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CARDIAC REHABILITATION LOS ANGELES Paul Smith Justyn Robbins

CARDIAC REHABILITATION LOS ANGELES Paul Smith Justyn Robbins All Wales Cardiac Rehabilitation Conference Wednesday 12 th May, 2010. Caernarfon. BACR TRAVEL AWARD 2009 The initial idea!

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CARDIAC REHABILITATION LOS ANGELES Paul Smith Justyn Robbins

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  1. CARDIAC REHABILITATION LOS ANGELES Paul Smith Justyn Robbins All Wales Cardiac Rehabilitation Conference Wednesday 12th May, 2010. Caernarfon

  2. BACR TRAVEL AWARD 2009 The initial idea! ‘sum of money up to the value of £2000 to contribute towards the cost of travel to attend an innovative course/conference or to visit a centre of special interest/expertise in order to develop knowledge in the field of C R’. Submitted application end of May 2009 Awarded July 2009 July 2009 – April 2010 Visit Planning

  3. OBJECTIVES • Paul • Compare C R models utilised by services • Examine modes of performance monitoring / audit • Review forms of clinical documentation in use • Review integration of ‘Cardiac’, ‘Pulmonary’, & ‘Vascular’ rehabilitation • Develop greater international networking within C R to sharing best practice • Compare health-economic and organisational aspects between UK and US • Justyn • Review techniques of pre-programme risk-assessment • Appraise different approaches to exercise prescription • Explore models of exercise programmes in use • Enhance knowledge of exercise prescription for patients undergoing new and emerging interventions

  4. CALIFORNIA State Capital - SacramentoKey Cities - Los Angeles, San Diego, San Francisco3rd biggest state in the USA (x2 UK / x20 Wales) Most populous state in the USA (x0.5 UK / x10 Wales)Industries – agriculture, oil, mining, electronics, film making/entertainment & tourism Main Rivers - Sacramento River, Colorado RiverHighest Point - Mt. Whitney, 14,495 ft above sea levelLowest Point - Death Valley, 282 ft below sea level Number of Counties - 58Bordering States - Oregon, Nevada, ArizonaBordering Country - MexicoBordering Body of Water - Pacific Ocean

  5. University of California Los Angeles Ronald Regan Medical Center is recognised as 1 of the top 3 hospitals in the US and the top hospital and the West Coast The hospital has been ranked in the top twenty in 15 of the 16 medical specialties ranked by the US News ranking. Ten of those specialties were ranked in the top ten.

  6. UCLA – Cardiopulmonary Rehabilitation • MDT: • Exercise Physiologist • Registered Nurses • Respiratory Therapists • Clinical Dietitian • Manager • Administrative Assistant • Monday, Wednesday and Friday • 6:30 am to 4:30 pm • Tuesday and Thursday • 7:30 am to 4:30 pm • 40 Phase II Patients per day

  7. UCLA TEAM

  8. MISSION VIEJO HOSPITAL • Orange County, California • 1969 Clinic on a ranch • Orange County’s Regional Medical Facility • California’s State Neurosurgery Facility • Designated Cardiac Receiving Center • Emergency Chest Pain Center • Cardiac Centre: • Cardiac Intensive Unit (27 beds) • Cardiac Telemetry Unit (24 beds) • Cardiopulmonary Rehabilitation

  9. MISSION VIEJO HOSPITAL • MDT: • 2 Exercise Physiologist • 2 Registered Nurses • 1 Respiratory Therapists • 1 Manager • Administrative Assistants • Referral to ‘Therapies Team’ – Dietitian, OT, Physiotherapist • Monday – Friday 07.30 – 18.30 • 65 Patients seen daily

  10. MISSION VIEJO HOSPITAL Carol Catalano C R Coordinator

  11. CR exercise Phase III takes place on Monday, Wednesday and Friday in the am with Phase IV in afternoon at UCLA and a separate facility on site for Phase IV at Mission Viejo Telemetry is used to monitor all Phase III patients CARDIAC REHABILITATION EXERCISE

  12. Classes are all cardiovascular aerobic exercise – 1 hour in length Separate sessions for resistance training All classes are gym based with no circuit training facilities available UCLA - 10 patients per session maximum with 14 stations Mission Viejo – 15 patients per session maximum with 21 stations CARDIAC REHABILITATION EXERCISE

  13. Located next to the Cardiopulmonary Rehab Center at Mission Viejo the center for Rehabilitation/ Sports/Wellness caters for all areas for Rehabilitation and in particular CR. Center for Rehab/Sports/Wellness

  14. Using a Nintendo Wii as an alternative to rehab Patients using Wii Fit Plus must under go a risk assessment for falls Competitions between patients in 10-pin bowling, golf and basketball Wii-hab

  15. CHALLENGE OF ETHNIC DIVERSITY • 135 ethnic groups in California • Russian • Jewish • Persian • Korean • Spanish • Interpreter Services • Translation & Resources

  16. AACVPR SERVICE ACCREDITATION • National peer-reviewed accreditation process • Sponsored by the American Association of Cardiovascular and Pulmonary Rehabilitation known as ‘AACVPR’ • Provides guidelines and essential standards of care • Recognized by insurance companies as part of performance measures • First available in 1999 • Currently about 1500 programs nationally are certified • Certification is for 3 years • $600 – initial accreditation • $500 – re-accreditation • In California, only 25 C R (27%) and 25 P R programs (?%) are certified • Only five percent of programs nationally hold dual accreditation

  17. AACVPR SERVICE ACCREDITATION • Demonstration of excellence in 16 categories: • Documentation / evidence over a 15 month period • Simpler categories include: • Staff competencies • Written policies and procedures • Emergency in-services • Team meeting minutes • Consent process • Physician referral process • More complete categories include: • Complete plan of care for an actual patient demonstrating assessment, • intervention, re-assessment and follow-up re: Education, Exercise, • Nutrition, Psychosocial • Outcomes in four domains: Clinical, Behavioral, Health, Service www.aacvpr.org/certification

  18. Without Insurance Orientation/Assessment = $165.00 (£110) Monitored sessions = $104.50 per session (£70) They must do at least 3 monitored sessions Assessment plus 1 week of monitored exercise will cost (approx £320) With Insurance – Billing to insurance companies Orientation/Assessment including 1st monitored session = $897.00 (£600) Monitored sessions after that = $230.00 (£155) Typically CR would be 6 - 12 weeks x 3 sessions per week Without insurance = $3,927.00 (approx £2,600) paid by patient With insurance = $9177.00 (approx £6,120) with approximately 1/3 paid back by insurance Costs for Cardiac Rehabilitation without and with insurance

  19. FUNDING Phase IV or non-monitored programme is $50.00 (£35) per month with monitoring every 3 months. Patients can use facilities as often as they choose on this option Donations are gratefully received from their patients - $10,000 per tile on this wall as recognition of donations

  20. PATIENT UPTAKE • 15-20 % of insured pts who qualify for CR are even referred • Majority of programmes centralised on urban city hospital sites • Issues with referral of patients from rural areas • US Insurance system • Reimbursement a big issue • Part of ‘Get with the Guidelines’ for ACS • Part of CMS requirements to be lung transplant and LVRedSurg centers

  21. ‘MENDED HEARTS’ PATIENT SUPPORT PROGRAMME • US National patient support programme • 260 ‘Chapters’ across US • ‘Chapter’ Officers (Patients) • Volunteers • Hospital Visitor Programme (227,000) • Family Visitor Programme (30,000) • Support Groups • Facebook Support • National Conference – Minnesota May 2010 • $17 Annual Membership • www.mendedhearts.org

  22. CALIFORNIA SOCIETY FOR CARDIAC REHABILITATION • ‘State Societies’ affiliated to US National AACVPR • Each ‘State Society’ has a ‘State President’ • Annual State Conference • Culture of networking & mentorship • Online resources • Desire to forge International links • www.cscr.org Elaine Gotro CSCR State President

  23. CULTURE OF STAFF RECOGNITION Jenny Hall Director C V Services Mission Viejo

  24. Thank you BACR! • BACR TRAVEL AWARD 2010………. • CLOSING DATE AUGUST 31ST 2010 • www.bcs.com/bacr

  25. Thank you for listening…… • …...any questions? • Further Information: • Email - paul.smith4@wales.nhs.uk • Email - justyn.robbins@wales.nhs.uk

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