The Next Step

Vol. 18 • Issue 4 • Page 10
Allergy and Asthma

Most respiratory professionals agree when it comes to asthma education, it pays to get certified – at least as far as patient care is concerned. But they hope certification eventually will pay off financially too.

Getting the Centers for Medicare & Medicaid Services to assign CPT codes for patient self-management of chronic diseases was the first step toward reimbursement.

“The next part of the process is getting dollar amounts associated with those codes through Medicare and to do that, we need to establish exactly what they’re asking for,” said Shawn McCormick, BS, RRT, AE-C, past chair of the National Asthma Educator Certification Board.

Essentially CMS is asking programs to show that qualified health care professionals are educating patients using a curriculum that meets high quality standards. While asthma educators can prove they are qualified with an AE-C credential, there has not been a formal mechanism to verify a curriculum’s credibility until this year.

“I think a national standard for asthma education is going to be imperative,” said Karen L. Gregory, MS, APRN-BC, CNS, RRT, AE-C, president of the Association of Asthma Educators.

Two professional organizations are pursuing that goal through different avenues. The American Association of Respiratory Care recently launched its Asthma Self-Management (ASME) certification program, and the Joint Council of Asthma, Allergy, and Immunology is working to publish a standardized asthma education curriculum later this year. Asthma educators hope these steps finally will open the door to much-needed reimbursement dollars.

“We’re patient advocates, first and foremost,” Gregory said. “But it takes money to get the job done, and reimbursement would allow us more opportunity to better care for our patients with asthma.”

Easing the burden

Up until now, asthma programs that deliver education and training for patient self-management have had to substantiate their curriculum on a payer-by-payer basis with documentation to prove they meet national guidelines.

Gregory experienced that struggle firsthand when she co-owned an asthma management clinic years ago. “We knew our program was good because it followed the NAEPP guidelines, but we had no official standard to measure it by at that time,” she said.

The AARC hopes the launch of its ASME certification program in February will ease some of those burdens. “We’ve essentially taken a lot of that headache away by compiling standards that adhere to the Expert Panel Report,” said Thomas Kallstrom, RRT, FAARC, chief operating officer of the AARC.

The thorough review process takes about 60 to 90 days to complete, and is open to any asthma disease management program that has accepted patients for at least six months, Kallstrom explained. Certification is awarded for a three-year period.

“Our hope is that this certification provides more marketability and hopefully better reimbursement for programs,” said Bill Dubbs, MEd, MHA, RRT, FAARC, director of education and management services for AARC. “This is not something we anticipate Medicare is going to embrace, but we’re looking more toward private third-party payers right now.”

Standardizing care

By creating an evidence-based standardized curriculum for asthma education, the Joint Council is hoping to gain Medicare’s and third-party payers’ approval. They enlisted the expertise of several professional respiratory societies and used a curriculum the American Lung Association developed years ago as a starting point. They conducted a literature review and expert consensus process to update it with current guidelines and standards of practice.

The professional organizations currently are reviewing the completed curriculum and providing final comments and feedback. They hope to submit the curriculum for publication in a journal before the year is out.

Once they get an article written with the curriculum completed and published, then their intention is to ask for a meeting with Medicare.

“If we get a national coverage determination that asthma education should be compensated, then it will encourage private carriers to cover it as well,” said Donald W. Aaronson, MD, JD, MPH, executive director of the Joint Council. “We’re hopeful that they will see we have really complied with all of the requirements of the code, and that we’re providing useful services for which there should be reimbursement.”

More money, more applicants

Many asthma educators also believe additional reimbursement will lead to more interest in the field and in asthma educators’ professional certification. The NAECB already has seen a spike in numbers since the CPT codes were published, with about 30 to 50 new asthma educators earning certification each month, McCormick said.

“We think asthma education programs are being more successful in getting paid for their services, and as more reimbursement opportunities turn up, you’ll start to see our numbers climb even higher,” she said.

However, it is not just new test-takers who will be lining up for the exam this year. Asthma educators certified in 2002 will need to recertify before a 2009 expiration date to maintain their AE-C credential. The exam also will undergo some changes this year, with an updated version based on the EPR-3 guidelines slated for release in July, McCormick said.

Many resources can help providers brush up on current practices and guidelines in preparation for the exam. The NAECB offers a free candidate handbook with information about the exam on its website, and several professional organizations provide comprehensive review courses.

Colleen Mullarkey is assistant editor of ADVANCE. She can be reached at [email protected].