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Turn and Face the Strange Changes

By Mike Hess posted 03-14-2017 09:47

  

(Originally posted on my LinkedIn blog. Connect with me to be among the first to see new updates!)

Last week was a big one for transitions in the chronic lung disease world. AARC President Brian Walsh shared his latest article (written with one of the godfathers of our profession, Dr. Robert Kacmarek) about how respiratory care stands at a crossroads. COPD Foundation founder and Chair-Emeritus John Walsh passed away after a lengthy struggle with injuries sustained in a fall last year. Congress has started marking up bills to repeal various parts of the Affordable Care Act. Here in Michigan, our almost-daily weather transitions seem to be wreaking havoc on those with allergies, asthma, and COPD. And, of course, most of the US just switched to Daylight Savings Time (for better or for worse). So this is as good a time as any to reflect on where we are as a profession, and where we're going.

I first wrote about respiratory care being at a crossroads just over two years ago. In that article, I wrote about the need for adapting to a more outpatient-focused model, because of changing reimbursement models and the push for evidence-based practice. I've been a part of this transition, building on work and evidence from programs like the innovative, respiratory care-driven care management initiative led by Dr. Jean Wright at Carolinas HealthCare and the UC-Davis ROAD Program (led by two respiratory therapists), which focuses on education and self-efficacy. At the 2016 AARC International Respiratory Congress, I was able to meet several other practitioners from around the country, working on similar projects. Whether it's a full cross-continuum approach, improved care coordination, or increasing our presence in primary care, momentum is building, and it WILL transform our practice.

How can I be so sure? Two reasons: Money and expert recommendations.

You see, 2015 not only saw my first prognostication, it also ushered in a new era of Medicare payments. The Medicare Access and CHIP Reauthorization Act of 2015, also known as MACRA or the "permanent doc fix" was signed into law in April of that year. MACRA did away with the wildly-flawed "Sustainable Growth Rate" calculation that, in theory, determined how much physicians got paid for various Medicare services (but in reality got altered every single year, because the supposed adjustments were just silly)(and yes, this is a vast oversimplification). It also provided for two new payment frameworks, the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (AAPMs). Both of these frameworks start moving Medicare reimbursement away from the traditional fee-for-service model (an environment where respiratory therapists have had limited success fighting to have our services covered) and toward a more inclusive quality-based system that rewards providers for efficiency and improved outcomes. I'm sure it's not news to anyone reading this that respiratory therapists have a history of providing both, which provides us with a compelling argument to start performing as true therapists and disease managers right in physician offices. On top of increasing penalties as COPD continues to get phased in under the Hospital Readmissions Reduction Program, it's clear that disease management WILL save practices and healthcare systems money. The only question is whether RTs do it, or whether we cede this to other disciplines (as we did for nurses with tobacco cessation).

The expert consensus has been longer in coming, but it is definitely on our side. The latest Global Strategy for the Diagnosis, Management and Prevention of COPD (#protip: Don't call them the "GOLD Guidelines"...they don't like that) calls for an increased focus on patient education programs with an eye on improving self-management and self-efficacy. The recommendations have an overall bent toward outpatient management, as it is becoming more and more clear that if we can keep people out of the hospital, not only for readmissions but for INDEX admissions, we can save money and improve the quality of life for those living with chronic lung disease. This philosophy is also backed up by the upcoming COPD National Action Plan, which will similarly be calling for outpatient management rather than episodic acute treatment, and will likely be suggesting enhanced, ongoing pulmonary fitness and exercise regimens. Both of these certainly suggest a larger role for respiratory therapists, IF we mobilize enough to take advantage of these opportunities.

How can we do that? That's a story for next week. Stay tuned...

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