PRE FINAL Flashcards
____ is another issue that must be addressed.
Class size
Theoretically, ____ for a rehabilitation program could range from _____ , depending on available _____ and ______.
class size / 1 to 15 participants/ space, equipment, staff, and patient condition/needs
However, to foster group identity, interaction, and support, ____ are encouraged.
small-group discussions
The ideal class size should range from _____.
5 to 10 participants
Keeping the ____ manageable facilitates vital group interaction processes and allows for more individualized attention.
class size
These factors help sustain ___ , reducing the likelihood of ____.
motivation / participant attrition
Both the instruction and the reconditioning component of the program require ____ .
equipment
To meet the educational needs of the program, a ____ and ___ can be very useful.
whiteboard or flipchart, computer with a PowerPoint projector screen, and CD/DVD player
___ and _____ dealing with the educational topics covered during the rehabilitation program should be available for ___ and _____.
Videos / formal learning packages / group / individualized presentation
If possible, learning materials should be available in ___ or the _____ in the community surrounding the location; this alternative may facilitate learning when ____ are present.
different languages / predominant language / language barriers
For physical reconditioning, ____ and _____ constitute the minimum equipment requirements.
stationary bicycles, treadmills, rowing machines, upper extremity ergometers, weights, pulse oximeters, / inspiratory resistance breathing devices
The quantity of equipment needed depends on ___ and ____
class size, available space, and financial resources available.
Sufficient equipment should be ____ to keep all patients exercising and to monitor their activity.
on hand
It is important to maintain equipment ___ and in ___ for safety;
clean / good working conditions
___ or ____ equipment may discourage patients from attending.
dirty or malfunctioning
___ and ____, as well as an _____ should also be maintained in the rehabilitation area.
Emergency O, / bronchodilator medications / automated external defibrillator (AED)
Equipment guidelines for a class of 5 to 10 participants include the following:
five stationary bicycles,
two treadmills,
two rowing machines,
two upper extremity ergometers, five pulse oximeters for monitoring heart rate and
O, saturation,
one emergency 0, cylinder (E), and bronchodilator medications.
In addition, each patient should be supplied with an ____
inspiratory resistance breathing device.
Because equipment can be expensive, care must be taken in its ___ and ___.
selection / purchase
____ and _____ should be durable, easy and safe to use, simple to maintain, and not overly expensive.
Devices and appliances
Initially, ___ items are purchased.
basic
As a program develops and expands, ____ can be enhanced.
equipment resources
Maintaining individual patient manuals, including ___ or activity diaries
daily log forms
Providing ____ for program participants
light refreshments
Developing a _____ to announce schedule changes because of emergencies or cancellation of class sessions because of illness or weather
communication network
Identifying available ____ providers for participants in need of specialized home care equipment
durable medical equipment
Developing a system of ___ and a ____ for patient payment
charges / mechanism
By considering all of the factors needed for effective implementation of PR, programs have ____ and a greater chance for ____.
lower patient attrition / overall success
As programs are conducted, ____ must be made by both patients and staff.
regular evaluations
Needed changes should be implemented on an ____
ongoing basis.
Only in this manner can one expect continued refinement of the ___ and improvement in ____.
process / patient outcomes
In addition to traditional face-to-face PR programs, web-based offerings known as ___ platforms are becoming a viable alternative and are now being offered by an increasing number of health service providers.
telerehabilitation
Such ____ packages use a combination of a personal computer or device, a reliable internet connection, a patient monitoring module and relatively low-cost exercise equipment to allow patients to participate in PR.
telerehabilitation
In such programs, a _____, often including an ___ in a central location with a digital interface, permit patients to participate in such programs from their home.
physician-led, multidisciplinary team / RT
Preliminary research suggests that all benefits of face-to-face PR programs, including fewer hospitalizations, can be achieved through ____.
telerehabilitation
In addition, these types of offerings have the added advantages of ___ and the ability to include patients who are ___ or live in remote locations and who may otherwise be excluded.
lower cost / home-bound
____ is an alternative to traditional PR programs for home-bound patients or those in remote geographic areas.
Web-based telerehabilitation
Rehabilitation programs usually project their fees based on the ____.
average cost per participant
According to____ and ____, costs vary throughout the United States.
regional labor and material prices
___ factors must be considered when projecting program costs
Several
The ___ the class size and the more participants involved in the overall program, the lower the per-patient cost.
larger
The aim should be to offer and conduct the ____ program possible at a reasonable cost that meets any existing budgetary constraints.
highest-quality
When determining patient charges, ____ must also be given to the type and amount of funding that has been received to offset program expenses and available insurance reimbursement.
consideration
___ and ____ testing and evaluations naturally generate revenues but should not be included in the ____ of program charges.
Pre-program and post-program / formulation
However, payments for _____and other evaluations may help to keep a PR program financially viable.
pulmonary function testing, exercise testing, arterial blood gas analysis,
___ for an entire program or for each session must be structured in a way that does not deter patient attendance.
Charges
Many patients with a ____ are on a fixed income and have other living and medical expenses.
chronic pulmonary disease
A happy ____ between a patient’s ability to pay and program expenses must be ____.
medium / identified
Funding from local charitable organizations, foun-dations, or agencies such as the _____ and the ____ can help ease the financial burden.
American Lung Association / COPD Foundation
The most comprehensive and effective program available can have no impact if patients are unwilling or unable to attend and participate because of _____
financial limitations.
Along with health care costs in general, the cost of providing PR has ____ over the years.
increased
Nationwide charges for PR ___, depending on program length, whether the offering is in-person or web-based, and, most importantly, _____.
vary / insurance coverage
With most insurance plans reimbursing programs at ___after a deductible, each patient would be responsible for the remaining ____.
80% / 20% or copayment.
The out-of-pocket amount may vary if the program is offered in a ____ (20% after insurance payment) or _____ (copayment per session).
doctor’s office / hospital outpatient program
Additional or ____ may cover this balance.
supplemental medical coverage
____ for participation in these programs and inpatient rehabilitation reimbursement policies vary throughout the United States.
Charges
The CMS, has published the final rules for Medicare reimbursement guidelines for ______.
comprehensive outpatient rehabilitative facilities (CORFs)
Under Part B of Medicare, the scope of services of a ___ includes reimbursement for outpatient activities and one home visit.
CORF
Reimbursement requires that the CORF meet the conditions of participation established in section ______;
933 of Public Law 96-499
this also includes provisions for certification of the program. To establish reimbursement mecha-nisms, each CORF must present its program ____ and ____ to local third-party payers.”
description / anticipated results
The ____ has also developed guidelines for program design, implementa-tion, and recognition.
AACVPR
By following recognized guidelines, ____ has established an allowable charge for PR and reimburses 80% of this rate after the patient meets the annual prescribed deductible.
Medicare
In the past, inpatient and outpatient PR programs obtained reimbursement from ____ by charging for rehabilitation sessions as physical therapy exercises for COPD, reconditioning exercise sessions, office visits with therapeutic exercises, serial pulse oximetry determinations, or physician office visits.
third-party payers
The goal was to obtain as much ____ as possible, decreasing the ___ on the patient
insurance reimbursement/ financial burden
To help ensure adequate ____ for PR, identify patient goals and objectives; formulate and implement an effective exercise prescription for each patient; use diagnostic codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM); use current and proper CPT (Current Procedural Terminology) coding and documentation from patient’s medical record to support the need for PR.
reimbursement
Programs have to obtain ____ from their Medicare beneficiaries following accepted protocol, policies, and provisions specified by Medicare.
reimbursement
Coverage is for patients with stage _____ (moderate to very severe according to the GOLD standards).
II, III, and IV COPD
The programs must include five components, which must be documented in the patient’s medical record:
- Physician-prescribed exercise
- Education and training that relate to an individual patient’s needs
- Psychosocial assessment
- Outcomes assessment
- Individualized treatment plan.
Nongovernment health insurance programs-private, single, or group health
insurance plans
Health maintenance organizations (HMOs)
Preferred provider organizations (PPOs)
Medicare supplement
Federal and state health insurance programs
Medicare
Medicaid
Uncompensated services (Hill-Burton)
Comprehensive outpatient rehabilitative facility
Veterans Administration benefits
Civilian Health and Medical Programs of the Uniformed Services (CHAMPUS)
Federal workers insurance
-related to automobile accidents
Automobile insurance
-related to accidents on the job
Workers’ compensation
related to injuries sustained on business premises
Business insurance coverage
-related to injuries sustained on the owner’s premises
Homeowner’s insurance
on providers of health care
Malpractice insurance
-related to injuries caused by a
product or service
Product and service liability insurance
Other options of reimbursement
Senior care
Rehabilitation hospitals
Grants
Under current guidelines, ____ covers PR when it is determined to be medically necessary and patients meet the necessary criteria.
Medicare
The patient must be diagnosed with moderate to very severe
COPD (GOLD Classification ____) or any chronic respiratory disease with disabling implications before being referred to the program by the treating physician.
II, III, & IV
____ results can be utilized to support the diagnosis in addition to the GOLD Classification.
Pulmonary Function Test (PFT)
A physician’s order. The chart must have documentation showing that a physician prescribed an ___ for each day.
exercise plan
_____ showing the patient completed each daily plan of care.
Documentation
____ showing education and training provided to the patient and specific to the patient’s needs.
Documentation
____ showing psychosocial assessment.
Documentation
Outcome ____ after the program is completed.
assessment
An individualized treatment plan reviewed and signed by the physician must be provided. This plan has to be reviewed by the physician every ____.
30 days
Correct billing code for the services provided. For pulmonary rehabilitation, it is ____.
G0424
The reviewer from the insurance company has the authority to request additional documentation for determination, if the person considerers that current documents do not support the ____.
filed claim
According to CMS, claims for Medicare patients should be submitted to ____ for any component of PR performed during a hospital stay
Medicare Part A
claims for rehabilitation components provided on an outpatient basis must be submitted to ____.
Medicare Part B
This payment mechanism has already undergone changes and it is anticipated that ____ will continue to change its reimbursement policy for PR in the future.
Medicare
It is incumbent on clinicians who provide PR to stay abreast of any changes in ___ and ___ and to make necessary adjustments to receive payment.
reimbursement policy and procedure
At the present time, there is provision to reimburse programs for two ___ rehabilitation sessions per patient per day up to____
1-hour / 36 sessions.
An additional ____ over an extended period can be approved by the individual Medicare contractor based on patient need for continued rehabilitation and physician referral.
36 sessions
Individual sessions must be at least ____ in length.
31 minutes
If two sessions are performed on the same day, services may be reported only if the duration of the combined treatments is at least ____.
91 minutes
It is essential that the ____ who conducts PR is familiar with all current practices so that therapy that is provided and billed for complies with current Medicare policy, is properly documented for each patient, and is submitted in a timely manner.
practitioner
__ and ___must be evaluated at the conclusion of the program
Patient and program outcomes
This evaluation must compare patient status before the program with current patient status and may include ____ and ____
physiologic, psychological, and sociologic data.
Common outcome measures include _____ and ____
exercise tolerance, levels of dyspnea at rest and with exertion, and quality-of-life surveys.
The ___ collected may support reimbursement claims or if the physician needs to order additional sessions for the patient to achieve the plan of care.
data
Results of PR must be communicated to the ___ and ____, if appropriate.
patient, referring physician, and family
Further goals and objectives for continued improvement may be established to provide the basis for ____ and ____
follow-up and reinforcement activities.
____ and ____ PR programs and patients’ outcomes are important to achieve the current guidelines and to promote the benefits of the programs.
Tracking and documenting
The ____ can be used by providers to negotiate reimbursement rates based on the positive outcomes obtained.
data
If no improvements in physical or psychosocial measures occur within a class or group, ____are often the cause.
program deficiencies
insufficient professional training in rehabilitation methods, a lack of a uniform approach, inadequate program length, and lack of follow-up are the major reasons for _____
unsatisfactory outcomes.
If a very small number of patients (i.e., one or two) from a large class show no improvement, it may be the result of a lack of _____ to the plan of care.
patient’s compliance
Finally, ___ has become recognized as an ideal setting for certain patients with severe chronic respiratory diseases who are able to undergo lung volume reduction or lung transplant surgery.
PR
The program can provide information before the procedure to help to educate patients about benefits, risk, and outcomes of the surgery;
PR
_____ helps to stabilize exercise tolerance and muscle function to improve survival and outcomes after surgery.
physical reconditioning
Potential Hazards
Cardiovascular abnormalities
Blood gas abnormalities
Muscular abnormalities
Miscellaneous
Cardiovascular abnormalities
A. Cardiac arrhythmias (can be reduced with supplemental
O, during exercise)
B. Systemic hypotension and hypertension
Blood gas abnormalities
A. Arterial desaturation
B. Hypercapnia
C. Acidosis
Muscular abnormalities
A. Functional or structural injuries
B. Diaphragmatic fatigue and failure
C. Exercise-induced muscle contracture
Miscellaneous
A. Exercise-induced asthma (more common in young patients with asthma than in patients with COPD)
B. Hypoglycemia
C. Dehydration
Proper patient ______are key factors in reducing possible hazards.
selection, education, supervision, and monitoring
To help avoid potential hazards and identify contraindications, it is necessary to conduct an initial _____ to identify any medical condition that may interfere with the success of the program and achieving the plan of care and goals.
individualized assessment
The assessment will help the team to determine the patient’s ____ and possible adherence to the program.
willingness
In all situations, patient ___ must be a high priority for the PR team.
safety
Similar to PR, good ____ programs are multidisciplinary in approach and focus.
cardiac rehabilitation
Goals include patient education promoting heart-healthy living, physical reconditioning to improve work capacity, weight loss, and a return to work when possible.
cardiac rehabilitation
___ and ____rehabilitation share many similarities and differences.
Pulmonary and cardiac
___ include the need for patient evaluation before program enrollment, patient education, the focus on exercises to increase fitness and stamina, and the need to monitor patients during exercise and for compliance.
Similarities
_____ include disease focus, patient age (most cardiac patients range in age from late 30s to 60s and 70s, whereas pulmonary patients for the most part are 250 years), and exercises used within the program.
Differences
(most cardiac patients range in age from _____,
late 30s to 60s and 70s
pulmonary patients for the most part are ______),
> 50 years
Breathing exercises to improve ventilation are essential to the ____ patient but are not that important to cardiac patients.
pulmonary
Finally, respiratory involvement in cardiac rehabilitation is significantly ____.
lower
For the most part, the ___ is involved with instruction on O, use and may assist with patient exercise sessions during cardiac rehabilitation.
RT
A properly ____ and ____ program can produce positive and measurable patient outcomes.
planned and implemented
____ and ___ of PR should be written in these measurable terms and be explained to the patient in a _____ to achieve optimum therapeutic outcomes.
Goals and objectives / clear, concise fashion
The success of ____ depends on this along with careful application of current clinical knowledge and the use of a multidisciplinary approach throughout all phases of program organization, implementation, and evaluation.
PR
____ will help to achieve the healthcare initiatives to reduce healthcare cost and reduce readmission rates and will continue to gain greater acceptance.
PR
The role of the RT in PR will likely ____.
increase
