Cardiac rehab

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Specializes in acute care.

Hey everyone! I was wondering whether NP's do cardiac rehab and if so, what their role generally is. Also, would ACNP or ANP be more suitable for this?

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Specializes in Education, FP, LNC, Forensics, ED, OB.
Hey everyone! I was wondering whether NP's do cardiac rehab and if so what their role generally is. Also, would ACNP or ANP be more suitable for this?[/quote']

Hi, Angie,

I have two friends who are associated with a very large cardiology practice. They are ACNP and do rehab. Not sure of what their duties consist.

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I've worked cardiac rehab for the past ten years in Texas and have not encountered a single NP in cardiac rehab. The reason I have been given is because cardiac rehab is heavily reliant on medicare for reimbursement. The current OIG (Office of the Inspector General) guidelines state that cardiac rehab reimbursement is dependent upon physician supervision....and that reimbursement is a PITTANCE....like 40.00 per session.

Different hospitals and cardiac rehab facilities have struggled with these guidelines in the past two years. After OIG inspections, some have been shut down d/t lack of physician supervision. Medicare demanded that hundreds of thousands of dollars be paid BACK to Medicare because these facilities were out of guidelines.

Other thoughts for you: when patients are referred to cardiac rehab at our facility, the referring physicians retained their role as referring physician and therefore made all of the adjustments in meds (statins, beta blockers etc) that we routinely encounter in cardiac rehab. I can't see (under the current guidelines) that it would be feasible for a facility to be required to have a medical director or physician on the premises AND also pay for an NP.

I could type a book about cardiac rehab....let me know if you have more questions.

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Hi, Angie,

I have two friends who are associated with a very large cardiology practice. They are ACNP and do rehab. Not sure of what their duties consist.

I would be interested to know what their duties consist of. We had a c.r. rehab center shut down per government agencies because the facility was owned by a cardiology group and they were, of course, referring their patients to their own cardiac rehab facility...which is quite illegal. Also...see my note below about the OIG, recent inspections and mandates on physician presence.

I am, however, hopeful that a role for the NP will be carved out in cardiac rehab in the years to come. I would be SOOOO happy !

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Specializes in acute care.

By physician supervision, do you mean that the program is overall directed by the physician and they need to be available if needed, or that they need to actually be watching the rehab sessions?

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Specializes in Education, FP, LNC, Forensics, ED, OB.
By physician supervision do you mean that the program is overall directed by the physician and they need to be available if needed, or that they need to actually be watching the rehab sessions?[/quote']

Depends upon the individual states, Angie. In my state, the NPs are directly supervised in the rehab clinic. This is one of the very few times where physician presence is warranted.

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Specializes in acute care.

What state are you in? Also, does anyone know how it works in MA?

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Specializes in Education, FP, LNC, Forensics, ED, OB.
What state are you in? Also does anyone know how it works in MA?[/quote']

Sorry, Angie, do not know about these concerns in MA. You can contact the MA BON and probably get the answers.

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The term "physician supervision" has been hotly debated in the last year or so. Up until this point, clinics and rehab centers were left on their own to define this term. Some considered the ER docs in the hospital to be ok for supervision, others had Dr's in the building and still others would pay a family practice resident to come and just sit while sessions were being completed.

The OIG inspections changed all of that. This is countrywide and not just per state. They went in to these facilities and defined physician supervision as a Dr' being IN the building, physically present....not even on another floor seeing patients. Like I said, many programs had to give back hundreds of thousands of dollars because of this undefined term.

Our program has it's own medical director who is in the building during cardiac rehab times. He does an intial assessment on all of our new patients and signs off on the cardiac rehab sessions daily.

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Here is a link to help you understand more. Like I said, it is my hope that NP's will have a role in cardiac rehab but right now I don't see how it is very feasible and don't understand what their role would be. Siri, I would love to visit your friends who are doing this. Our referring docs have all made it clear that our medical director was to do NO med adjusting and all problems were to be referred back to them. So there is no Rx role there for NP's in a situation like that.

If the NP's are working for a cardiology group who owns their own rehab facility...that is illegal and it is just a matter of time before that gets sniffed out.

Here is the link:

http://www.aacvpr.org/oigreprt.cfm

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