessions – for services in that 90 post d/c payment window.
There will be 90 MSAs included in this particular incentive program - 45 of which will come from the “bundled payment” MSAs and 45 from all other eligible MSAs not chosen to participate in the bundled payment model.
The “incentive” includes a $25 bonus (in addition to the customary payment for the CR service) for sessions 1-11 and then the incentive bonus increases to an additional $175 per session for sessions within the 90-day post discharge period. 
Very Important – this incentive payment goes to the hospital that discharged the patient – so it is incredibly important that you have or build strong relationships with your referring hospitals
There are 90 MSAs included in this particular incentive program - 45 of which will come from the “bundled payment “ MSAs and 45 from all other eligible MSAs not chosen to participate in the bundled payment model. This graphic illustrates the breakdown of MSAs
Your program may be in an MSA that is part of the bundled payments, the incentives, both, or neither. 23

25. In Kentucky: Elizabethtown/Ft. Knox MSA – EPM+CRI
EPM/CRI for Kentucky
In Kentucky:
Elizabethtown/Ft. Knox MSA – EPM+CRI
Evansville MSA – CRI only
Huntington/Ashland MSA – EPM+CRI
Lexington/Fayette MSA – EPM only
Together with this change in reimbursement is an exciting incentive program to increase referral to, and participation in, cardiac rehabilitation programs for patients with these same diagnoses.
The “incentive” includes a $25 bonus (in addition to the customary payment for the CR service) for sessions 1-11 and then the incentive bonus increases to an additional $175 per session for sessions within the 90-day post discharge period. 
Very Important – this incentive payment goes to the hospital that discharged the patient – so it is incredibly important that you have or build strong relationships with your referring hospitals
There are 90 MSAs included in this particular incentive program - 45 of which will come from the “bundled payment “ MSAs and 45 from all other eligible MSAs not chosen to participate in the bundled payment model. This graphic illustrates the breakdown of MSAs
Your program may be in an MSA that is part of the bundled payments, the incentives, both, or neither. AACVPR can help you determine which group your program falls in to, if you don’t already know. 25

26. Primary Goals of CMS project
1. To understand whether and how the effects of a financial incentive for use of CR/ICR services differ depending on whether a beneficiary’s care is covered under bundled payment or FFS
2. To examine each intervention’s separate effects on quality and efficiency of care beneficiaries receive.

27. 1. Hospital readmission rates 2. HCAHPS patient satisfaction scores
CMS will examine if CR affects AMI/CABG outcomes important to CMS, such as:
1. Hospital readmission rates
2. HCAHPS patient satisfaction scores
3. Mortality
4. Amount of care deferred beyond the
90-day post-hospital discharge episode
5. Most Importantly - Cost Savings
HCAHPS – Hospital Consumer Assessment of Healthcare Providers and Systems

28. Benefits to Cardiac Patients
Increased access to CR programs
Earlier engagement in CR programs and more immediate support post-hospital discharge
Incentive payment can used to directly benefit patient (e.g. transportation support)
Coordinated and more satisfactory care
Improved patient outcomes with better care through lower cost
And bonus-= there are real benefits for PATIENTS not just programs

29. Program Benefits Increased referrals to CR programs
Increased awareness of CR
For some, financial benefit with two-tiered incentive payments in addition to customary reimbursement for CR services
Increased opportunities for your program to design and implement innovative practice models
If you’re part of bundles, incentives, or both, there’s no time to waste

30. What does this mean for me?

31. What is Evident is…….
Cardiac Rehab is the Best SOLUTION for High Quality, Efficient Cardiovascular Care Across the Continuum

32. Program Benefits Increased referrals to CR programs
Increased awareness of CR
For some, financial benefit with two-tiered incentive payments in addition to customary reimbursement for CR services
Increased opportunities for your program to design and implement innovative practice models – and better integrate into CV services
Depending on which group your program falls into, and what role you play, you must take some concrete steps in order to prepare for this new reality.
If you’re part of bundles, incentives, or both, there’s no time to waste

33. Necessity is the Mother of Invention
- English Proverb

34. Know your Cardiac Rehab Program
What is Your Role?
Know your Cardiac Rehab Program
Clinical Benefits
Business
Staff
Understand how to leverage your CR team
Know AACVPR resources for your program
Articulate how to integrate CR into quality and continuum of care discussions
Get an audience with the decision makers

35. Articulate Patient Benefits
Improved functional capacity
Increased knowledge of heart disease
Improved adherence to positive lifestyle changes
Enhanced compliance with medical regimen
Increased self-esteem and confidence
Reduced subsequent morbidity & mortality
Improvement in cardiac psychosocial risk factors

36. Talk to Your Docs Financial incentive to enroll patients in CR
58% relative risk reduction in mortality at 1 yr (34% at 5 yrs)
Benefit is “dose dependent” (more CR=better outcomes)
Automatic referral need to reduce D2P (Class 1 indication NQF Quality Measure)
CR cost effective and least costly disease management model
Incorporates evidence-based practice guidelines
CR is your PARTNER for med compliance, lifestyle modification for CV risk reduction, patient education and satisfaction (CGCAPHS)
Reduces re-hospitalization rates
Reliable surveillance for improved clinical outcomes
Enhanced access to physician services
Despite these benefits CR is under utilized - need to increase referrals

37. And - Share the Specific Evidenced Based Data
Decreased all-cause mortality (15-28%)
Reduced risk of fatal MI (≥ 25%) / cardiovascular mortality (26-31%).
Decreased severity of angina & need for anti-angina medications
Decreased re-hospitalizations (31%)
Decreased cost of physician office visits & hospitalizations (≤35%)
Fewer ER visits
Decreased cardiac event rates
Understand your program’s data
Cost of health care is a national, state and local issue providers and patients deal with every day.
Cardiac rehab programs have shown statistical improvement in utilization and cost of health care.
By providing education on prevention and signs and symptoms of their cardiac disease, patients are able to make better judgments about obtaining access and entry to the appropriate health care provider.
Ades, PA, et al (2000) Medical Clinics of North America
Sudlow, C, et al (1999) Clinical Evidence
Lavie, CJ, et al (1999) Cardiology Clinics

38. Understand Financial Impact
Understand Your Cardiac Rehab Department’s Profit and Loss and the additional financial benefits:
Improvements in quality
Decreasing overall costs
Readmission penalty avoidance
Downstream revenue
Additional revenue streams

39. Know Your Numbers!

40. Obtain Buy-In From Administration
Share aspirational vision of your program
A solution to bundled payments
Share program performance and expertise
Describe alignment with service line’s strategic priorities
Outline benefits to the hospital or system
Increased referrals
Increased payment (if applicable) from bundle
Clinical benefits to the patients
Innovative programming, solutions for other problems
Projected financial performance
Articulate the win-win scenario to the service line

41. Benefits of Administration Buy-In
A clear understanding of the investment in your program and long-term benefits
The hospital or system will be willing to seek opportunities for your program to grow and expand
Allocate marketing and outreach resources
Internally promote and highlight your program as a solution
Be willing to invest capital resources in your program
Early buy-in = long-term success

42. Keys to Success
Be open to change
Refer to, and share, best practices
Potentially re-design program to accommodate more patients
Stay informed (AACVPR website, webinars, regional workshops and Reimbursement Updates)
Educate Your Team

44. Check out aacvpr.org Events & Education R2R

46. Questions? Thank You Glenn A. Feltz, Psy.D.