AACVPR Outpatient Pulmonary Rehabilitation Registry

Launch Webcast FAQs

The Registry and Medicare
Q: How many outcomes are required by Medicare and which ones are
they?
A: Medicare requires objective clinical measures of effectiveness of the pulmonary
rehabilitation program for individual patients based on patient-centered outcomes
conducted at the start and end of the program. Those outcomes include written
evaluation of the patients mental and emotional function (including psychosocial
evaluation of the individuals response to and rate of progress under the treatment
plan), exercise performance, and self-reported measures of shortness of breath and
behaviors.
Q: Does Medicare require the same outcomes for cardiac and pulmonary
rehabilitation? If not, can you please clarify which are required for each?
A: The outcomes measured in cardiac and pulmonary rehabilitation are not the
same, though the concepts/areas measured are.
Per current CMS regulations for CR programs: Outcomes assessment: These
should include: (i) minimally, assessments from the commencement and conclusion
of CR, based on patient-centered outcomes which must be measured by the
physician immediately at the beginning and end of the program, and (ii) objective
clinical measures of the effectiveness of the CR program for the individual patient,
including exercise performance and self-reported measures of exertion and
behavior. Note there is no mention of what outcomes need to be measured
specifically. AACVPR takes the above to mean the CR program should measure
pre/post outcomes in several patient-centered areas, including clinical, behavioral,
and health domains. AACVPR has required that at least one (1) outcome (though
more are recommended) be measured in each area for certification purposes.
For PR patients per CMS: Objective clinical measures of effectiveness of the
pulmonary rehabilitation program for individual patients, including: Written
evaluation of patients mental and emotional function including psychosocial
evaluation of individuals response to and rate of progress under the treatment
plan, exercise performance, self-reported measures of shortness of breath and
behaviors based on patient-centered outcomes conducted at the start and end of
the program. Therefore, exercise performance, i.e., some functional assessment
(typically the 6-minute walk test), measures of shortness of breath and its impact on
daily activities, and psychosocial assessment, including emotional and mental
functioning, should be measured for PR outcomes. Screening for depression or
anxiety are some of the areas that can be assessed for the psychosocial outcome.
The commonalities between CR and PR outcomes assessment are that, minimally,
for each patient you should assess physical functioning, psychosocial functioning,
and symptoms. These are components of what has been defined as patientcentered health status.
Q: Will Ferrans & Powers cover Psychosocial?

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A: The Ferrans & Powers Quality of Life Index (QLI ) is a measure of health-related
quality of life and in the context of the AACVPR Registry would not be used for a
patients psychosocial score. In the context of CMS, however, the Ferrans & Powers
Quality of Life Index-Pulmonary version may be an appropriate instrument for
assessing health-related quality of life in PR patients.

Data Collection: Pulmonary Function/Spirometry

Q: What if only pre-program PFT/Spirometry is performed? Are you
expecting programs to request an order for PFTs post-discharge and
follow-up?
A: If only one PFT is available, no others are required. The additional fields are
included in the registry to allow you to enter the data at discharge and follow-up if it
is available, but they are not required fields. Please use the most recent PFT.
Q: Do you want Pulmonary Function/Spirometry data from within the last
year only?
A: The registry does not require that PFT be done within the past year. Please use
the most recent PFT.
Q: Will Medicare pay for a PFT pre and post program?
A: Not necessarily. Medicare coverage is normally based on a physicians order and
what is medically reasonable and necessary. Post PR PFT is not required by the
registry. If it is obtained, however, please include it in the registry data.
Q: Can we use bedside spirometry to meet the standards?
A: Spirometry must meet ATS standards for quality and reproducibility and must be
performed and interpreted by skilled, trained, qualified clinical personnel. If the
spirometry meets those requirements, it can be bedside spirometry. Read more in
Standardisation of Spirometry, Eur Respir J. 2005; 26:319-338.

Data Collection: Psychosocial and Quality of Life

Q: On Psychosocial, the data entry form also has CES-D listed. Is the CES-D
an acceptable tool to use, and will AACVPR collect this data in the
registry?
A: Yes, the CES-D is one of the included options in the registry for recording
Psychosocial Scores. This was an oversight in the presentation slide and has been
updated.
Q: Can SF-12 be used instead of the SF-36?
A: We are evaluating the validity, reliability and evidence base of the SF 12 in
chronic lung disease. If these areas can be addressed, we will add the tool.

Registry Data Fields / Supported Assessment Tools

Q1: At what point will you consider other outcome measures, and how
does one suggest other tools to be included in the registry?

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Q2: We are currently collecting data with the PSET (pulmonary selfefficacy tool), which has been part of WisPro (Wisconsins PR outcomes
collection) for years. It is not currently one the AACVPR Pulmonary Rehab
Registry data collection tools. Do you think it might be added in the
future?
A1 & 2: A limited number of additional tools and measures could be added to the
registry based on the level of validation, reliability, and use in PR programs and
research. Please forward any related comments and supporting documentation to
registry@aacvpr.org.
Q: On the outcome / diagnosis page can an other category be added?
There are some esoteric diagnoses that are not listed.
A: Thank you for your feedback; we will be adding this option to the PR Registry.
Q: Where would one gain access to some of these outcome measuring
tools, as our program doesn't currently use some of them?
A: A great reference for measuring outcomes is the AACVPR Pulmonary
Rehabilitation Outcomes Toolkit, available online to registry subscribers and AACVPR
members. The toolkit includes the following sections:
Functional Status/Exercise Capacity
Dyspnea Measurement
Quality of Life
Psychosocial
Chronic Lung Disease Assessment Tools and Resources (including COPD
Assessment Test, METs, FEV1, BODE Index, and 6MWT)
References

Data Collection: Follow-up

Q: For follow-up, how do you define at six (6) months from start of care? Is
it from start of PR program?
A: Yes, the six months is being calculated from the start of the patients pulmonary
rehabilitation program.

Reporting and Comparisons

Q: Will outcome metrics be benchmarked as a percentile rank for best
practice identification and performance improvement projects?
A: Yes, they will.
Q: Will we get an aggregate program score for the comorbidity index as
compared to other programs?
A: Yes, the aggregate program score for the comorbidity index is part of the
reporting and comparison options. Please note that this aggregate score is not
intended for use in risk adjustment comparisons.
Q: Will raw patient data be exportable into Excel or another flat file?

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A: The registrys Data Extraction utility provides data in Microsoft Excel format.
Please note that your program can only extract data that your program has entered.
You will not be able to extract data from other programs.
Q: Will the registry data be available for research and statistical
purposes?
A: There will be a procedure for accessing and using data for research; this process
is separate from registry subscription and data entry by a program.

Registry Subscription
Q: Is the AACVPR Pulmonary Rehab Registry included in AACVPR
membership?
A: No, the registry requires a program subscription, independent of AACVPR
membership.
Q: How much does it cost to subscribe to the registry?
A: Participation in the registry is based on an annual program subscription. The fee
is dependent on program size, based on the number of new Phase 2 patients who
enroll in your program annually. The current fee structure is as follows:
With payment received April 1 December 31, 12-month subscription fee valid
through June 30 of following year:
Annual enrollment of more than 75 patients: $150/year
Annual enrollment of 25-75 patients: $125/year
Annual enrollment of fewer than 25 patients: $100/year
With payment received January 1 March 31, 18-month subscription fee valid
through June 30 of following year (after which renewal will based on 12-month
subscription above):
Annual enrollment of more than 75 patients: $225/year
Annual enrollment of 25-75 patients: $187.50/year
Annual enrollment of fewer than 25 patients: $150/year
Q: Can the same Participation Agreement be used for cardiac and
pulmonary programs at same facility?
A: No. Each program must have its own Participation Agreement in place with
AACVPR for participation in the registry. In addition, if a program is participating in
both the AACPVR Cardiac and Pulmonary Rehabilitation Registries, the program
must have a separate Participation Agreement in place for each registry.

The Registry and Program Certification

Q: Is the registry what we use to certify now?
A: The AACVPR Registry and AACVPR Program Certification remain two separate
programs. Creating an interface between the registry and the Certification Center to

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populate the Certification application with outcomes from the registry is currently
being addressed and will be available in the future. (Additional data may still need
to be obtained from other sources and entered manually.) For now, the process for
Program Certification remains the same. Please visit the AACVPR Web site to learn
more about Program Certification.
Programs do not need to be certified to use the registry, nor is registry participation
a requirement for Program Certification.

The Registry and Telemetry Systems

Q: Will the registry interface with the Cardiac Science Q-tel system?
A: Cissec Corporation, the developer of the registry, has provided telemetry
companies with the information needed to complete an interface with the registry.
Each telemetry company is at various stages of establishing a link directly to the
registry to upload data. Please contact your sales representative for details.
Currently among AACVPR partners, ScottCare Cardiovascular Solutions reports the
capability to collect pulmonary rehabilitation outcomes, and LSI is working to do so.
Cardiac Science (Quinton) does not currently have a system to collect pulmonary
rehabilitation outcomes.

About this Webcast

Q: Will we be able to access the slides from the Webcast?
A: Yes; you will receive an e-mail with a link to the archived Webcast.
Q: Will this Webcast be available in the event the principal user changes?
A: Yes, the Webcast was recorded and will be available online for your reference and
the training of all additional registry users. It is part of the mandatory training for all
users of the AACVPR Pulmonary Rehabilitation Registry, whether Principal User or
Secondary User.
Q: Did you say the AACVPR Pulmonary Rehab Registry go-live date is June
24?
A: Yes, Monday, June 24 is the official go-live date. Programs that have completed
the Participation Agreement, paid the subscription fee, attended the training
Webcast, completed the online training, and received access from AACVPR can
enter data now, however.
Please note that each program participating in the registry must complete these
steps before being able to enter data into the registry. Download the subscription
instructions.

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For more FAQs, please click here.

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