“Leaders measure success through the success of all those they serve and they live by a fundamental tenet –that service to others is one of life’s truest meanings, highest honors and greatest obligations.”© 2016 Henry S. Givray
By Ana Mola, PhD, RN, ANP-C, MAACVPR | October 17, 2019
Dear AACVPR Colleagues,
It is an honor and a privilege to serve as your President. I want to thank the Immediate Past President, Kate Traynor, for her years of service on the Board of Directors and her role as AACVPR President. She has inspired and enabled AACVPR to make an indelible impact on the national landscape of both cardiac and pulmonary rehabilitation (CPR). This past year, she co-led the CDC/CMS Million Hearts (MHs) Cardiac Rehab Collaborative with the MHs Team, engaged AACVPR in the AHRQ TAKEHeart Initiative, partnered with a scientific team to explore the role of cardiac rehabilitation within the cardiac oncology population, led pivotal governmental meetings for AACVPR legislation advocacy and guided the BOD on the strategic plan with fiscal diligence. Kate has seamlessly eased my transition to President and I am forever grateful for her mentorship.
In preparation for the privilege of becoming President, I interviewed eight past presidents of AACVPR to seek insight, inspiration and lessons from their tenure. A common theme among these accomplished leaders was “leading is teaching”. Their leadership successes surfaced from the ability to empower others to achieve their goals and inspire others to embrace a spirit of lifelong learning and professional growth. I am so grateful to these mentors for influencing my personal and professional leadership development over the past decades.
As President, I will steward the three-year strategic plan (SP) that is tactically developed and executed by the AACVPR Board of Directors (BOD) in partnership with the AACVPR Staff. The execution of the SP goals is also a shared responsibility among the various AACVPR committees, workgroups, state and affiliate leaders. The next three-year strategic plan includes enhancing membership engagement and strategic partnerships, a focus on program quality and sustainability, and expanding the breath of opportunities for CR/PR science and outcomes.
As we stay focused on our priority legislative advocacy, HR4838 has been signed regarding Section 603. . For background on this legislative priority, Medicare payment methodologies differ dependent on site of service. This is due to the actual payment methodology used by Medicare to determine payment amounts based on several cost factors. Therefore, it is not unusual for the same service to receive different payment amounts based on the “site of service.” Both Congress and CMS recognized that this can create strong incentives to game the payment system by moving a type of service to the higher paying site of service.
To address this problem, Section 603 of the 2015 Budget Act mandated that hospitals would no longer be able to bill under the hospital outpatient methodology, i.e., higher reimbursement rate, under certain conditions:
- If an existing off campus (beyond 250 yards) service moves to a new location, the hospital is required to bill at the physician fee schedule rate rather than the hospital outpatient rate.
- If a hospital opens a NEW hospital outpatient service, that new service must be within 250 yards of the main campus in order to receive hospital outpatient reimbursement; otherwise, the physician fee schedule rate applies.
Impact on Pulmonary/Cardiac Rehabilitation (PR/CR): Hospitals that choose to expand or relocate (beyond the 250 yard threshold) services must bill at the physician fee schedule rate (much lower payment vs hospital based programs), thereby creating a very strong disincentive for hospitals to improve access to PR/CR services. CMS recognizes this reality as an “unintended consequence” of Section 603, but the Agency states it has no authority to address our problem. This HR 4838 bill will deal with off-cacampus services to be saved from drastic reimbursement cuts and promote robust support for this “unintended consequence” of Section 603. We can l go live with our virtual lobbying software that allows you to identify your US Representative & (when we have a senate companion bill)- 2 US Senators), by zip code and send a letter (a template with an option ability to edit-personalize), all with a few clicks. This tool will be available to AACVPR members, non-members, grateful patients (a patient letter template will be posted as well), program medical directors and physicians (template letter provided). Obviously, the goal is to increase the volume of letters to Congress, so please use this virtual lobbying platform and have your voices heard and counted.
Over the next 12 months, my goal is to stay “in touch” with our members at state and joint affiliate conferences and possibly via other innovated outreaches. These opportunities provide important networking with membership, so I can learn from you about the challenges facing our CPR programs and the innovative program ideas that are surfacing from our members. In closing, let’s all partner to remain resilient and innovative in our CPR scope of practice with a commitment to scientific discovery of CPR benefits to patients and other stakeholders and participate in constant advocacy for new and sustainable CPR services.
Ana Mola, PhD, RN, ANP-C, MAACVPR