ASME Certification Makes a Difference
August 28, 2013
A few years ago, new CPT codes came out allowing organizations to bill for asthma self-management education delivered by non-physician health care professionals, providing the program was certified by a professional organization.
To help more therapists take advantage of these codes, the AARC developed the Asthma Self-Management Education (ASME) certification program and rolled it out to the RT community in February of 2009.
ASME certification is good for three years, at which point programs must recertify to continue to display the ASME seal of approval. Mike Shoemaker, RRT-NPS, AE-C, runs the second program in the nation to earn ASME certification and just received word that his program would be recertified for another three years this summer.
Patients enrolled in the Asthmania Academy at AnMed Health Women’s and Children’s Hospital in Anderson, SC, attend a 1½–2 hour session where they receive diagnostic testing and asthma education, along with an Asthma Action Plan and contact information for an asthma educator. Three RRT/AE-Cs staff the program and about 130–140 children have been seen each year for the past couple of years –– though that number will likely go up this year thanks to a new plan in the works.
Since originally receiving ASME in 2010, explains Shoemaker, he and his colleagues have been working on an initiative aimed at extending the program past the hospital and into the schools. “One of the biggest changes for our program is that we will be working closer with our local school system for the 2013-2014 school year, and school nurses will be able to refer children directly to the program,” says the manager. “In addition, we will help facilitate communication between patients/families and primary care physicians.”
The program has learned, for example, that primary care physicians aren’t always aware of frequent albuterol use at school. “We hope to bridge that gap so that appropriate interventions can be implemented.”
Partnering with BC/BS
Shoemaker says ASME certification has definitely paid off for his Asthmania Academy. “We have been able to partner with — and negotiate reimbursement for asthma education using CPT codes 98960/61/62 — with BlueCross BlueShield of South Carolina,” he explains. “The partnership, and subsequent reimbursement, is based largely on Asthmania Academy being an ASME certified program.”
He and his colleagues are now working with Select Health of South Carolina to effect a similar arrangement.
“I think the most important aspect of these discussions lies in the fact that we are not simply seeking reimbursement for asthma education, we are looking for innovative ways to partner with payers that will improve health for their clients while simultaneously lowering their cost,” says the AARC member. “Preventative asthma education is less costly — but only if it results in better asthma control with fewer hospitalizations and/or ER visits.”
The latter has definitely been the case for Asthmania Academy. Most recent outcomes show the hospitalization rate for pediatric asthma per 1000 acute care admissions dropped from 6.67 in 2007, to 4.67 in 2010, to 4.15 in 2012. “One of the most exciting trends we are seeing in Anderson County is an improvement in the racial disparities specific to pediatric asthma,” he adds.
Passion, knowledge, support
Shoemaker believes ASME certification helps programs like his “set the bar” for payers seeking those programs most likely to help their clients achieve better health. It also reflects the commitment of the organization to asthma education in the community. “It’s that combination of passion, knowledge, and support that really empowers an ASME certified program.”
In addition to Shoemaker’s Asthmania Academy, three other programs across the country have earned ASME certification as well:
Pulmonary Lab 4 Middle
Asthma Intervention and Respiratory Education Program