While growing up with a severe case of asthma, I learned firsthand what it is like to be a patient with a chronic illness and to be breathless at times (many times). I had chosen nursing as a career field initially because I had been around so many medical professionals, it seemed to be my destiny. Gradually, I had come to believe that all of those needles, chest x-rays, and medications had to be part of my life for some reason. I always held a special place in my heart for people afflicted with lung disease. While working at the American Lung Association as a health educator, I began to see the real importance and need for quality asthma education. In order for a patient with asthma and his or her family to be able to live a normal life, they need to know how to take care of him or her when an episode arises and to realize when to call it quits if trouble begins. Asthma educators can play a huge part in helping asthmatic patients to become experts in management skills. If you are questioning the need for standardized asthma education across the miles and through various medical disciplines, please understand that the key to controlling asthma and living with a better quality of life is being educated so that you learn about good asthma management and what that can truly mean.

A young patient I worked with had been told to put his turbuhaler into his spacer and take three puffs. A turbuhaler looks like it would fit a spacer, but the mechanics of the turbuhaler don't allow for any medication to reach the patient through a spacer. As simple as this error was, the patient had gone months not getting the medication that he needed to stay controlled. That is just one example of many stories I could tell you to help explain why there needs to be a standard. We want to curb the fastest growing and largest chronic disease among children. By becoming a Certified Asthma Educator, you can become part of a team of professionals that care about those with asthma and who hope to make a difference for these patients.

Submitted by Kristin Homze, RN, BSN, AE-C

The reimbursement section of the NAECB website was developed to assist with coding, billing, and reimbursement for patients with asthma. We are gathering information that is state-specific for Medicare and Medicaid reimbursement guidelines and will add specific, local Managed Care Organizations in the future.

What is coding and were do these codes come from?

The American Medical Association (AMA) and Centers for Medicare and Medicaid Service (CMS) determine the codes and descriptions of services. The codes are reviewed, revised and published each year and are available through several sources such as medical bookstores, AMA or Ingenix . CPT Book - The Current Procedural Terminology (CPT) book is used by physicians, hospitals and outpatient settings to identify services or procedures provided to a patient. HCPCS Book, I, II & III - The Healthcare Common Procedural Coding System (HCPCS) book is used to identify drugs, equipment and supplies provided to patients in various healthcare settings. ICD-9-CM - The International Classification of Diseases (ICD) codes, 9th edition and clinical modification (CM), is used by healthcare providers to accurately describe a patient's diagnosis.

How do I find out if my state database is posted?

The states that have posted databases are highlighted in green on our USA map and can be viewed at NAECB. Simply click on your state to view the relevant coding information. Information of more national usage (e.g., Medicare codes) are found directly off the reimbursement section "home page."

My state database is not posted, how can I volunteer to help get this done?

You can email Sabra Caldwell (reimbursement specialist). She has developed a standard template to gather specific coding information to help compile coding data for your state. You do not need to be a coding expert to help with this project. We do encourage people to develop a small committee with both clinical experience (i.e., healthcare professionals) and billing/coding expertise (i.e., administrators) to help identify and interpret local codes and procedures.

How do I get started gathering information for my state?

The first payer we focus on in each state is Medicaid. You can typically retrieve information by searching your state's Medicaid website. Look for information under the fee schedules and provider manuals section.

I would like to be notified about future posting and information regarding coding and reimbursement. Can you put me on a mailing list?

Yes, our contact database allows us to add your name and email address and send out new information. If you would like to add your name to our database, please email Sabra Caldwell and provide your name, degree, mailing address, and preferred email address.

I have reviewed my state's information and have new information regarding coding coverage for my state. How do I let you know about these changes?

On the coding pages, you will find an edit button next to each procedure code. If you'd like to submit suggestions or new information, you can click on the edit button and send us the information. The email is sent to Sabra Caldwell and she will review and post any new changes. Thanks in advance for your help! We could not complete this important work without the help of hundreds of volunteers like you. For a list of those who already have worked on this project, please see the acknowledgements section. We hope to hear from you soon!

Submitted by Sabra Caldwell, Reimbursement Specialist, NAECB

There are few things that are more heartbreaking than talking to a mother who is grieving the loss of a child - a death caused because of asthma. In April, I had the chance to meet one such mother who, after 13 years, is still struggling with this tremendous loss. Many parents like her have commented that quality asthma education could have saved the lives of their loved ones. This is the mission of the National Asthma Educator Certification Board, and its founder Dr. Linda Ford, (pictured above). Recently, I had a chance to talk with Dr. Ford about what spurred her to take on this mission and why others should get involved:

Q: Why should asthma educators become certified?A: For years, there was some asthma education in the country, but there were many different degrees of quality. Insurance companies and patients have no idea of the quality of information that's being delivered. When a person passes the examination given by the NAECB they receive the designation AE- C. Others can be assured that the educators who carry the AE-C give a high level of quality in their asthma education. The AE-C designation can also make those who hold it more employable. They have enhanced the status of their position, and could obtain raises based on the AE-C title.

Q: What prompted you to formulate AE-C certification?A: Quality. I've seen so many instances where companies offer asthma education, but if you ask them about their curriculum and instructors, the quality is missing. It is an unregulated situation. AE- C certification helps eliminate that. Changing behavior, though, is more than just teaching information. You have to have the knowledge of how to teach to be able to effectively convey information to the patient to really make a difference in the lives of people with asthma.

Q: How do asthma educators who are certified stack up against those who are not certified? A: This is a measurable outcome that NAECB is developing. As the years pass we should be able to track this information.

Q: What benefits can health care providers get from requiring AE-C status for their asthma educators?A: We know that education helps. We know that a person with asthma will have increased quality of life with education and we assume that the certified asthma educator is able to teach better. Health care organizations will see a decrease in cost for hospitalizations and emergency room visits when patients are educated and empowered to care for themselves. Patients do better. In addition, if I were a third party payer and I wanted to educate my patients, I would insist that the educator/councilor has mastered the information. Third party payers pay up to $2000 for asthma education for each patient. If the education is not delivered appropriately, the third party payer has lost money and the patient has lost, as well.

Q: What demographic should consider taking the exam?A: The examination is open to any licensed health care professional. This includes, nurses, physicians assistants, nurse practitioners, behavioral scientists, pharmacists, and even doctors. You submit your application to the board to get permission to sit for the examination. If you are not a licensed health care professional but have taught asthma education, you can possibly fit into a second group who have at least 1,000 hours of supervised asthma education. For example, an medical assistant does the asthma education in a doctor's office could be granted the ability to sit for the examination with supporting information from the physician who supervised the asthma education.

Q: How satisfied are you with the progress of the AE-C program?A: It has outperformed my expectations. Since we started, in Jan of 1999, when we had our first meeting to explore the possibility, so much has been accomplished - with so little money. That's due to the dedication and passion of the board of directors.

Q: What challenges do asthma educators face? A: I think the challenge is to prove the worth of an AE-C designation. My personal bias is that there is worth in becoming certified asthma educators. Another challenge is health literacy. The general public does not understand what their doctors are saying to them. They do not know how to take their medication or even when to take it. We as physicians need to recognize the problems. We tell our patients to take medicine a certain way and if they don't do it, we blame the patient. That is wrong. Maybe we should have relayed information better and empower the patient with knowledge and skills. Patients need to commit to their treatment plan. However, before commitment comes knowledge. Many physicians simply lack the time necessary to make sure their message matches the patient's comprehension level. It may be more effective, in those cases, to delegate the responsibility of asthma education to an AE-C. In this way, the asthma education could be done outside of a regular doctor's visit. In asthma education, we talk about co-management. The patient needs to be a part of their management and commit to it. They need to be empowered enough to know how to take their medication - and know when that medication is not enough, and when they should seek help.

Q: The NAECB depends on financial contributions to continue and expand its work. How do you encourage donations? A: If your beliefs are like our beliefs that asthma educators can make a difference, you can't help but have a desire to see the work of the NAECB continue. But this work takes a money. One of the NAECB's programs provides scholarships for people who cannot afford to take the examination. Many of these educators work for nonprofit health care organizations or clinics on tight budgets and cannot afford to pay for their employees to take the AE-C exam. The desire is there, and we need the generosity of others to keep the NAECB on its successful path.

-Pamela Jones Public Member, NAECB

Wanted: A few interested AE-C educators who would like to participate in writing new items for consideration in future versions of the exam or practice modules. The committee strives to have a balance of item writers who have a range of experience in pediatric and adult asthma and multi- disciplinary mix. We will provide training in item writing but having experience in exam design is useful. Need to be willing to commit to a travel to a 1 day workshop initially and to spend several hours a year writing items on an ongoing basis.

Interested individuals can contact the co-chairs of the committee, Marianna Sockrider, MD or Theresa Prosser, Pharm.D.

JUNE AARC-Illinois State Meeting June 16-18, 2004 Maureen Mulhall PO Box 10261 Springfield, IL 62791

AARC-Texas June 23-25, 2004 Gary Herrin PO Box 515239 Dallas, TX 75251 (972) 495-9200

AARC-California State Meeting June 24-26, 2004 Abbie RosenbergCSRC 1961 Main St., Ste. 246 Watsonville, CA 95076 (831) 763-2772

JULY Association of Asthma Educators July 16-18, 2004 Sheraton-Society Hill One Dock Street, 2nd and Walnut Streets Philadelphia, PA

Your newsletter editors are: Tim Op't Holt and Bill Pruitt, faculty at the University of South Alabama.

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