An item that is included in the National Asthma Educator Certification Examination is made up of three main parts: the stem, the key and the set of distractors. All items are multiple choice with some having combinations of answers to chose from but most having a single best answer. The stem is the statement or question to which candidates respond. This may be an incomplete sentence or a question. The amount of detail included in the stem depends on the difficulty level of the item (cognitive level) but the exam committee tries to make sure that necessary information to answer the question is included and that extraneous or unnecessary information is limited to allow candidates to read and answer items quickly and efficiently.

The key is the right answer as defined by the examination committee and content experts. In some cases, the key should be considered as the BEST answer meaning that while other choices may also be correct, they would not be the first thing to do or would not be the best choice for the situation presented. The distractors are the wrong answers that are meant to be plausible but wrong and able to distinguish able candidates from weak candidates. Every exam item is matched to a specific item on the content matrix to assure it is relevant and to allow the committee to select items that create the right balance according to the standards set by the NAECB board.

Each item is also defined by its cognitive level. The three cognitive levels included in the NAECB exam are recall, application and analysis. These refer to the difficulty and format of an item. Recall items are typically items that depend on rote memorization and the answer is true for any situation. Application items are more situation dependent or involve some type of calculation or manipulation of information. Analysis items are more complex, usually presenting three or more pieces of information. Analysis items often focus more on what asthma educators should do rather than just what they know. An item is not included in the exam unless there is unanimous approval by the exam committee. Every item undergoes pre-testing and its performance is reviewed before it becomes active.

Every NAECB exam item is carefully written and reviewed before it can be included as a pretest item. An item writer will write an item to match a specific content matrix item and cognitive level. This item is put into the REV (review) pool. The item will be reviewed and edited by members of the examination committee. Once the committee reaches unanimous agreement on the item wording the item is moved to the PRE (pre-test) pool. Each form of the examination has 25 pretest items that do not count in a candidate’s grade.

After a number of candidates have taken the pretest items (usually more than 250 people), the NAECB Exam Committee together with the Applied Measurement Professionals (AMP) consultants will look at the item’s performance analysis. If the item has performed well as written, it will be moved to the ACTIVE pool and be included on future forms of the exam. If the item has not performed adequately or there are comments made by candidates or reviewers that require re-writing, the item will return to the REV pool for re-working or is rejected. All items undergo review with new forms of the exam, when candidates send in comments, and/or when there is a change in the field that suggests a need to update the item. Any revision to an item requires that it return to the PRE pool. The NAECB is committed to continually looking at the quality and accuracy of items and to building the item bank over time.

Individuals who are AE-C certified and would like to learn about becoming an item writer may contact Lisa Overman at the NAECB office, loverman@naecb.org.

Sabra: How did the NAECB Coding site help you with your asthma program? Cathleen: Your national knowledge of state billing practices was invaluable in providing specifics about methods/billing codes used by various states for asthma education and in-home respiratory therapy for ventilator-dependent patients.

Sabra: What codes were you not aware of to enhance your current reimbursement? Cathleen: Specific codes for disease management, preventive medicine, EPSDT program, smoking cessation, and respiratory care home care codes.

Sabra: What information, through links and other state-specific information were useful? Cathleen: The sites to which you referred me for source information on specific issues have proven very fruitful. Your knowledge of effective content of an appeal and of strategies for increasing the likelihood of a positive outcome of an appeal will help us decide if that is a route we wish to pursue.

Sabra: Did you identify information on the website that clarified questions that you were unable to obtain else where? Cathleen: Medicaid billing by a Medicare certified agency providing in-home service from a certified respiratory therapist without an initial in-home evaluation by a registered nurse. It was brought to my attention through the NAECB that some other states do not require an initial in-home evaluation by a registered nurse or by one of the categories of care givers identified in the federal Medicare provider manual in order to bill for respiratory therapy.

Sabra: Did you find that the information provided in the “Reimbursement” section of the NAECB has benefited your organization and has improved your ability to file, appeal and submit claims? Cathleen: Yes to all above. Basically, you provided solid information with which to move forward. I very much appreciate your knowledge and your generosity in sharing it.

For additional information, contact: Cathleen Urbain, Ph.D. Pediatric Home Service 2800 Cleveland Ave. No. Roseville, MN 55113 Main Number: 651-642-1825

submitted by Sabra Caldwell, Reimbursement Specialist, NAECB

The following article is from the AARC Times. The information is very current regarding the new CPT codes and is valid for all qualified non-physician healthcare professionals.

AARC representatives recently attended an American Medical Association CPT meeting where the 2006 CPT codebook was released and includes some codes of special interest to respiratory therapists. AARC Director of Government Affairs Cheryl West, and Board member Susan Rinaldo- Gallo attended the CPT conference in Seattle earlier this week. New codes in the patient education area may be useful for respiratory therapists providing patient education. Specifically the new codes are:

* 98960 Education and training for patient self- management by a qualified, nonphysician health care professional using a standardized curriculum, face-to- face with the patient (could include caregiver/family) each 30 minutes, individual patient.

* 98961 2-4 patients

* 98962 5-8 patients

"The purpose of these codes is to teach self- management of a patient's illness or disease, or delay disease comorbidity" said Rinaldo-Gallo after looking through the AMA's CPT 2006 manual and the CPT Changes, 2006, An Insider's View. "Asthma was an example given where patient education could be provided.

"The curriculum used in patient education must be recognized by a physician society or by a nonphysician healthcare professional society/association, such as the AARC. "The AARC, as a professional society with a history of approving and providing educational curricula may be able to provide assistance to respiratory therapists involved in these important activities," said West."These new codes have interesting potential for allowing reimbursement of patient education on self- management geared at improving quality of life through preventive care and lowering total healthcare costs as a result," said Rinaldo-Gallo, noting that these are areas where respiratory therapists excel.

It is unclear at this point exactly how the codes will be used and what the specific reimbursement will be, but the AARC will be represented in these future developments and will pass on pertinent information as soon as it is available. CPT® is Current Procedural Terminology, and was developed by the American Medical Association in 1966. Each year, an annual publication is prepared, that makes changes corresponding with significant updates in medical technology and practice and is used almost universally to code procedures for reimbursement by third party payers. Rinaldo-Gallo is the AARC's representative to the CPT/HCP Advisory Committee and ensures that the interests of respiratory therapists are communicated as new codes are developed.

© December 2005 AARC Times, a publication of the American Association for Respiratory Care

Washington, DC November 3, 2005 Responding to mounting data that primary care providers need more environmental health training to prevent, recognize and treat diseases caused by environmental exposures, The National Environmental Education & Training Foundation (NEETF) today released Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers. The National Institute of Environmental Health Sciences (NIEHS), a component of the National Institutes of Health (NIH), funded development of the guidelines.

The guidelines are designed to help pediatric primary care providers advise families about environmental interventions to help reduce or eliminate triggers for children diagnosed with asthma, the nation's leading pediatric chronic illness.

The role of environmental triggers of asthma is well recognized and has been included in the NIH, National Heart Lung and Blood Institute, National Asthma Education and Prevention Program (NAEPP) Guidelines for the Diagnosis and Management of Asthma. Research, including the Inner-City Asthma Study about individualized, home-based environmental interventions for hundreds of children in major U.S. cities, has demonstrated that environmental interventions decreased allergen levels, resulting in reduced asthma symptoms.

According to a recent study published in Environmental Health Perspectives, pediatric medical and nursing education currently lacks the environmental health content necessary to appropriately prepare pediatric health care professionals to prevent, recognize, and manage diseases related to environmental exposures.

More than six million American children have asthma, which is the leading cause of school absenteeism attributed to chronic conditions and the third-leading cause of hospitalizations among children under age 15. Asthma can be a life-threatening disease if not properly controlled through appropriate asthma care management, which relies on physicians' and nurses' clinical knowledge and skills, as well as parents' and children's daily attention to asthma triggers and medications. Environmental asthma triggers include allergens and pollutants. Allergens can be dust mites, cockroaches, animal allergens, molds, and pollens. Indoor and outdoor pollutants include secondhand smoke, chemicals, combustion by-products, smog and fine particles.

"Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers" is filled with practical strategies for integrating environmental management of asthma into health professional's curriculum and clinical practice. These practical strategies are built upon NEETF's previous study funded by the NIEHS, which examined the medical and nursing educational structures and identified the leverage points where environmental health can be incorporated.

The guidelines were developed and peer-reviewed by expert panels and are founded on the National Asthma Education and Prevention Program (NAEPP) Guidelines for the Diagnosis and Management of Asthma and are intended to be used in conjunction with its clinical and pharmacological components, as part of a child's comprehensive asthma management plan. The guidelines are built on current best practices and include competencies for management of environmental asthma triggers in pediatric care; a quick, user-friendly environmental history form; intervention guidelines for specific environmental triggers; patient flyers that are perforated for easy duplication; and references. The guidelines are supplemented by an online list of resources with Web links.

The guidelines are part of NEETF's Pediatric Asthma Initiative in partnership with the National Institute of Environmental Health Sciences. The initiative is a long-term project focused on integrating environmental management of asthma into pediatric medical and nursing education and practice. The guidelines are an extension of NEETF's "Position Statement on Health Professionals and Environmental Health Education," which is endorsed by more than 20 leading medical, nursing and education organizations such as American Academy of Pediatrics, Ambulatory Pediatric Association, National Association of Pediatric Nurse Practitioners, American Association of Colleges of Nursing, and Association of Academic Health Centers. Complete guidelines are available at http://www.neetf.org/Health/asthma.htm.

NAECB member Laurel Talabere, PhD, RN, AE-C was on the steering committee that assisted with the new guidelines.

The NAECB would like to know what asthma-related meetings you have attended.

Please reply to Lisa Overman at: loverman@naecb.org.

The National Asthma Educator Certification Board (NAECB) is pleased to announce the results of the election of five new board members for the 2006- 2008 Board of Directors term. The following individuals were elected by ballot sent to all Certified Asthma Educators (AE-C®). The NAECB appreciates those who participated in the voting process. We are excited to welcome these new board members and look forward to their enthusiasm in promoting excellence in asthma education.

Diane Porretta Fox, RN, RRT-NPS, BA, BSN, MSN, AE-CI am an Assistant Professor of Nursing at Eastern Michigan University and Educational Leadership Doctoral student, initially a Respiratory Therapist in 1978. My teaching experience involves teaching Registered Respiratory Therapy students from 1988-2004 at Monroe County Community College and Registered Nursing students at Washtenaw Community College from 2000-2004. I became certified as an asthma educator in 2003, acknowledging the interdisciplinary approach to asthma management. Asthma education of patients and families includes six years as an asthma educator at Mott Children’s Hospital/University of Michigan Health System and eight years as Cardiopulmonary Services Director at Saline Community Hospital. I would like to serve on this board because I am committed to health promotion, management of chronic respiratory disease, and educational leadership. Professional contributions include asthma education presentations to healthcare professionals in area hospitals and the Michigan Society for Respiratory Care (NAECB examination review).

Nicola (Nick) A. Hanania, MD, FCCP, FRCP(C), FACP I am delighted that I am being considered to serve on the National Asthma Education Certification Board. I am currently an associate professor of medicine in the Department of Medicine, Section of Pulmonary and Critical Care Medicine at Baylor College of Medicine in Houston, Texas. I have great passion for asthma and have focused the last ten years of my career on this area of Medicine. As the Director of the Adult Asthma clinic at Ben Taub General Hospital, a tertiary care County hospital affiliated with Baylor, I oversee the care and delivery of asthma education to hundreds of high-risk, indigent patients with asthma. In addition, I am the principal investigator for the American Lung Association Clinical Research Center at Baylor. I have published numerous articles, book chapters, and abstracts and have been an invited lecturer for many local, national, and international meetings.

I am a fellow of the American College of Chest Physicians and the Royal College of Physicians and Surgeons of Canada as well as a member of many professional societies, including the American Thoracic Society, the American College of Physicians, and the Society of Critical Care Medicine. I am currently the chair of the Clinical Pulmonary Network and Vice Chair, Council of Networks of the American College of Chest Physicians. I am associate editor for Respiratory Medicine and an ad hoc reviewer for several peer-reviewed journals including European Respiratory Medicine, Chest, Drugs, and Pulmonary Pharmacology and Therapeutics.

Karen L. Meyerson, RN, BSN, AE-C I am Manager of the Pediatric and Adult Asthma Network of West Michigan (PAANWM), the asthma coalition serving West Michigan. I supervise a staff of asthma educators and medical social worker providing in-home asthma case management, for which we receive reimbursement from five health plans, and are believed to be the first organization in the nation to receive reimbursement for asthma education. I have lectured extensively on asthma for professional and lay audiences and am currently completing my Master’s degree in Nursing. I helped develop a college-level course for asthma educators and currently serve on the Michigan Asthma Advisory Committee (overseeing the state strategic plan for asthma), the Michigan Pediatric Asthma Mortality Review Panel, and the Michigan Consortium of Asthma Coalitions Steering Team. I would like to bring my experiences with case management, reimbursement, funding and evaluation to the Board to help underscore the value of certification for asthma educators.

Stephen F. Wehrman, RRT, RPFT, AE-C I have been a respiratory therapist for 29 years and have taught respiratory therapy for 23 years. During my career, I have been involved in many aspects of asthma education. I ensure the training all of my students for their role in asthma education via the American Lung Association Open Airways program and at our local asthma camp. I regularly teach nurses, paramedics, and respiratory therapists on various aspects of asthma management. I believe that strong partnerships are the key to success in addressing complex issues and making a difference for our patients and clients. The work we have accomplished in Hawaii has been recognized by the American Lung Association with both local and national awards and by the American Respiratory Care Foundation with the Dr. Charles Hudson Award for Cardiopulmonary Public Health. I look forward to the opportunity to serve the larger community as a member of the NAECB and to further the cause of educating patients and professionals in this vital public health endeavor.

Dennis R. Wissing, PhD, RRT, CPFT, AE-C My respiratory therapy career began in 1974. My early years were spent as a department head of respiratory care services in a major hospital. In 1984, my career focus shifted to academia when I began 21 years of service as a program director for the LSU Health Sciences Center’s Cardiopulmonary Science Program and recently have been promoted to assistant dean of academic affairs. I remain active in teaching and clinical research. I am currently the primary investigator in three asthma-related clinical research projects. I am developing a school based out-patient pulmonary and asthma rehabilitation program which will open fall 2006. We are the first school based program in the country. I currently serve as president of the American Lung Association of Louisiana. During the past two years, I have coordinated six asthma education certification preparation workshops and oversee a number of asthma related projects the association is involved with. In addition, I am president-elect of the Louisiana Society for Respiratory Care. I bring to the NAECB three decades of expertise in the care of the patient with asthma, leadership skills, and motivation to help move the board forward to meet the challenges ahead.

Your newsletter editors are: Tim Op't Holt toptholt@jaguar1.usouthal.edu and Bill Pruitt wpruitt@jaguar1.usouthal.edu, faculty at the University of South Alabama. Send your articles and ideas!

If you want to mail something to us: Cardiorespiratory Care, University of South Alabama, 1504 Springhill Ave., Mobile, Alabama 36604. Phone: (251)434-3405, fax (251) 434-3941. We look forward to hearing from you!