Inpatient Cardiac Rehabilitation

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1 Inpatient Cardiac Rehabilitation John G. Leech, M.A. Manager of Cardiovascular and Pulmonary Rehabilitation Lexington Medical Center, West Columbia, S.C. Disclosures I have no commercial interests to disclose. Today s Presentation Benefits of Inpatient Cardiac Rehab Getting Approval by Director of Audit and Compliance CMS Approval for Inpatient Cardiac Rehabilitation Other Hospitals with Inpatient CR Programs Services Provided Surgery Patients STEMI, Non-STEMI, & PCI Patients Tele-Management Follow-Up Calls Staff Productivity Final Thoughts 1

2 Benefits of Inpatient Cardiac Rehab Ambulation speeds recovery of CV Surgery patients. Decreases depression and anxiety of patients Decreases stress and anxiety of families Decreases length of stay (LOS) Floor nurses greatly appreciate Cardiac Rehab assistance. Education provides patients & families with additional explanations of the entire hospital experience. For those patients not able to attend an outpatient cardiac rehab program, the education provides them with the an introduction to a heart healthy lifestyle. Education reduces the re-admission rate for MI patients. Not in ACSM guidelines for terminating exercise Getting Approval for Inpatient CR Billing at Lexington Medical Center When I first met with our Director of Audit and Compliance, he said that Inpatient CR billing was not allowed by Medicare. I told him that it was approved by Medicare in other parts of the country (Texas & Wisconsin). He asked for proof. I presented information from several other hospitals that had a history of billing for it. He was surprised and very interested, and asked me to find something from federal government supporting it. 2

3 Getting Approval cont. I presented him the report conducted by the OIG, at the request of CMS, that audited 34 cardiac rehab programs across the country, in the early 2000 s. This audit was primarily focused on the issues of Physician Supervision and the Incident To requirements. However, on page 2 of the Introduction, they made a statement concerning Phase I coverage by Medicare. Getting Approval cont. Phase I. Phase I begins in the acute convalescent period following a cardiac incident. This phase is considered part of the hospital stay and is covered under the Medicare diagnosis-related group allowance for the hospital stay. When our Director of Audit & Compliance saw this, he checked with some of his resources in SC. He then told me to proceed and we have been charging for inpatient since March, We have had a couple of denials, but these were non- STEMI patients listed as Observational patients. Aurora Health Care, Milwaukee, WI St. Luke s Medical Center They do approximately 1,500 cardiac surgeries annually. They bill 20,000 30,000 inpatient CR visits annually. In the early 2000 s, they were one of the first of 34 CR programs to be audited by the OIG at the request of CMS. The OIG was primarily reviewing physician supervision & incident to issues; however, they did review the inpatient program. The OIG (and CMS) found nothing wrong with their billing for inpatient CR. Sandra Zemke, RN Manager (414) Sandy has been there over 30 years and reports never having a problem. 3

4 Christus Spohn Health System, Corpus Christi, Texas cardiac surgeries annually. Bill approximately 6,000 inpatient CR visits annually Barbara Flato, MSN, RN-BC, FAACVPR, Director (been there over 25 years). (361) Barbara stated Always considered part of the DRG & general hospital care, with no problem billing for it. Meriter Hospital, Madison, WI cardiac surgeries annually Bill 5,000+ inpatient CR visits annually I managed the inpatient program from I met regularly with our Director of Audit & Compliance, and there was never a problem with inpatient billing. Meriter Hospital, 202 South Park St, Madison, WI (608) East Texas Medical Center, Tyler, Texas cardiac surgeries annually 4,500+ billed inpatient CR visits annually They walk CV surgery patients 3X/day, and non-surgery patients 2X/day. I started the program in 1993 and left in Twyla Selvidge has been the Director for many years: (903)

5 Other Hospitals with Inpatient CR Northwest Houston Medical Center, Houston, TX 710 Cypress Creek Parkway, (281) The Methodist Hospital, Houston, Texas Texas Medical Center, 6565 Fannin St., (713) I worked and billed Inpatient CR at both of these hospitals, and never heard of any problems with billing issues. Lexington Medical Center We began billing for inpatient CR in January, Cardiac surgeries annually Billed 3,674 visits in 2013 On track to bill 4,500+ visits in Inpatient Revenue (billed) = $681, Inpatient Revenue (projected) = $832,000+ Services Provided CV Surgery Patients: I&A Surgery Family Consults Progressive Exercise Discharge Teaching Tele-Management Follow-Up Calls STEMI, Non-STEMI, PCI, and some CV Surgery Pts: Education (Classroom or Bedside) 5

6 Services Provided CV Surgery Patients I&A - We provide pre-admission (1-3 days) teaching for scheduled patients and spouses, and bed-side teaching for inpatients scheduled for CV surgery. Typically minutes. Surgery Family Consults After the family is escorted from the Surgical waiting area to the CVICU waiting room, we provide teaching to the family about what to expect during the ICU stay. (20-30 minutes) Services Provided CV Surgery Patients Progressive Exercise Starting 24 hours post-op, in CVICU, we begin progressive exercise. We see the patients twice a day and use a Swedish Walker for ambulation. We continue working with the patients until discharge or until they are able to ambulate a full lap of the telemetry floor (597 ), independently. We bill these in 15-minute units. The CVICU 6

7 CVICU Hallways Telemetry Floor Room Telemetry Floor Hallways 7

8 Services Provided CV Surgery Patients Discharge Teaching We review the basic instructions for going home and what to do for the next couple of weeks. (30-minutes) Tele-Management Follow-Up Calls Patient needs to be called within first several days for clinical follow-up. We also call a few weeks later to check on enrollment into a cardiac rehab program. Tele-Management Clinical Follow-up Call Highlights Phone Assessment (with whom) Discharge weight in hospital and at home Temp, blood sugars, BP, HR Medications & Pain Incision & CT stitch TEDs and edema Appetite & Elimination Respirations Incentive Spirometery Activity & Sleep Psychosocial Other concerns Cardiac Rehab Tele-Management Call Patient: Dx./Procedure (and date): Date/Time of Call: Staff member/rn making call: Reason for Call: PHONE ASSESSMENT: Phone Conversation with (whom) Relationship to patient: Discharge Weight (in hosp.): Discharge Weight (at home): Current Weight (at home): Temp: Blood Sugars: BP(if avail): HR (if avail): Medications: Pain (0-10 scale): Describe pain below (where, when, relief from/by) Amount & type of pain medications taken per day: Incision(s): Healing well per pt. No signs/symptoms of infection per patient Drainage Redness Swelling Open area Describe: CT Stitch: Date to be removed: Removed: Teds (on am & off pm)? Yes No Edema? Yes No Describe: Appetite: Drinking well? Yes No (# of 8 oz glasses of good fluid/day ) Describe: Eating well? Yes No Describe: Elimination: Urinary Difficulties Constipation Diarrhea N/V Describe: Respirations: SOB with activity SOB at rest SOB while lying down Cough while lying down Cough while upright No problems per pt. Describe: Incentive Spirometer Use: # of times/day Activity: Showering QD Dressing QD Walking (Minutes/walk: Times/day: ) Other activity: Activity tolerance (describe): Other: Fatigue Dizziness Lightheadedness Weakness Sweating Vision Changes Patient Concerns No problems per pt. Describe: Sleep: No change as compared to pre-surgery Other (describe below) Psychosocial: Positive attitude/mood Frustration Depression Anger Overwhelmed Anxious to get back to usual activities No problems per pt. Describe: 8

9 Services Provided STEMI, Non-STEMI, PCI and some pre-op inpatient CV Surgery Patients Education Includes: Cardiac A&P, Heart Disease, MIs, PCIs, Surgeries, Medications, Risk Factors, Healthy Lifestyle, etc. Classroom on 3 rd floor Interventional Cardiology from 10:00-11:00, Monday through Saturday Bedside for those patients not able to make it to the classroom. Taught by Nurses or Exercise Physiologists Troponin List Inpatient CR Education Classroom Productivity Billable vs Non-Billable Billable Work Units: Education (STEMI, Non-STEMI, PCI) (1hr) Progressive Exercise/Education (15-Minute Units) Discharge Education (30 minutes) 9

10 Productivity Billable vs Non-Billable Non-Billable Work: Daily Report EPIC Update Reports OR, Cath Lab, MD, RN, PFS I&As Patient & Family Education Supplies Charting Charging Phone calls Misc. Computer Work Cardiac Rehab Phase 1 Productivity Billable vs. Non-Billable Time 100% 64% 36% Billable Time Non-Billable Time Total Staff Time Future Opportunities Inpatient Pulmonary Rehab COPD education to reduce re-admission rates. Inpatient Vascular Rehab strong request from our Vascular surgeons. 10

11 Time to Smile Stressful Jobs? Think you have had a stressful day? Stressed Out? Most of us who work in cardiac and pulmonary rehab really love our work, which is to help patients with chronic diseases to live healthier lives. However, we all have those days when our jobs seem somewhat stressful. So, when you re feeling down and stressed out, just think about these workers 11

12 How would you like to work here? Enjoy working with your co-workers? I wonder what his heart rate is? 12

13 Is this considered strength training? Be Happy, Be Healthy, and Be Thankful! 13

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