The summer Diagnostics Section Bulletin is now online.

Gregg Ruppel discusses the use of z-scores to analyze pulmonary function data. Those of you who are statistic-phobic will find this article refreshingly easy-to-understand.  Matt O’Brien discusses the important and often overlooked issue of infection control in the pulmonary function laboratory, and then I briefly discuss an increasingly recognized disease pattern: combined pulmonary fibrosis and emphysema (CPFE). The Quarterly Case Report highlights the importance of biologic control testing, and I close out the issue with an amusing anecdote from my own practice.

I am currently looking for submissions for the winter issue, so if you'd like to submit an article or quarterly case report please let me know.


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Do you have a respiratory care-related photo that takes your breath away? If so, we want to see it!

AARC Times
is looking for creative AARC members to enter our monthly Photo Contest. Finalists will receive a FREE one-year membership renewal and will have their photo entered into our Photo-of-the-Year Contest.

The deadline for submitting photos is November 14, 2014. AARC members will then vote online for their choice following the release of the January 2015 issue. We plan to have the winning photo on the cover of March 2015 AARC TImes.

Don't miss this great chance – enter your photo today!

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I must say that this trip to Austin to address the Sunset Commission has been an eye-opener for a number of reasons. I've not been a very politically active person so Cheryl West (bless her) has been getting me up to speed so that I understand not only the basic issue but the consequences of the potential actions that could be taken by the Sunset Commission.

The basic issue is that the RT licensure act comes under review every so many years. In Texas, this was scheduled to happen in 2014... and it did. The group produced a report that addressed a great number of issues within the government bodies. One of the recommendations of this report is to deregulate respiratory therapists; specifically, eliminate the regulatory process that Texas RTs currently undergo to legal work as a respiratory care practitioner.

The Sunset Commission isn't bad, in and of itself; however, this recommendation is harmful for a great number of reasons. If you're interested in reading the background and the implications, check out this AARC news article:

My motivation for this blog is not to educate about the process (I would defer to my colleague Cheryl West for that!) but rather to record my observations during the 2 days I've been in Austin. As I sit here waiting to deliver testimony, I look around the viewing room, the hallways, and the hearing room and see respiratory therapists from all over the state supporting the profession. Yesterday, Senator Nichols reported that he has received countless phone calls, emails, and visits over the last 3 weeks from respiratory therapists in his district. He expressed great concern that a profession such as ours would be considered for deregulation. Several other representatives and senators on the commission appeared to echo his concerns and Chairwoman Nelson called together a subcommittee to address the regulation issues. We're not done yet (and we haven't given public testimony) but this is a good sign.
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As I write this, I'm about 30 thousand feet above the earth flying towards my home in Danbury, CT.  I've just spent the last two days in Mississippi saying goodbye to a dear friend of many RTs around the country.  Heck, Jerry Bridgers was a dear friend to all he met.  You've all heard the saying that we really don't know the lives we've touched until we're gone.  Fortunately for Jerry, he knew how many lives he touched. I met so many people in Mississippi this week and the stories were plentiful.

You never know a person until you hear about them from others. I met one gentleman who told me his story that was much like Jerry's.  He was addicted to alcohol and was at rock bottom.  He went into a rehab facility and as per the rules went to an AA meeting and the guest speaker was a Jerry B.  Well, you guessed it; Jerry Bridgers was the guest speaker.  The funny thing though was this gentleman had met Jerry before in his role as bio-med at the hospital.  After the meeting, Jerry and this gentleman met and 27 years later I was told Jerry changed his life and has been the only sponsor he had during that time.

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At 7:12 AM (CDT) on June 14, 2014 in Mississippi, a long-time member and ardent supporter of our profession passed away.  Jerry Bridgers was a man who would give you the clothes off his back if you needed them.  He was a strong advocate for every piece of legislation this profession has brought before Congress and his passion for getting people involved was unmatched.  Jerry was a man of 70+ years who I consider one of my very best friends.  We met at an AARC PACT meeting in Dallas and became friends immediately.  He was more than 20 years my senior, but I felt like and was treated like a brother.  Jerry and I would speak weekly.  His infamous 7:30 AM calls to my house on Sundays were met with my wife answering the phone because Jerry could not remember I went to church early on Sundays.  

In your life, you meet many people and most will not even make you turn your head.  Jerry with his beaming smile and jolly laugh knew how to live life.  He had a hard life early on, mostly by his own design.  With the love and support of his family and many RTs from the Mississippi and Louisiana area, Jerry righted his life and found God.  His passion for this profession could be seen in how he talked about it.  He knew history of things that went on not only in his hometown and in state, but he could tell you stuff about national respiratory events without having to think about it.  Those of us who served in the AARC House of Delegates always knew when something was brewing by how red and animated Jerry would get.  Then we'd see the Mississippi placard go up and then he'd stride to the microphone.  Everyone knew Jerry would command the microphone for quite some time, but when he spoke he spoke from the heart and always had a message....even if he used 2, 3, 4, 5...stories to get the point across.  If you wanted to hear how Respiratory Therapy was practiced in the early days, all you had to do was have Jerry tell a story from his early days as an oxygen orderly.  His passion for patient care was still there even after he retired about 3 years ago.  He would always tell me, the RTs today need to know it is not just about giving breathing treatments; they need to help the patient and even the nurse.

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I am being asked to research how many RT departments across the country intubate? We intubate at our facility, but our Risk department is wondering how prevalent this is accross the nation. In my research I have not been able to locate any such reference. I appreciate your help and insight!

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Very pleased to see fellow RTs utilizing the use of social media (Facebook, YouTube) and various websites, such as to assist the hard work of our state societies and the AARC in promoting the profession. We need to make sure our profession has a strong presence in all these avenues.
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What is the standard of changing grades in the students favor to pass a final they have clearly failed? I had an Associate Dean change the lowest scoring student from a 65% to passing of 75% only because the student came into the office to complain that they "know" the material. 

Also I had seen new graduates teach students didactic classes such as mechanical ventilation due to the fact the college simply did not have any instructors adequate to teach such a class. It happened years ago at a particular school.
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Greetings Colleagues,
  This blog is an simply an awareness that the State of Texas has now followed Indiana and Michigan with movement to de-license or as the Texas Sunset Committee states in their May report "discontinue" the Respiratory Care Practitioner licensure in the state of Texas. While we are reaching out to colleagues on several Social Media venues, we are utilizing the Texas Society Respiratory Care FB page as the main venue for discussion and updates. The AARC and TSRC are collaboratively working together with this announcement which just occurred during our annual State Meeting on Thursday, May 29th,2014. Our main focus is rapidly getting out the word to our colleagues and more information will certainly be forthcoming in the next few days. We need unity on this professional announcement, so please visit our TSRC Facebook Page : The Texas RCP's are most grateful for your involvement.
****Addendum (06/02/2014)- There is an official statement from the AARC/TSRC on the TSRC web page at
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The Charge Manager at our sysemy has noticed a significant increase in CMS reimbursement for select Respiratory Care specific CPT codes.  Those codes and the 2014 vs. 2013 reimbursement from our intermediary are listed below:
CPT-HCPCS 2014 APC Wage Adjusted
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AARC Times is looking for members to enter our AARC Photo Contest so that the Association will have photos of how RTs enhance the lives of their pulmonary patients. Contest finalists will receive a free one-year membership renewal and have their photo entered into our Photo-of-the-Year Contest with the chance of it being chosen to appear on a 2015 cover of AARC Times.

For instructions and on submitting a photo, select the AARC Times icon on and click on the “Photo-of-the-Year Contest” link.

We look forward to seeing your prize-winning photo soon!
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I've been following the conversation regarding new therapists versus old therapists for the past week to ten days on the Management List Serve and have tried to stay out of the conversation, but finally decided to jump in with my two cents.  I've become a little concerned with the tone regarding experienced therapists.

In today's healthcare care climate the workforce is aging and it's important that we do not exclude those therapists with many years of experience just because of their age.  Many of us "old farts" still have much to contribute and not all of us have bad habits.  Some of us have had the misfortune of having their position eliminated, and it's harder for us to obtain a new job because of this.  No one will say it, but there is age discrimination.  I'm not sure if it's because of our so called "bad habits" that many of you have referred to, or if it's because you might have to pay us a little more money than an inexperienced graduate. 

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The respirathory Therapy Profession  is developving (development). recently UDELAS (State University of Panama) create the master degree of respirathory therapy with enphasis in Critical Care in Panama. 

In two years Panama will have one of the biggest Hospital City in Central America, It will be manage by the Social Security System.

Udelas have been graduating respiratory therapist in the past 12 years, so It is time to keep with its academic formación at other level.   
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The New Healthcare Normal, requires organizations and health care workers to retrench and repackage in order to ensure survival in the era of the Affordable Care Act (ACA).  Market consolidation and new entrants are causing disruption in some areas, which is cause for concern for those that have not been proactive and have effectively prepared for change.

The healthcare industry in our country is relatively young, thus has experienced transitional evolution to where it should be focused - - - on the patient.  Too often we have been task oriented based on activities that generate revenue. Quality obviously has been a focus by most, but has not resulted in better health outcomes and reduced costs.  So, we are now charged with truly placing the patient at the center of everything we do on a daily basis.  It is interesting to note, that while we understand the needs of patients, it is much more enlightening when you or loved-ones are actually a patient; particularly if you are a healthcare worker.

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When reviewing the article regarding the changes that were announced: KentuckyOne cuts respiratory therapists from emergency rooms; a few thoughts came to mind. First and foremost is the fact that the health system is a Market Based Organization (MBO) of Catholic Health Initiatives (CHI) of which, I was employed as the Vice President of Clinical Operations at another one of CHI's MBOs.  So I understand fully the period of discernment that occurs when making difficult decisions.  Second is the fact that respiratory therapists (RTs) are essential to meet the complex medical needs of patients with emergent and acute conditions of the lungs. Third, is that the perceived value relative to the actual benefits of the expertise RTs offer, was not clearly understood or articulated during the deliberations that concluded with the removal of respiratory therapists in the emergency rooms. 

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Healthcare organizations and providers are charged with having the ability to quantify the data obtained from patients in the electronic health record (EHR) to show that the resources utilized in the care and treatment of patients results in better health outcomes while reducing costs.  


The expectations under the new healthcare laws and regulatory requirements; call for each entity whether hospitals and health systems or physicians to demonstrate meaningful use three (3) in which the data shows that the entity effectively cared for their patients.  So what does this mean for data analytics and dedicated resources with clinical and financial expertise to compile the information in a manner that is useful for the organization, relevant to Centers for Medicare and Medicaid Services (CMS) and allows for performance improvement?  

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The deadline for enrollment under the new healthcare law has come and gone; well for most it has but for a few [that experienced technical issues], they will have a couple of weeks to sign up for health insurance under the Affordable Care Act (ACA).  The target for total enrolled was initially 7 million; then the Congressional Budget Office (CBO) scaled back the number to 6 million. The final numbers based on preliminary results are close to the original estimates of the CBO.
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