Annual Meeting

Education Sessions

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Wednesday, October 6 (Pre-Meeting Workshops)

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9:00 a.m. - 12:00 p.m.

P101: AACVPR Program Certification Workshop

AACVPR Program Certification is the only peer-review accreditation process designed to review cardiovascular and pulmonary rehabilitation programs for adherence to standards and guidelines developed by AACVPR and other professional societies. AACVPR-certified programs are recognized as leaders in evidence-based medicine, practice and patient care. This workshop will provide information about program certification to ensure that your program is on track for excellence. The workshop will be an in-depth review of the requirements for successfully completing the certification process. All pages of the application will be reviewed, and frequent denial reasons for each page will be discussed. The workshop will also include a dedicated ITP section that will include the review of sample ITPs to highlight ITP strengths and weaknesses. Attendees will also have the opportunity to submit questions for the live Q&A portion of the workshop to have your specific questions about Program Certification answered by the experts. Finally, the workshop will review the new performance measures that will be put into place for the 2023 Program Certification application. Those who are striving for excellence in their programs, applying for or reapplying for program certification are appropriate candidates for this workshop.

Speaker(s): Margo Aceino, MS, CEP, CCRP; Tonja Bell, MS, CCRP, FAACVPR; Bonnie Clark, RRT, CPT, FAACVPR; Karen Edwards, MS, RCEP, RRT, FAACVPR; Susi Mathis, MS, RCEP CES, RN, CCRP, FAACVPR; Julie Rounds, CEP, RCEP, CSCS, CCRP; and Ashley Wishman, MS, CEP, CSCS, EIM3, FAACVPR

CE Credit(s): 3.00

Learning Objectives: 

  • Review the AACVPR Program Certification process.
  • Outline requirements for Staff Competencies, ITP, Emergency Preparedness, Exercise Prescription, and Performance Measures, including new Performance Measures for 2023
  • Identify common reasons for denial for the various application components.  
  • Review ITP examples and identify opportunities for improvements. 

1:00 p.m. - 4:00 p.m.

P103: CR Today - What Should Cardiac Rehabilitation Be Now That the World Has Been Changed by COVID?

This pre-meeting workshop will focus on the rationale and attributes for distinct models of cardiac rehabilitation programs, each premised on different models of care.  Each speaker will give a strong account regarding the value of their program model’s design, providing a description, rationale, supporting data, and overall feasibility/utility in responding to contemporary healthcare challenges. This session will also aim to provide clarity regarding the various terms that are used to provide cardiac rehabilitation, health coaching, and other wellness and heath-promoting activities. These talks will last no more than 12 minutes. The ~90 minutes of cumulative talks will be followed by a 90-minute panel discussion (with initial 45 minutes of discussion among the panelists and then 45 minutes for audience participation).  

Speaker(s):  Alexis Beatty, MD, MAS; Neil Gordon, MD, PhD; Rich Josephson, MS, MD FACC, FAHA, FACP, FAACVPR; George Kipa; Chip Lavie, MD, FACC, FACP, FCCP; Linda Petersen, MD, FACC, FAHA, FASE; Randy Thomas, MD, MS, MAACVPR; and Mary Whooley, MD

CE Credit(s): 3.00

Learning Objectives:

  • To clarify key features that constitute the essence of cardiac rehabilitation in any format that is used.
  • To clarify differences in a patient’s experience of cardiac rehabilitation in the different formats that are now available.
  • To clarify the different payment models related to different formats of cardiac rehabilitation.

Keynote Sessions

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Thursday, October 7 | 8:00 a.m. - 9:30 a.m.

GS-1: Building Equity in Rehabilitation - A Panel Discussion to Facilitate Inclusion

Persistent disparities exist in the utilization of cardiac and pulmonary rehabilitation for notable groups who are overrepresented in cardiovascular disease burden and death but underrepresented in cardiac rehab referral, participation, and completion rates. Social determinants of health are contributory, and systematic patient and provider related factors coexist to perpetuate the problem. Panelists will participant in a conversation around stories that explore the role of implicit bias and overt discrimination in the rehab setting that impact referrals, participation and completion rates.  The session will highlight opportunities for participants to see themselves personally in the effort for health equity. 

Speaker(s): Columbus D Batiste, MD, FACC, FSCAI; Yvette Gerdes, MS, ACSM-RCEP, CCRP; and Salim B. Street, M.Ed., CSCS

CE Credit(s): 1.00 

Learning Objectives:

  • Raise awareness of disparities in cardiac and pulmonary rehabilitation through stories and vignettes highlighting experiences of patients and the rehabilitation team.
  • Promote a discussion among panel members to model productive conversations around inclusion and equity in our programs.  
  • Create a framework for personal action to help deconstruct systemic bias and barriers.

Friday, October 8 | 12:45 p.m. - 2:00 p.m.

GS-2: Awards Showcase

CE Credit(s): 1.00

Saturday, October 9 | 10:30 a.m. - 12:00 p.m.

GS-3: Wrestling with Change

Cardiopulmonary rehabilitation is one of the most nuanced services in available in healthcare.  Navigating the regulatory and quality waters can be quite challenging.  Despite the ever-changing quality and regulatory landscape, there are constants that can help ensure a program's success and sustainability.  This keynote presentation will provide attendees strategies that are sometimes overlooked, but nonetheless important for viability.  Additionally, the presentation compares the similarities of the world of professional wrestling and cardiopulmonary rehabilitation making this a fun and dynamic event.

Speaker(s): Ash Walker, DHSc, MA, ACSM-RCEP, FAACVPR

CE Credit(s): 1.00

Learning Objectives:

  • Attendees will understand and apply three (3) key ingredients needed for successful cardiopulmonary rehabilitation programs.
  • Attendees will be able to understand and apply simple strategies to enhance their cardiopulmonary rehabilitation brand.
  • Attendees will be able to understand and apply simple strategies to better understand their cardiopulmonary rehabilitation business.
     

Thursday, October 7

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10:45 a.m. - 12:00 p.m.

B101: Beginning Investigator Presentations

Details coming soon.

B102: Charging and Auditing for PR and Respiratory Therapy Services

Track: Program Management

This session will include a brief review of billing for COPD PR with a primary focus on billing for respiratory therapy (RT) services. The Federal Register states use of G0237-9 may be used by RTs and specially trained professionals. These codes are generally used to bill for non-COPD care.   Attendees will learn to review the process from screening referrals to posting charges and conducting an internal audit to assess compliance. Additionally, case study examples will be included with an important Q& A session to discuss the way forward when gaps in coverage prevail.

Speaker(s): Aimee Kizziar, MHAL, BA, RRT – NPS, RCP and Connie Paladenech, RRT, RCP

CE Credit(s): 1.25

Learning Objectives:

  • Attendees will be able to identify appropriate billing codes for RT services. 
  • Attendees will be able to identify options for documenting clinical care when charging with timed codes.
  • Attendees will be able to conduct an internal audit assessing department charging practices.

B103: Covid-19: An Opportunity to Address Gaps in Nutrition Education

Track: Nutrition

COVID-19 continues to impact our cardiac rehab patients and this warrants a change in nutrition education. Due to added stress and isolation from the pandemic, the nutritional status (and weight) of our patients has been greatly impacted. In this session, we will address nutritional concepts and tools to address the gap for effectively educating our patients. This session will include concepts and tools on mindful eating, appetite regulation, and immune-fighting nutrition through food versus supplements. Additionally, we’ll cover immunity-related FAQ’s and provide science-based answers.

Speaker(s): Christine Alongi, MS, MBA, RDN, LD; and Kerri Whitley, MS, RD/LD, EP-C, CCRP

CE Credit(s): 1.25

Learning Objectives:

  • Explain the impact that COVID-19 has on nutritional status.
  • List three concepts or tools that can be used for mindful eating and appetite regulation.
  •  Describe ways to positively influence the body’s immunity through proper nutrition. 
  • Identify common nutrient concerns of patients and sensible solutions.

B104: Preparing for the post-COVID future of CR (Million Hearts)

Track: Cardiovascular Rehabilitation

While innovative approaches to cardiac rehabilitation have been evolving long before COVID-19, implementation was habitually slow. However, with COVID-19 the norms of cardiac rehabilitation were suddenly undercut such that interest in remote and virtual approaches to cardiac rehabilitation became newly catalyzed, as well as related concerns regarding the process, safety, and efficacy of new models of care. 

This AACVPR Breakout Session will describe the formative changes in cardiac rehabilitation that have evolved since COVID-19, and which are likely to endure.  Proposed speakers: (1) Steve Keteyian, Henry Ford Hospital, will discuss updates in remote- and virtual- administration of cardiac rehabilitation; (2) Alexis Beatty, UCSF, will discuss new technologies that are being used to augment cardiac rehabilitation delivery; (3) Hilary Wall, CDC, will discuss the dynamic shifts in cardiac rehabilitation implementation nationally; (3) Laurence Sperling, CDC and Emory University, will speak about the anticipated synergy with Million Hearts cardiac rehabilitation participation goals.

Speaker(s): Alexis Beatty, MD, MAS; Steven Keteyian, PhD; Lawrence Sperling, FACC, FACP, MD; and Hilary Wall, MPH

CE Credit(s): 1.25

Learning Objectives:

  • To understand the evolving concepts of direct-, remote-, hybrid- and hybrid- approaches to cardiac rehabilitation. 
  • To explain the evolving concepts of technology and cardiac rehabilitation (apps, wearables, and other options) amidst the challenges of socioeconomic disparities. 
  • To explain the likely impact of COVID on health care delivery for decades ahead.  
  • To educate the audience on how to best organize and grow cardiac rehabilitation based on these evolving insights and principles.  

2:00 p.m. - 3:15 p.m.

B105: JCRP Highlights from the Journal to your Patient

Track: Cardiovascular Rehabilitation

This session will highlight selected studies that have appeared in JCRP during the past year. The presenter(s) will briefly review the rationale (i.e., importance and relevance of the study), key findings, and the potential impact on cardiopulmonary rehabilitation programming. The goal of the session is to highlight the most impactful and clinically relevant research that was published in JCRP. Also, the session will "translate" the research results so that the rehabilitative professionals can integrate the findings into their clinical practice to meaningfully affect patient health outcomes.

Speaker(s): Lenny Kaminsky, PhD, FACSM, FAACVPR; and Patrick Savage, MS, FAACVPR

CE Credit(s): 1.25

Learning Objectives:

  • Attendees will be able to explain the clinical significance of selected research studies that appeared in JCRP. 
  • Attendees will be able to summarize the content and the conclusions of the selected studies.
  • Attendees will be able to describe ways to apply the information conveyed in the session to their current practice.

B106: Performance Measures: 2021 Update on New Value-Based Measures, Program Quality, and Program Certification

Track: Innovative Leadership

In 2017, the Quality of Care Committee of the AACVPR introduced 7 performance measures for both cardiac and pulmonary rehabilitation to assure uniform and reliable measurements across programs. Between 2018 and 2020, 1407 cardiac and 608 pulmonary programs submitted performance measures data as part of the certification application. In this session, we will review current program performance; discuss its implication for national program quality; introduce 4 new value-based performance measures; and discuss potential thresholds for performance that may be used in future program certification applications.

Speaker(s): Gerene Bauldoff, RN, PhD, MAACVPR; Anne Gavic, MPA, RCEP, MAACVPR; Quinn Pack, MD, MSc; Mark Stout, MS, CCRP, FAACVPR; and Hank Wu, MD, FAACVPR

CE Credit(s): 1.25

Learning Objectives:

  • Introduce the new value-based quality measures around program enrollment and adherence and discuss the development and rationale for these measures.
  • Review the existing performance measures, the submitted data from the 2018-20 certification cycles, and some potential data quality issues.
  • Discuss how the existing and new performance will be used in future program certification, including discussing performance thresholds for future certification.
  • Encourage programs to use performance measures to improve program quality and set goals for improvement. Discuss the potential role of the AACVPR registry in this endeavor.

B107: Practical Suggestions to Minimize Caregiver Burden: Optimizing the Positive Outcomes of Group Intervention for Caregivers of Cardiac and Pulmonary Patients

Track: Behavioral Change

Caregiver distress when caring for a person with chronic illness, such as COPD or CHF, can manifest in health-related problems, social concerns, and profession-related problems for those who are working. The probability of a problem arising increases with the degree of patient dependence (Barcu & Mert, 2016). Groups, both psychotherapy and support, can be beneficial for the caregivers of COPD and CHF patients in terms of their functional coping and patient outcomes. Groups that include psychoeducation have been shown to improve overall family coping, reframing, and mobilizing to acquire help (Figueiredo, Jacome & Marques, 2016). Caregiver groups for this population have also reflected improvements in overall burden, reactions to caregiving, physical demands of caring and family support. Although more research is required in this domain, clinical experience confirms these findings. The supportive dynamic between participants and their ability to identify with one another differentiates this group format from individualized treatment. Assisting the caregiver to empower the patient in collaborative self-management and increased adherence is beneficial. In addition, education regarding caregiver stress and the skills required to cope, are a necessity. This session aims to explore practical suggestions that aid in the facilitation of groups for caregivers of both COPD and CHF patients. In light of Covid-19 and the potential long-term demands to facilitate these groups virtually, suggestions for optimizing online groups will be explored. These skills are relevant for all rehabilitation professionals within the multidisciplinary team.

Speaker(s): Leanne Levin, MS, MA, PhD; and Matt Whited, PhD

CE Credit(s): 1.25

Learning Objectives:

  • Participants will gain a better understanding of the potential adverse consequences of caregiver burden and distress.
  • Attendees will gain an understanding of research findings and clinical insights regarding caregiver group intervention.
  • Attendees will learn proven methods of facilitating group intervention that can decrease caregiver burden and enhance patient outcomes.
  • Participants will explore methods of facilitating online caregiver groups.

B108: Key Considerations for Virtual Pulmonary Rehabilitation

Track: Pulmonary Rehabilitation

Virtual PR offers advantages of patient convenience and serving rural patients historically excluded from PR. Speakers will address the evidence base, pros and cons, reimbursement and regulatory considerations, and provide resources.

Speaker(s): Surya Bhatt, MD, MSPH; and Chris Garvey, FNP, MSN, MPA, MAACVPR

CE Credit(s): 1.25

Learning Objectives:

  • Describe two outcomes from research studies of virtual Pulmonary Rehabilitation.
  • Give two Pulmonary Rehabilitation components required to optimize virtual Pulmonary Rehabilitation.
  • Describe three risks of virtual Pulmonary Rehabilitation exercise.

3:30 p.m. - 4:15 p.m.

B109: A Whirlwind Tour of Inpatient and Outpatient Tobacco Treatment Innovations That May Be Integrated Into Cardiopulmonary Rehabilitation Services

Track: Innovative Leadership

Tobacco use is a major risk factor for cardiovascular morbidity and mortality and the leading preventable cause of death. Healthcare practice patterns often provide various challenges to the effective delivery of tobacco cessation treatment in both inpatient and outpatient settings. In addition, educating healthcare providers is typically not sufficient to ensure the delivery of routine quality tobacco treatment. Various tobacco treatment options and strategies exist for hospitalized, discharged, outpatients and employees. This offers a unique opportunity for providing effective smoking cessation services given the skills and experience of cardiopulmonary rehab staff and their commitment to the health of their patients.

Speaker(s): Richard Josephson, MS, MD FACC, FAHA, FACP, FAACVPR; Laura Lucchesi, MS, BSN, CTTS ; Priyanka Satish, MD; and Richard Sukeena, MS, MBA, FAACVPR

CE Credit(s): .75

Learning Objectives:

  • To identify multiple options for educating healthcare providers and variables to help improve implementation of outpatient tobacco treatment.
  • To highlight inpatient tobacco treatment opportunities as part of cardiopulmonary rehabilitation.
  • Outline the success of integrating a certified tobacco treatment specialist, along with in-person and virtual individual tobacco counseling into the cardiopulmonary rehabilitation department and the hospital setting.
  • To provide an update on research that utilizes community health worker-based counseling that covers eligible people who use tobacco in a geographical area, combined with text messaging support, that will help tobacco users quit.

B110: Snacking – The Missing Key to Unlock A Healthy Diet?

Track: Nutrition

Although we often focus nutrition-related questions and education on meals, snacks account for 22% of the average US adult’s calories. Imagine the difference if those snacks were nutrient-dense foods that helped fill nutritional gaps, instead of major sources of sodium, saturated fat and added sugars. In this session, we will examine a range of snacking patterns that may be important contributors to your patients’ eating habits: aimless snacking, snacking stemming from boredom or emotional stress, the choice of “grazing” based on the belief that it raises metabolic rate and enhances weight loss, and snacking as a replacement for meal planning and preparation. This session will review what current research does and does not support, and discuss practical applications, on how snacking choices can help fill nutritional gaps; reduce excess saturated fat, sodium and added sugars; and support a healthy weight. Our goal will be to help attendees develop patient-appropriate talking points to reinforce nutrition counseling and combat common misunderstandings about snacks in a healthful eating pattern.

Speaker(s): Karen Collins, MS, RDN, CDN, FAND

CE Credit(s): .75

Learning Objectives:

  • After this presentation, participants will be able to describe at least three different patterns of snacking that significantly influence overall diet quality and how they might be addressed differently.
  • After this presentation, participants will be able to identify at least three examples of how snacking choices may help fill nutritional gaps and support cardiovascular health.
  • After this presentation, participants will be able to synthesize research about snacking to address common patient misunderstandings and questions with research-based, realistic bottom-line messages consistent with cardiovascular health.

B111: Building Resilience Among Healthcare Workers in the COVID-19 Era: Where Do We Go from Here?

Track: Behavior Change

Emergent research is confirming what many US healthcare workers have been experiencing since 2020 – the exacting mental health toll of the COVID-19 pandemic. Healthcare workers in cardiac and pulmonary rehabilitation faced particularly unique challenges during this pandemic, such as working in facilities with increased risk of exposure, caring for a population recognized as high-risk for a severe course of COVID-19, and adjusting to abrupt changes in service delivery models. Past research on healthcare workers who navigated other infectious disease outbreaks, including Ebola (2014-2015), SARS (2003), and MERS (2012, 2015), tells us that the detrimental effects of such an event on mental health can persist even after the crisis has ended. Therefore, building resiliency among cardiac and pulmonary rehabilitation healthcare workers is imperative for maintaining their physical and mental wellbeing, as well as that of their patients. Drawing from research on large-scale collective traumas, occupational burnout, compassion fatigue, and posttraumatic stress and growth, this session is intended to facilitate a timely conversation about how to help the helpers. This session presents the latest research about how the COVID-19 pandemic affected the mental health of healthcare workers, contextualizes these findings within the broader literature on stress and resilience, and provides actionable resilience-building steps for cardiac and pulmonary healthcare workers and their patients.

Speaker(s): Sharon Y. Lee, PhD

CE Credit(s): .75

Learning Objectives:

  • Describe the latest research findings of the impact of COVID-19 on healthcare workers’ mental health.
  • Understand implications of research on stress and resilience for cardiac and pulmonary rehabilitation healthcare workers.
  • Identify signs and symptoms of occupational burnout, compassion fatigue, and trauma reactions.
  • Apply empirically supported techniques for promoting resiliency among healthcare workers.

B112: Maximizing Your Phase 3 Cardiac Rehabilitation Program

Track: Pulmonary Rehabilitation

While traditional cardiac and pulmonary rehabilitation programs focus on insurance reimbursement to recoup costs and deliver services, phase III maintenance programs have the potential to supplement and sustain department budgets while providing desirable health services. This session aims to describe how to implement and run a successful and self-sustainable phase III program. Topics covered include areas of income and the benefits of a self-pay service which is not subject to negotiated rates by insurance companies and organizational or facility fees. Furthermore, we will detail items of consideration regarding patient safety and satisfaction such as physician consultations, exercise tolerance tests, and staffing considerations as well as weekly, monthly and yearly patient checkups. As cardiac and pulmonary rehabilitation professionals are uniquely qualified to provide exercise prescriptions and risk factor management, we will discuss the importance of obtaining internal referrals and incorporating patients with diverse clinical backgrounds in order to grow and sustain a program (COPD, atrial and ventricular arrhythmias, cancer, diastolic heart failure, peripheral artery disease, behavioral weight loss programs, etc). Through the use of our own internal data, we will describe various strategies for the recruitment and retention of phase III patients. Finally, we will address the impact of COVID-19 and the challenges of prioritizing and running phase II and phase III simultaneously.

Speaker(s): Philip Ades, MD; and Jason Rengo, MS, CCRP, FAACVPR

Credit(s): .75

Learning Objectives:

  • Recognize factors associated with implementing a successful phase III cardiac rehabilitation program.
  • Describe how phase III cardiac rehabilitation can supplement and sustain cardiac and pulmonary rehabilitation programs.
  • Identify areas of expansion in phase III cardiac rehabilitation delivery.
  • Identify challenges and solutions to gym availability related to COVID-19.

4:30 p.m. - 5:30 p.m.

B113: What's Ahead for Medicare Policies, Payment, & Programs: Navigating Policies & Payment for Rehab Services in 2021

Track: Program Management

Current and future landscape of cardiopulmonary rehabilitation services in Medicare's world. This session will discuss current and future coverage rules, legislation that would improve coverage policies and payment, and coding & billing guidelines for Medicare and commercial payers.

Speaker(s): Susan Flack, MS, RN; and Karen Lui, RN, MS

CE Credit(s): 1.00 

Learning Objectives:

  • Attendees will be aware of changes and potential changes to Medicare policies regarding CR/ICR/PR/SET services.
  • Attendees will be familiar with billing & coding frequently asked questions. 
  • Attendees will understand current Medicare regulatory issues for CR/PR/SET services.
  • Attendees will be knowledgeable regarding current AACVPR legislative actions on behalf of CR/PR/SET.

Friday, October 8

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8:00 a.m. - 9:00 p.m.

B201: Why Health Literacy Matters: The Impact of Limited Health Literacy on Cardiac Rehabilitation Outcomes

Track: Cardiovascular Rehabilitation

Throughout cardiac rehabilitation (CR), patients receive critical education on cardiovascular risk factor modification. However, limited health literacy may impede maximum understanding of risk factor modification recommendations. Health literacy impacts care in multiple ways including seeking appropriate care, understanding and processing health information, communicating needs, and taking appropriate actions to improve health. Importantly, limited health literacy has been shown to be a predictor of morbidity and mortality, healthcare use, and healthcare costs. At VA Pittsburgh, phase 2 CR patients complete a baseline health literacy assessment using the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM- SF). Limited health literate patients have shown lower baseline and final functional assessment scores. Based on data from the VA Pittsburg CR program, the association between health literacy and functional outcomes will be presented, alongside a discussion of how to efficiently assess health literacy in CR. Methods for tailoring education delivery to overcome limited health literacy such as the use of teach-back methods, an adaptation of education materials, and use of plain language recommendations will be presented. Special emphasis will be placed on how cognitive impairment may impact associations between health literacy and outcomes and practice considerations for aging patients. 

Speaker(s): Emily C. Gathright, PhD; Joel W. Hughes, PhD, FAACVPR; and James J. Kostra II, Ed.D

CE Credit(s): 1.00

Learning Objectives:

  • Define “health literacy” and distinguish “health literacy” from cognitive impairment.
  • Understand how limited health literacy may impact functional outcomes.
  • Learn simple and efficient tools to assess health literacy in CR and how to interpret the findings.
  • Learn best practices for adapting education delivery for patients with low health literacy. 

B202: Registry / Data Analytics Center

This session will discuss the current status and purpose of the AACVPR Data Analytic Center at the University of Alabama at Birmingham and its role in using the data within the AACVPR Cardiac and Pulmonary Rehabilitation Registries for research purposes. The session will also cover AACVPR’s plans to handle data research requests, any preliminary findings from the initial data review process by the Data Analytic Center team, and suggestions users can follow to help improve their program’s data quality and completeness. 

Speaker(s): Todd Brown, MD, MSPH, FACC, FAACVPR 

Credit(s): 1.00

Learning Objective(s):

  • Attendees will explain the purpose, goals, objectives and current status of the Data Analytic Center.
  • Attendees will be able to outline the planned research request process for data analytic center analysis requests. 
  • Attendees will be able to discuss preliminary findings by the Data Analytic Center, and identify common data quality and completeness issues 

B203: Innovations in Pediatric Cardiac Rehabilitation

Track: Program Management

Historically, pediatric cardiac rehabilitation programs have faced unique challenges compared to their adult-oriented clinical counterparts, including lack of pediatric-specific guidelines, reliance on parents for transportation to the outpatient setting and lack of universal and streamlined billing codes for services.  COVID-19 further increased pressures to develop and implement innovative clinical programming in pediatric cardiac rehabilitation settings, as the virus rapidly altered the healthcare landscape.  The Ann & Robert H. Lurie Children’s Hospital of Chicago Cardiac Rehabilitation Program has been able to successfully launch several pioneering clinical programs to supplement existing pediatric cardiac rehabilitation offerings as well as enhance referral rates for eligible patients.  Aided by amended CMS coverage guidelines, this team was able to develop an innovative curriculum, establish itself as qualified healthcare professionals, and secure MD supervision to expand enrollment and participation in exercise medicine sessions via telehealth.  These programmatic adaptations further included the development of resources for patients and families to support remote exercise participation.  These and other developments have resulted in a 67.6% enrollment rate into phase II cardiac rehabilitation, which is notably higher than the national participation rate of roughly 24.4%.

In addition, when compared to 2019 data, telehealth sessions resulted in a 38% increase in patient volume in 2020 despite a pandemic-related 14% decrease in in-person exercise sessions.  Overall, the Lurie Children’s Cardiac Rehabilitation Program offers a unique example of successful programmatic adaptations to remove barriers to participation in pediatric cardiac rehabilitation and promote exercise therapy in a vulnerable patient population.

Speaker(s): Katie Baschen, MS; Garett Griffith, MPH; Brittany Holst, MS; Melissa McMahon, MS; and Kendra Ward, MD, MSCI

CE Credit(s): 1.00

Learning Objectives:

  • Understand key stakeholders in the phase I to phase II cardiac rehabilitation referral pathway.
  • List strategies to increase outpatient cardiac rehabilitation participation among eligible pediatric patients.
  • Understand recent CMS guidelines changes and how exercise physiologists can be qualified healthcare providers for these telehealth services.
  • List elements of a defined exercise consultation and cardiac rehabilitation telehealth curriculum.
     

B204: Virtual & Remote CR Rehab Across Practice Settings

Track: Innovative Leadership

This session will provide information for facilities interested in adopting alternative cardiac and pulmonary rehabilitation models with an overview of key components and terminology, technology and tools available, and billing/documentation requirements.  In addition, the session will highlight the Montefiore and Veterans Affairs models while sharing experiences and lessons learned while implementing these programs in rural, suburban and urban settings. 

Speaker(s): Kariann Drwal, MS, CCRP, RCEP, ATC/LAT and Vanessa Pahlad-Singh MS, CCRP

CE Credit(s): 1.00

Learning Objectives:

  • Identify potential barriers and facilitators to implementing telehealth models. 
  • Participants will develop an understanding of currently available technology and tools used to build a remote cardiac rehab component in their practices. 
  • Practical aspects of coding, billing and supporting documentation will be reviewed as well as financial modeling. 
  • Summarize experiences from the Veterans Affairs with the delivery of cardiac and pulmonary rehabilitation by telehealth. 

10:45 a.m. - 11:45 a.m.

B205: Your Questions, Our Answers: An Expert Panel on Behavioral Health Support for Cardiac and Pulmonary Patients in the Era of COVID-19 and Beyond

Track: Behavior Change

The benefits of cardiac rehabilitation are dependent on the ability of patients to make behavioral changes. Smoking cessation, increases in physical activity, changes to diet, and medication adherence are all necessary for optimal secondary prevention. However, behavior change is challenging and may require intense or repeated intervention. In this session, we will review the evidence for behavioral interventions that target these four common behavioral goals within the context of CR. Additionally, we will explore the issues with having multiple behavioral goals to target simultaneously and discuss the gaps in the current literature.

Speaker(s): Diann Gaalema, PhD

CE Credits: 1.00

Learning Objectives:

  • Review the importance of smoking cessation, physical activity, diet, and medication adherence for secondary prevention. 
  • Identify common barriers for patients to engage in behavior change.
  • Examine the existing evidence for interventions that have been tested to improve these behaviors within the context of CR.
  • Discuss the issues with trying to intervene on multiple behaviors at once.

B206: What You Need to Know About the New Home Oxygen Clinical Practice Guideline for Adults With COPD & Ild

Track: Pulmonary Rehabilitation

This session will include a comprehensive review of scientific evidence and identify key recommendations to guide your practice. This American Thoracic Association Clinical Practice Guideline was published ahead of print in the Nov.15 issue of the American Journal of Respiratory and Critical Care Medicine. This is a must-attend session for those clinicians specializing in pulmonary rehabilitation.

Speaker(s): Brian Carlin, MD; and Chris Garvey, FNP, MSN, MPA, MAACVPR

CE Credit(s): 1.00

Learning Objectives:

  • Identify 3 recommendations for oxygen therapy use in COPD.
  • Identify 2 recommendations for oxygen therapy use in ILD.
  • Identify one consideration/recommendation for LOX use.

B207: Partnering with Local Department of Health and Human Services

Track: Innovative Leadership

Describe how to find and implement grant-funded partnerships with State-level DHHS.

Speaker(s): Karen Fuller, MPH; Mike McNamara, MS, FAACVPR; Jim Peacock, MPH, PhD; John Silveri, CCRP; Laura Vaughn, CCRP; and Hilary Wall, MPH

CE Credit(s): 1.00

Learning Objectives:

  • Identify different departments within DHHS.
  • Learn how to find grant requests for relevant work.
  • Understand reporting obligations when receiving funding.
  • Know how MSCVPR leveraged their partnership.

B208: The Impact of COVID on Capture and Drop-out rates in Cardiac Rehab:  Optimize Virtual Rehab’s Potential Benefits on Capture, Access, Adherence & Finances

Track: Program Management

COVID’s impact on traditional and intensive cardiac rehab has permeated all aspects of program delivery. Changes in program delivery coupled with patient safety concerns may negatively influence capture and drop out resulting in financial implications and decreased capture. This session will demonstrate how to utilize program data to assess the impact on enrollment, retention and finances creating opportunities for Virtual Rehab to reverse the negative implications of a national pandemic on cardiac rehab.

Speaker(s): Julianne DeAngelis, MS, CCRP; and Loren Stabile, FAACVPR

CE Credit(s): 1.00

Learning Objectives:

  • Describe changes to program delivery to provide a COVID safe environment while expanding access to care and improving program finances.
  • Analyze changes in capture, adherence and drop out to determine the financial gap created by COVID.
  • Allow your program data to drive change and learn how virtual rehab can improve the gaps in access, capture and financial outcomes.

2:15 p.m. - 3:15 p.m.

B209: Pulmonary Rehabilitation: The Year in Review 2021

Track: Pulmonary Rehabilitation

This session will review the latest updates in the science behind pulmonary rehabilitation that have been published in 2021.

Speaker(s): Brian Carlin, MD, MAACVPR

CE Credit(s): 1.00

Learning Objectives:

  • At the conclusion of this session, the learner will be able to list two new updates in the field of pulmonary rehabilitation.
  • To name two methods used for the rehabilitation of a patient recovering from COVID-19 pneumonia.
  • To incorporate one new finding into your pulmonary rehabilitation program.

B210: Cardiac Complications of COVID-19 Infection and the Role of Physical Activity

Track: Cardiovascular Rehabilitation

Attendees will recognize the cardiovascular manifestations of the COVID-19 infection as well as the management of COVID-19 associated cardiovascular complications in cardiac patients.  Presenters will also discuss the role of cardiopulmonary exercise testing and cardiac rehabilitation for patients with post-COVID-19 syndrome. 

Speaker(s): Aiman Smer, MBBCh; and Ray Squires, PhD, MAACVPR

CE Credit(s): 1.00 

Learning Objectives: 

  • Recognize the cardiovascular manifestations of the COVID-19 infection
  • Understand the management of cardiovascular complications of COVID-19 infection
  • Appreciate the role and outcomes of cardiopulmonary exercise testing and cardiac rehabilitation for post COVID-19 infection

B211: Value-Based Care Bootcamp: The Value of Cardiopulmonary Rehab 

Track: Program Management

Attendees will have the opportunity to learn about value-based care from experts in the field of cardiopulmonary rehab. Knowing what data to collect and how to use that data to drive change is an integral part of value-based care.  We live in an ever-changing environment, where we need efficient, time-saving strategies to enhance the value of cardiopulmonary rehab across the healthcare continuum. 

Speaker(s): Karen Edwards, MS, RCEP, RRT, FAACVPR; Marjorie King, MD, FACC, MAACVPR; and Tedd Walsh, CCRP

CE Credit(s): 1.00

Learning Objectives: 

  • The big-picture value of Cardiac and Pulmonary Rehab in Healthcare
  • What data is important to track, why and how it can be utilized
  • Practical strategies to implement value-based care principles in any rehab setting

B212: The New Dietary Guidelines for Americans: Nutrition Implications for the Cardiac and Pulmonary Population

Track: Nutrition

The 2020-2025 Dietary Guidelines for Americans (DGAs) were released on December 29, 2020. For the first time, the DGAs have directed guidance for each life stage, including older adulthood. As healthcare providers, it is imperative that we understand the specifics and implications that the DGA provides for our patient population. This presentation aims to summarize the key dietary points for the adult and older adult patient populations in cardiac and pulmonary rehab and also give practical guidance for application. Focused time will also be spent on clearly describing the special dietary modifications for our patients (e.g., cardiac, pulmonary, diabetes, renal, food allergies). Finally, practical guidance will be given on how to implement the healthy dietary patterns prescribed within the DGAs. This will include realistic ways to incorporate all of the healthy food groups and easy meal preparation.

Speaker(s): Ruth Rasmussen, MA, MS, RDN, LD, CCRP; and Allie Redding, RDN, LD

CE Credit(s): 1.00

Learning Objectives: 

  • Describe the new 2020-2025 Dietary Guidelines for adults and older adults.
  • Understand the needed dietary modifications for our patient population (e.g., cardiac, pulmonary, diabetes, renal, food allergies).
  • Devise a plan for practically adding more fruits, vegetables, whole grains and specifically foods containing under-consumed nutrients, into typical meals in order to meet the new dietary guidelines.

3:30 p.m. - 4:30 p.m.

B213: Strategies to Break the Cycle of Severe COPD Exacerbation

Track: Pulmonary Rehabilitation

Attendees will benefit from an in-depth review of various causes that lead to COPD exacerbations.  Recommended treatments will be reviewed with an emphasis on the collaborative development of a personalized action plan.  Attendees will leave this session with a comprehensive understanding of how to facilitate exacerbation prevention and care.

Speaker(s): Brooks Kuhn, MD, MAS

CE Credit(s): 1.00

Learning Objectives:

  • Learners will be able to define an exacerbation.
  • Learners will learn the characteristics of phenotypes.
  • Learners will be able to identify recommended treatments to prevent and improve exacerbation management. 

B214: Program Certification

Track: Program Management

AACVPR Program Certification is the only peer-review accreditation process designed to review cardiovascular and pulmonary rehabilitation programs for adherence to standards and guidelines developed and published by AACVPR and other professional societies. AACVPR-certified programs are recognized as leaders in their field because they offer the most advanced, evidence-based practices and care. For the 2022 certification application cycle, programs will be required to provide outcome measurement data and analysis and the utilization of the 2017 AACVPR Performance Measures. This session will provide an overview of each page of the 2022 certification application and insight on how to successfully complete the certification process. The session will also preview the new Performance Measures that will be implemented for the 2023 Program Certification Application. Programs seeking AACVPR Certification for the first time and those renewing their certification are encouraged to attend.

Speaker(s): Ashley Wishman, MS, CEP, CSCS, EIM3, FAACVPR

CE Credit(s): 1.00

Learning Objectives: 

  • Attendees will be able to describe the requirements for each page of the Cardiac and Pulmonary Rehabilitation certification application.
  • Attendees will be able to summarize the AACVPR Performance Measures, including the new Performance Measures that will be implemented for the 2023 Program Certification Application
  • Attendees will be able to explain how technology and innovation have impacted Program Certification

B215: The Challenging Patient: Practical Strategies for Managing Behavioral Issues in the Rehabilitation Setting

Track: Behavior Change

Individuals arrive to CR with various cognitive, personal, emotional, and social resources that allow them to participate actively, collaboratively, and efficiently in the rehabilitation process. Sometimes individuals exhibit patterns of behavior that disrupt the provision of services and/or medical care, and this can negatively impact patient outcomes for that patient or cohort mates. Research on barriers that influence participation in CR has identified intrapersonal (person-specific) factors, among others. Studies have suggested that program directors and physicians commonly cite perceived lack of patient motivation and commitment as an intrapersonal barrier to the rehabilitation process, yet CR patients consistently report preventative services as a high priority in their healthcare plans. Elevated anxiety sensitivity leading to fear of exercise also hinders participation in CR, particularly when patients perceive prolonged bouts of exercise as more effortful or uncomfortable. Fears of negative consequences from exercise may be especially pertinent when CR programs are serving more patients with post-COVID syndrome, on which research is currently limited but appears to include increased risk for anxiety sensitivity and decreased functional capacity. Finally, hostility is a known psychosocial risk factor for morbidity and mortality in cardiopulmonary patients; patients may present to CR with irritability, distrust, and/or agitation, which can be difficult for CR staff to manage. There have been anecdotal reports of COVID-specific problematic behaviors related to anger and hostility, such as rebelling against safety protocols. The purpose of this presentation is to examine three categories of problematic intrapersonal behaviors (i.e., nonadherence, exercise avoidance, and hostility) commonly encountered in the CR setting, better understand the potential etiologies of these behaviors, and learn practical management strategies to improve patient outcomes.

Speaker(s): Megan McMurray, PhD, Carly Goldstein, PhD, FAACVPR

CE Credit(s): 1.00

Learning Objectives: 

  • Identify three commonly-seen categories of problematic behaviors that can hinder the rehabilitation process.
  • Understand potential etiologies of these problematic behaviors.
  • Learn practical, behavioral strategies the rehabilitation team can utilize to help manage problematic behaviors.
  • Ideally, the acquisition of skills to manage these problematic behaviors will also confer increased job satisfaction for attendees and colleagues.        

B216: Training Future Clinical Exercise Physiologists: Building a Bridge Between Pedagogy and Practice

Track: Cardiovascular Rehabilitation

The purpose of this session is twofold. First, is to detail an academic training curriculum for future clinical exercise physiologists.  This will include a model of university-based academic coursework combined with hospital-based clinical training (i.e., internship, clinical rotations). Second, is to have an open dialogue regarding knowledge and skills that novice (early career and internees) Clinical Exercise Physiologists currently have, should have, and will need to have in the changing clinical environment. The overall goal is to bridge academic training with clinical practice, which has been largely absent in the field of clinical exercise.   

Speaker(s): Rachael Nelson, PhD; Melissa VanZant, BS, RCEP; and Micah Zuhl, PhD

CE Credit(s): 1.00

Learning Objectives: 

  • Describe the Central Michigan University and Henry Ford Hospital models for training future Clinical Exercise Physiologists.
  • Discuss perceived knowledge and skills novice Clinical Exercise Physiologists have/should have entering the workforce (or internship).
  • Identify gaps in knowledge and skills; and discuss who best to mitigate these (e.g., instructors, internship programs, employers).
  • The potential role of AACVPR and clinical certifications in guiding clinical training. 

Saturday, October 9

Click the session titles below for more details: 

8:00 a.m. - 9:00 a.m.

B301: Physical Activity, Fitness & Cardiac Rehabilitation: The Year in Research 2020 -2021

Track: Cardiovascular Rehabilitation

This presentation will review recently published research (2020-2021) that rehabilitation professionals who treat patients with cardiovascular disease should understand and consider employing to further advance patient care.

Speaker(s): Murray Low, EdD, MAACVPR, FACSM

CE Credit(s): 1.00

Learning Objectives:

  • Review the recently published scientific literature related to the role of physical activity and physical fitness as significant predictors for cardiovascular morbidity and mortality.
  • Analyze the interactions of physical activity, physical fitness, and its pleiotropic benefits for the prevention & treatment of cardiovascular disease.
  • To understand the scientific basis for delivery of Cardiac Rehabilitation service as a powerful therapeutic modality for primary and secondary prevention of cardiovascular disease.

B302: Enhancing COPD Referrals and Enrollment in Pulmonary Rehabilitation: Improved Outcomes Through Integrating a Respiratory Disease Navigator and Clinician Engagement

Track: Pulmonary Rehabilitation

In spite of the benefits and evidenced-based treatment recommendations of pulmonary rehabilitation for patients with COPD, outpatient referrals and enrollment are under-utilized. Recent evidence suggests that referral rates after hospitalization are below 10%, with only a few patients enrolling in pulmonary rehabilitation services. To meet this need, two strategies were designed and implemented through an initiative led by a high reliability medicine and COPD task force. In 2018, two pulmonary rehabilitation programs were selected. One location implemented a full-time Respiratory Disease Navigator position and the other a structured education program. Data on referrals and patient outcomes was collected for one-year and compared to the previous year. Preliminary results suggests that both strategies demonstrate improved referrals, enrollment and patient outcomes.

Speaker(s): Megan McDonald, RRT; and Rich Sukeena, MS, MBA, FAACVPR

CE Credit(s): 1.00

Learning Objectives:

  • To develop a relationship with a Respiratory Navigator and clinicians transitioning COPD patients from hospital discharge into outpatient pulmonary rehabilitation within a timely manner.  
  • Outline essential responsibilities of a Respiratory Navigator within the respiratory therapy department and integration into pulmonary rehabilitation.
  • To identify COPD discharge data to help enhance potential referrals, COPD exacerbations, readmissions, clinician referrals and enrollment patterns.
  • To identify, track and address COPD patient referrals, enrollment limitations and barriers into outpatient Pulmonary Rehabilitation.

B303: Your Questions, Our Answers: An Expert Panel on Behavioral Health Support for Cardiac and Pulmonary Patients in the Era of COVID-19 and Beyond

Track: Behavior Change

In the spring of 2020, nationwide stay-at-home orders led to drastic and fast-paced changes in the delivery of center-based cardiopulmonary rehabilitation (CPR). In addition, CPR patients faced numerous psychosocial and behavioral challenges that impeded optimal cardiovascular and pulmonary risk reduction. COVID-19 also conveys cardiovascular and pulmonary effects, which further increased psychological and physical distress for CPR patients with and without COVID-19. This panel of behavioral health experts will review unique psychosocial (e.g., depression, repetitive stress, social isolation, fear and anxiety, grief) and behavioral (e.g., diet and food insecurity, increased alcohol use) challenges that have arisen or been exacerbated while supporting CPR patients during the COVID-19 pandemic. The neurological and psychiatric sequelae post-COVID (e.g., post-COVID cognitive fog, post-ICU syndrome) will also be addressed. Panelists include behavioral health providers who supported CPR outpatients, inpatients, and convalesced COVID patients and are assisting patients in ongoing adaptation to change. Audience members will be encouraged to bring forward questions and challenges faced in their CPR clinics during the height of the pandemic and currently. Experts will discuss relevant recommendations for supporting patients through the enduring psychological and behavioral impacts of the COVID-19 pandemic as patients navigate cardiovascular and pulmonary risk reduction alongside improvements in the public health crisis. 

Speaker(s): Joel Hughes Ph.D., FAACVPR, Leanne J.K. Levin, Phd, MSc, MA, BSocSci Honors, BSc; and Megan V. McMurray, Ph.D

CE Credit(s): 1.00

Learning Objectives:

  • Discuss common behavioral health challenges faced by patients during the COVID-19 pandemic.
  • Discuss common neurological and psychiatric sequelae associated with post-COVID syndrome, including cognitive fog and post-ICU syndrome (PICS).
  • Identify recommendations and tools for providing behavioral health support for patients experiencing behavioral and/or psychosocial challenges related to the pandemic.

B304: Using the ITP as a Tool for Quality Improvement

Track: Program Management

​​​​​​​The ITP is an often overlooked and haphazardly completed necessity in cardiac and pulmonary rehab. However, we can change how we examine the use of the ITP. It can be used as a tool for creating continuity between staff and administrators, ensuring patient improvement, and improving the overall quality of a program. This rapid-fire session and discussion centers around how we can create an ITP that focuses on patient success, and how we can instruct staff on how to view it as a tool for quality improvement rather than a burden.

Speaker(s): Molly Wainstock, MS, MPH, CCRP, FCSCR

CE Credit(s): 1.00

Learning Objectives:

  • Create/Edit your ITP to showcase your program's strengths.
  • Learn how to share your ITP between staff and administrators to improve continuity of care.
  • Use the ITP to improve the quality of care that your program provides.

9:15 a.m. - 10:15 a.m.

B305: Peripheral Artery Disease: Epidemiology and Disparities, What the Rehabilitation Experts Need to Know

Track: Cardiovascular Rehabilitation

This session Diane Treat-Jacobson will discuss the Prevalence and Implications to include the relevant demographics for age, disparities, implications of claudication, sedentariness, amputation, medications, underuse of statins and revascularization.

John Ehrman will discuss Supervised Exercise Therapy Exercise Prescription; protocol, modality, intensity, education, reimbursement and long-term lifestyle goals.

Speaker(s): John Ehrman, PhD,  FAACVPR and Diane Treat-Jacobson, PhD

CE Credit(s): 1.00

Learning Objectives:

  • Understand the prevalence of pad and disparities in diagnosis and management of PAD.
  • Understand pharmacotherapy in PAD.
  • Understand the benefits and supporting evidence for supervised exercise in PAD. 

B306: COVID Post - Acute Health Issues  and Pulmonary Complications 

Track: Pulmonary Rehabilitation

Attend this session to learn about the symptoms and impact to “long-haul” patients. Learn about the UC, Davis Health experience in establishing a post-COVID-19 comprehensive specialty clinic. Review pulmonary complications and explore various treatment options including pulmonary rehabilitation in this new population of referred patients. 

Speaker(s): Mark Avdalovic, MD

CE Credit(s): 1.00

Learning Objectives:

  • Attendees will learn the definition of “long-haul” in post-COVID-19 patients.
  • Attendees will identify multi-organ system complications that impact quality of life and physical functioning. 
  • Attendees will learn important aspects of assessment in developing a plan of treatment for pulmonary rehabilitation.

B307: Maintain or Gain; It's Not All About Weight Loss

Track: Nutrition

Patients often lose weight in a Cardiac Rehab program but it is vital that they maintain or gain lean body mass. Incorporating strength training and optimizing quality protein intake is the answer.

Speaker(s): Christine Alongi, MS, MBA, RDN, LD

CE Credit(s): 1.00

Learning Objectives:

  • Understand how to combine plant foods to make complete proteins.
  • Understand methods to incorporate strength training and other methodologies to decrease the loss of lean body mass.
  • Understand the importance of maintaining or gaining lean body mass as we age.

B308: The New Essentials in Cardiac Rehabilitation Programs – Mayo Clinic Model

Track: Innovative Leadership

In this session, we will talk about the last evidence in cardiac rehabilitation focusing on emerging areas along with others that are progressively gaining more relevance in CR. The session will include four different topics: a comprehensive approach to managing obesity in secondary prevention – a highly prevalent cardiac risk factor – empowering cardiac patients effectively, expanding the scope of our services: new and incoming indications for CR and all that is coming in Cardiac Rehab.

Speaker(s): Maria Collazo-Clawel, MD; Francisco Lopez - Jimenez, MB, MBA; Marta Supervia Pola, MD, MSc, CCRP; and Randal Thomas, MD, MS, MAACVPR

CE Credit(s): 1.00

Learning Objectives:

  • To review the contemporary guidance on managing obesity.
  • To discuss evidence-based strategies to empower cardiac rehabilitation patients.
  • To establish the new CR diagnoses that should be referred to CR.
  • To introduce the potential role of artificial intelligence in Cardiac Rehabilitation.

 

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