Throughout my travels, I have spoken with a number of people who have ITP questions as they relate to AACVPR requirements. So, we at ScottCare decided that this might be a useful venue for answering some of these common concerns for the benefit of others throughout the industry.
Q: What ITP information is required when submitting to AACVPR for Pulmonary Rehabilitation accreditation?
The Pulmonary ITP requires an oxygen section, along with exercise, psychosocial, nutritional, and other core components. So, when submitting an ITP for your Pulmonary Rehabilitation AACVPR accreditation, it needs to address the patient’s oxygen use (or no use) and titration. The oxygen section should include an assessment, plan, intervention, education, and goals, just like the other sections of your ITP.
Q: What information should be included in the psychosocial section of the ITP?
The short answer is, as much as possible. Have the patient talk about their feelings. Explore what is happening in their lives that might affect their recovery. Use the comment boxes and notes to record as much of the patient’s situation as possible. When completed, the form becomes a tool for tracking the cardiovascular and mental progress of your patient. This is especially critical after a life-changing event, such as heart surgery. Rehab programs use different tools to assess for quality of life and depression. There are no right or wrong ones, but PHQ-9 and Dartmouth COOP are common. What is important is the documentation and repetition in the follow-up. For example, if the patient's score is 5 or greater on the PHQ-9, this is above the safe threshold. The patient should complete the form again, then add it to their next reassessment. This sequence can repeat in the next reassessment to chronicle the patients' progress.
Q: How do you get the doctor or medical director to sign ITPs on time?
This is a very tricky question to answer. I have seen rehabs that complete the ITP on day 25, then give it to the doctor with a few days to sign. Others complete the ITP and give it to the doctor on day 29 for a more immediate workflow. Many facilities use a VersaCare system with an EHR interface, which then sends the ITP to the doctor. One of the best ways is to find a medical director that is very involved with the rehab. Seeing the doctor in in the rehab serves two purposes. It not only benefits your workflow, but it also benefits the patient to see an engaged physician.
Q: Does my initial individualized exercise prescription need to be part of my initial ITP?
Per CMS Guidelines, the submitted physician-signed initial exercise prescription must be a component of the planned interventions in the Exercise area of the Individualized Treatment Plan. The CMS requirement states that the physician reviews, signs and dates the initial ITP (and ExRx) at initial assessment and at least every 30 calendar days thereafter, including discharge.
Q: What are the required elements of an ITP for AACVPR Certification?
The Cardiac Rehab ITP requirements are as follows: Exercise, Nutrition, Psychosocial, Other Core Components/Risk Factors. For Pulmonary ITPs, the elements are Oxygen, Exercise, Nutrition, Psychosocial, Other Core Components/Risk Factors. Each element also includes an assessment, plan, reassessment and discharge/follow up. Click here for a downloadable copy of the complete checklist of elements for AACVPR ITP requirements.
Q: Will my ITP pass AACVPR certification if my program only does initial and discharge ITPs?
AACVPR requires initial, at least one reassessment, and a discharge ITP. You can do your reassessments at any time, but per CMS you need to have the ITP signed and dated at least every 30 days.
If you have other questions about anything related to AACVPR accreditation you can visit their website (aacvpr.org). If you have other questions on ITPs or cardiopulmonary rehab workflow issues, feel free to send them in and we will answer them in a future post.
Dallas Berry is a Clinical Application Specialist for ScottCare covering the Midwest Region. Before his time at ScottCare, Dallas worked in Cardiac and Pulmonary Rehabilitation. He holds a Clinical Exercise Physiologist Certification from the American College of Sports Medicine. Dallas is a member of AACVPR.