Texas Association of Cardiovascular and Pulmonary Rehabilitation

1
A Message From Your President
Welcome to the Fall edition of the TACVPR
newsletter. I hope everyone had a fun and
relaxing summer and is ready to get back into the
swing of things now that the kids are back to
school and the holidays are fast approaching.
There is a lot to look forward to with the
upcoming AACVPR conference and planning of the
2008 TACVPR conference. This newsletter is
filled with informative articles addressing a
variety of topics including an update on the
latest reimbursement news, the upcoming TACVPR
Conference and other events, Texas program
certification update, as well as articles on
Mindful Eating, Smoking Cessation, NHLBI Breathe
Better Campaign and Childhood Obesity. The
Texas state affiliate (TACVPR) continues to work
closely with the AACVPR on leadership and
legislative initiatives. Several board members,
including myself, will be representing TACVPR at
the 22nd Annual AACVPR conference in Salt Lake
City, UT this October 17-21st. We will be
attending many important meetings including the
Health Policy Reimbursement Workshop where we
will get the latest update on legislative issues
so we can bring that information back to you.
There will also be many networking opportunities
with other affiliates that will give us ideas of
how to help us improve our association. I will
also be representing Texas at the 2nd Annual
AACVPR Leadership Conference in Chicago on
November 15-16th. The purpose of this workshop is
to provide Affiliate leaders with tools to help
them succeed in their roles as state leaders and
to provide networking opportunities to strengthen
the local organizations. I hope you enjoy the
enclosed newsletter and find the information
helpful in your daily practice. If you are
interested in writing an article for the next
newsletter, please email Dean Diersing at
mdiersing_at_teamumc.com. Happy Fall everyone!
Julie Hartman, MS TACVPR President
Texas Association of Cardiovascular and Pulmonary
Rehabilitation
Do You Know Anyone Interested in Joining
TACVPR? To join or renew your TACVPR membership
you may sign up online or download a printable
membership application at www.tacvpr.org Annual
dues are 40/person (membership is good
January-December yearly)
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Save the Date - 2008 TACVPR Conference Rodeo,
Ropin Rehab Deep in the Heart of Texas April
25-26th,2008 Dallas, TX
Plans are underway for the 2008 TACVPR conference
to be held at the Doubletree Hotel Campbell
Centre in Dallas on April 25-26, 2008. Speaker
Topics We have confirmed a number of speakers
who will talk on a variety of topics for both the
cardiac and pulmonary professional. Some of the
topics include ? Obesity and Metabolic Syndrome
by Dr. John Foreyt ? Getting the Most Out of
Your Healthcare Team by Kathy Oppenheim ? Oxygen
Prescription with Exercise by Dr. Richard
Casaburi ? Therapeutic Benefits of Laughter by
Mark Iberg ? Certification Recertification by
Barbara Flato ? Broken Heart Syndrome by Danielle
Strauss ? and many, many more Friday Social As
we have seen over the last few years, the Friday
night social has continued to be one of the
highlights of the conference and we will continue
with it again at the next conference. It is a
great opportunity for those who are looking for
some additional networking time, or if you just
want to relax and enjoy the evening with your
rehab friends!
3
Whats New on the Reimbursement Front
By Twyla Selvidge, MS East Texas Medical Center
Regional HealthCare System
August 2, 2007 CMS, awarded TrailBlazer
Health Enterprises the contract for the combined
administration of Part A and Part B Medicare
fee-for-service claims in Jurisdiction 4 (J4),
called MAC, Medicare Administrative Contractor,
which includes Texas, Oklahoma, New Mexico, and
Colorado. The TACVPR is pleased with this
announcement. Since TrailBlazer has been the
Texas Medicare claims administrator and given the
fact that TrailBlazer issued a LCD for Cardiac
Rehab on 5/17/07 AND Issued a LCD for Pulmonary
Rehab on 5/30/07, we have hope that TrailBlazer
will not change either of these LCDs. One
specific quote from the announcement stated
Neither the providers, physicians, nor the
beneficiaries who receive service from the
current fiscal intermediaries and carriers in
this jurisdiction will be adversely affected by
the transition of their work to the J4 A/B
MAC. September 20, 2007 The ACC put out a
news release on Cardiac Rehabilitation. The gist
of the news release was to announce that new
standards should contribute to increasing the
number of patient referrals. You may view this
release at www.acc.org/media/rleases/highlights/20
07/sept07 See the information below that further
explains the new standards. October 2, 2007
The AACVPR/ACC/AHA has revised a new set of
performance standards for Cardiac Rehabilitation.
The full document is published in the October 2,
2007 issues of Journal of the American College of
Cardiology and Circulation. It is also available
on the AACVPR and AHA websites. In addition,
the AHA/AACVPR has issued a revised scientific
statement Core Components of Cardiac
Rehabilitation/Secondary Prevention Programs2007
Update. This can viewed at www.circ.ahajournals.or
gIf your program is currently certified by the
AACVPR or you are re-certifying or you are
considering certifying your program, these
standard performances and core components will
help.
Whats That? CMS Centers for Medicare and
Medicaid Services LCD Local coverage
Determination NCD National Coverage
Determination MAC Medicare
Administrative Contractor ACC American
College of Cardiology AHA American Heart
Association AACVPR American Association of
Cardiovascular Pulmonary
Rehabilitation
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Certification Corner By Barbara Flato MSN, RN-BC,
FAACVPR
The 2006-2007 AACVPR Certification and
Recertification application process has ended.
All results were recently mailed to the
applicants. Programs are recommended to the
AACVPR Board of Directors for Certification or
Denial. As the process for Certification and
Recertification evolves, there is now an
opportunity for a program to be placed into a
provisional status. This permits the applicant to
remediate the areas that do not meet essential
requirements allowing an opportunity for programs
to make improvements in order to reach minimal
standards for certification or recertification.
This year the Program Certification Committee
received 92 applications and the Program
Recertification Committee received 416
applications across the country. Texas
successfully submitted sixteen applications
bringing the total number of certified program in
Texas to 43. Currently approximately 25 of Texas
programs are certified. I know we can do better
than that! Congratulations to the following
programs Initial Certification CHRISTUS Spohn
Alice Hospital Cardiac Rehab Alice Doctors
Hospital Cardiopulmonary Rehab Dallas East
Texas Medical Center Fairfield Cardiac
Rehab Fairfield Hill Country Memorial Hospital
Cardiac Rehab Fredericksburg Memorial Hermann
Hospital Cardiac Rehab and Wellness Houston San
Jacinto Methodist Hospital Cardiac
Rehab Baytown Sierra-Providence Physical Rehab
Hospital Cardiac Rehab El Paso Programs
Successfully Recertified Baylor All Saints
Medical Center/Ft. Worth cardiac Rehab Fort
Worth Citizens Medical Center Cardiac
Rehab Victoria Denton Regional Medical Center
Cardiac Rehab Denton Medical Center Hospital Ann
Roden Deaderick Cardiac Rehab Odessa Medical
Center of Lewisville Cardiac Rehab Lewisville Med
ical City Dallas Health and Rehabilitation Dallas
Medical City Dallas Pulmonary Rehab Dallas Moth
er Francis Hospital Cardiac Rehab Jacksonville S
id Peterson Memorial Hospital Pulmonary
Rehab Kerrville New applications for the
2007-2008 year are available on the AACVPR Web
site. Certification and Recertification committee
members will be presenting a breakout session and
a workshop session at the AACVPR Annual Meeting
in October in Salt Lake. If you are submitting
your program for certification or recertification
this coming year, it is highly recommended that
you attend these sessions. Feel free to contact
the committee members at the state or national
level when preparing your application. These
volunteers are happy to work with you to help you
achieve AACVPR program certification or
recertification. Contact information can be found
at www.tacvpr.org or www.aacvpr.org. We are here
to help!!
Check out these websites! Cardiac Rehab is
getting good publicity from a paper released
September 20th http//www.acc.org/media/releases/
highlights/2007/sept07/rehab.htm http//www.acc.or
g/qualityandscience/clinical/pdfs/CardiacRehab_PM_
sept20.pdf
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Mindful Eating By Marilyn Burwitz, RN
Have you ever driven down the highway for miles
and then had no memory of how you got to your
destination? Have you ever sat down to eat a
meal, and when it was over, wondered how the food
actually tasted? In both instances, you were
practicing mindless cruise control. Often we
go through our days completely unaware of what is
going on around us. Our minds are so busy
dwelling on the past or the future that we fail
to really pay attention to the present
moment. Mindfulness, on the other hand, is the
moment-by-moment awareness of our experiences.
With mindfulness, our actions become intentional,
careful, slower and more thoughtful. When we
practice mindfulness while eating we are aware of
both our food and what our bodies are
experiencing as we eat. We are blessed in this
country to have a plentiful supply of food
(sometimes too plentiful). Do we feel a sense of
gratitude for this abundance or do we take it for
granted? As we approach our food in a mindful
manner, we should do so with gratefulness for
what is available to us. We need to give
ourselves time to experience thankfulness. Mindfu
lness also calls for us to use all of our senses
as we eat. Some things to think about while
eating How does my food look? How does it
smell? What is the texture and temperature of my
food? How does my food taste--is it sweet, sour,
bitter, or spicy? Where did this food come from
and what effort was made to get it to my table?
What kind of aftertaste does it leave in my
mouth? Mindfulness while eating also calls for
us to slow down and take our time. We need to
give ourselves time to savor each bite, rather
than just shoveling in the next bite as soon as
we get one down. Take smaller bites, put down
your fork, and chew slowly. Once that bite has
been chewed, enjoyed completely, and swallowed,
then and only then, do you reach for another
bite. While you are eating, you also need to
be mindful of how your body is feeling. We only
need enough at each meal to get us to the next
meal. Listen to your body. As soon as your body
signals you that youve had enough, STOP! That
signal should come long before you are stuffed.
Oftentimes, instead of heeding this signal we
keep right on eating to the point of misery
(think Thanksgiving meal). Once we learn to heed
our internal satiety monitor then we will find
that we are actually satisfied with much less
than we may have eaten previously. Mindfulness
does not come naturally. We live very hectic
lives and our minds tend to be working on many
different levels throughout the day. It is not
easy to focus on one thing at a time. It is
worth trying. Practice taking smaller bites,
focusing on what your food tastes like with each
bite, eating slowly and listening to your body as
you eat. Take time to stop and smell the roast!
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Helping our Patients with Smoking Cessation Nita
Pack, RRT

• Smoking is a personal decision, whether someone
  is starting or quitting, the choice is
• theirs and theirs alone. Although we would like a
  smoke free environment, it is at times
• difficult to approach the smoker, about
  cessation, that does not wish to quit.
• The effects of tobacco are addicting and when a
  person uses tobacco, the body thinks it
• needs nicotine and it becomes habit forming. When
  nicotine is taken into the body, the
• person gets a quick kick which is caused by the
  body releasing a hormone that causes a
• sudden release of sugar. The longer a person has
  used tobacco, usually the harder it is
• for them to Kick the Habit.
• The person should know that using tobacco can
• - Cause breathing problems - Increase the risk
  for heart attacks or stroke
• - Lead to circulation problems - Shorten their
  life
• - Cause erectile dysfunction - Increase
  cholesterol levels
• - Cause insomnia - Cause infertility
• - Cause osteoporosis - Make them heal slower
  than normal
• - Lead to high blood pressure - Bring on
  menopause earlier
• - Narrow the arteries and make them less able to
  stretch

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Helping our Patients with Smoking Cessation
(cont.)

• Next, the person should decide on a quit method.
  These would include
• - Quitting cold turkey which means stopping
  all at once.
• Tapering off using less and less tobacco each
  time. This can be done by decreasing the number
  of cigarettes or by cutting them down in length
  little by little.
• Nicotine Replacement Therapy is now available in
  many forms. The person can decide between the
  patch, gum, nasal spray, oral inhalers, lozenges,
  and pills.
• - Attending a Smoking Cessation Program may be
  helpful for some people while going through the
  quitting process. A list of programs in your area
  should be available through the American Cancer
  Society.
• - There are also telecounselling options
  available where the person speaks on the
  telephone with a counselor to help them with the
  quitting process. A couple of these are
  SmokeStoppers (1-800-697-7221) and 1 800
  QUIT-NOW.
• - The internet offers websites which are
  interactive and educational. Some of these
  websites include
• - SmokeStoppers.com
• - Quit-net.com
• - WebMD.com
• - Way2Quit.com
• - Cdc.gov
• - Smokefree.gov
• - Aha.com
• - Philipmorrisusa.com
• Other options are support groups, hypnosis
  therapy, and acupuncture.
• Recovery is getting past the withdrawal and its
  symptoms. No matter which method is

Texas Members Serving on AACVPR National
Committees We want to recognize our TACVPR
members who serve on national committees and
thank them for dedicating their time help Texas
to become more involved with AACVPR. Cheri
Duncan, RRT Reimbursement Committee Barbara
Flato, RN Certification Committee Julie
Hartman, MS Education Committee Poppy
Patterson, RN, BBA Certification
Committee Laura Raymond, RN Chair of State
Certification Committee If you are interested in
serving on an AACVPR committee, visit
www.aacvpr.org for more information.
8
Childhood Obesity on the Rise Recess Will Not
Help By Danielle Strauss, BSN-BC, RN

Have you asked your children lately if they have
recess anymore? Their response might surprise
you, there is a chance they will tell you no.
This may bother you because as a healthcare
provider you think that physical activity is
necessary for weight loss. Do you recall sunshine
on your face, the smell of grass and kickball
games? Time in the classroom for standardized
test instruction has taken over the available
time for recess. As a result, certain
organizations and individuals are making
recommendations for recess time. These
organizations and individuals may be associating
recess with calories burned. The math of this
association is not plausible. Every day,
literature crosses our desks and computers,
stories are featured on the television and
patients are seen in the emergency room because
of the number one killer, cardiovascular disease.
As healthcare professionals, we know that obesity
is a risk factor of this disease. Some might
think the risk factors for cardiac disease are
limited to 50-70 year old patients. This is not
the case in todays children. Literature states
that currently 16 of our nations children are
overweight. The CDC reports that in children ages
6-11 the rate is as high as 18.8 and for
children 12-19 years old the rate is
17.4. Recess is important and beneficial for
our young. The benefits include building bones,
strengthening muscles, reducing stress and
forming social skills. However, recess and
physical education class are not the solution to
the obesity rate in our children. Have you ever
really considered the amount of calories burned
during recess? A dodge ball game played during a
15-minute recess burns a total of 70 calories.
Have you also considered the caloric content in a
meal from McDonalds? One McDonalds meal
consisting of a cheeseburger, medium fries and
coke is a whopping 905 calories. Do the math and
you will find the answer. Have each child
jog/walk 9 miles during a 15-minute period of
recess, then one can assume the calories from
that unhealthy meal will burn off. Recess is not
going to make the slightest dent in the childhood
obesity problem. The truth is that the type of
food eaten and the amount of the food consumed
has everything to do with obesity.
In conclusion, parents have the most significant
impact on their childrens health. Parents have
the ability and knowledge to teach their children
the truth and should be held accountable for the
rising rates of obesity in their children. Recess
is and should be fun, physical education is
important for learning. Eating less is a
guarantee for weight loss.
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NHLBIs LEARN MORE BREATHE BETTER Campaign By
Kitty Collins, RRT

Anyone working in Pulmonary Rehabilitation is all
too aware of the devastating effects of COPD. How
many times have we heard I stopped smoking 10
years ago by someone who was in the moderate to
severe range of COPD when you first met them?
Over the last four years I have worked with
American Lung Association to promote COPD
awareness within the Austin community. The NLHEP
(National Lung Health Education Program) has
wonderful resources as well as the GOLD (Global
Initiative for COPD) program for helping educate
the public and health care community on early
detection and treatment for those suffering from
COPD. In spite of this there was not much media
attention given to this disease, even though it
was the fourth leading cause of death in the U.S.
Finally with the launch of NHLBIs (National
Heart Lung Blood Institute) campaign, Learn More
Breathe Better, on January 19th, 2007 there have
been articles in Newsweek, The Wall Street
Journal, and most recently Womans Day magazines.
They are all centered around Ted Koppels wife,
Grace Ann Dorney Koppel. She has become the
national spokesperson for NHLBI for COPD. Her
story is like many with COPD in that in spite of
her history of heavy smoking in the past and her
complaints of SOB, she had a difficult time
finally being diagnosed with COPD. She openly
talks about her frustration with this
particularly after she discovered that it could
have been detected with a simple spirometry test.
She has also been interviewed on Good Morning
America, The View and the CBS Evening News with
Katie Couric. Grace and her husband are doing
their part to help get S 329 passed and recently
attended meetings on Capitol Hill with members
and staff of the Senate Finance Committee on the
need for national coverage for pulmonary
rehabilitation. If you are not already involved
in COPD Awareness, now is the perfect time to get
started. World COPD Month is in November and
World COPD Day is Nov. 14th. It may be something
as simple as having a poster presentation in your
facilities lobby or something on a grander scale.
NHLBI has promotional materials that are free of
charge to get your project going. They even have
PSAs for media presentations and suggestions for
promoting COPD Awareness in your community. To
read more about the campaign and to receive
information go to www.learnaboutcopd.org. You
can also get wonderful resources at www.nlhep.org
and www.goldcopd.com. I would be happy to
assist anyone that needs help starting their own
community project and would encourage you to
contact your local American Lung Association
branch to find out what support they can give or
you can email me at kcollins_at_seton.org.
Congratulations to the RAP (Refer-A-Pal)
Candidates Winners Kori Rich   8 points
Free Conference Dues for 2008 Conference Dean
Diersing 8 points Free Conference Dues for
2008 Conference Katy Kennedy 6 points Anita
Gaddis 4 points Valerie Arizmendi 4
points Marilyn Burwitz 2 points Julie Hartman
2 points Clint Rivers 2 points
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IN OTHER NEWS
ATTEND THE UPCOMING NTACVPR MEETING All cardiac
pulmonary rehab professionals are welcome to
attend the next meeting which will be held
on Tuesday, October 30th at Don Pablos
Restaurant.  Location Don Pablos
Restaurant 3911 W. Airport Freeway (Rt
183) Irving, TX 75062 Topic Sammons Preston
will be highlighting the new/updated equipment
from Star Trac Sci Fit   NTACVPR Activities
 Election of Officers, sites to host next years
meetings, HOT topics for 2008 meetings, ideas to
increase participation, CEU opportunities
        Please RSVP to Ellen.Bracy_at_va.gov or
Margaret.Auchter_at_va.gov or by phone at
214-857-0101
Congratulations to Joanne Garcia for winning the
drawing for a free TACVPR membership for 2008 by
visiting all the vendors and completing the
vendor card.   
Is Your AACVPR Membership Up to Date? AACVPR
membership dues expired June 30th Dont forget
to renew! Membership fees 185
Member/Associate Member 75 Student Go to
www.aacvpr.org to join or renew your membership
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UPCOMING SEMINARS
CARDIAC YOGA TEACHER TRAINING COURSE Nov. 1-6,
2007 M. Mala Cunningham, Ph.D. Founder
Director - Cardiac Yoga Website
cardiacyoga.com GET CERTIFIED TO TEACH CARDIAC
YOGA FOR HEART PATIENTS 6-DAY CONDENSED COURSE,
NOVEMBER, 2007 Medical Personnel, Cardiac Rehab
Staff, Yoga Teachers and others are eligible to
apply Limited Enrollment - Register
Early Charlottesville, Virginia 6-day condensed
program, non-residential tuition 1275.00 Held
at the beautiful English Inn in Charlottesville,
VA For an application or more information Mala
Cunningham, Ph.D., info_at_cardiacyoga.com
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2007-2008 TACVPR Board of Directors
Board Officers President Julie Hartman,
MS Baylor Jack Jane Hamilton Heart Vascular
Hospital President-Elect Marilyn Burwitz,
RN East Texas Medical Center Fairfield Past
President Lorri Lee, BS, RCEP McKenna Memorial
Hospital Treasurer Twyla Selvidge, MS East
Texas Medical Center Secretary Nita Pack,
RRT Methodist Charlton Medical Center Board of
Directors Poppy Patterson, RN, BBA Hillcrest
Health System Kitty Collins, RRT Seton Medical
Center Mary Hart, RRT Baylor University Medical
Center Danielle Strauss, BSN, RN-BC, BS Baylor
Jack Jane Hamilton Heart Vascular
Hospital Barbara Flato, MSN, RN-BC,
FAACVPR CHRISTUS Spohn Cardiac Rehab Dean
Diersing, MS University Medical Center, Health
Point Fitness Cardiac Rehab
Interested in serving on the TACVPR Board of
Directors?
Contact Lorri Lee at llee_at_mckenna.org for more
information.