Transcript Creating a Vision of Care

Creating a Vision of Care 2015 and Beyond
Timothy R. Myers MBA, RRT-NPS, FAARC
Associate Executive Director, Brands Management
American Association for Respiratory Care
Adjunct Faculty, Assistant Professor
Department of Pediatrics,
Case Western Reserve University
Current Health System Issues
• Health costs in US growing faster
than:
– Employee wages
– Economy at large
• Preventive services are underused
• Low adherence to proven-effective
therapies for chronic diseases
• Medical errors and safety problems
remain too common, accounting
for many thousands of deaths and
billions of dollars in healthcare
costs
Property of PPCP: Created by KR 11/24/2010
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Changes in the Economy
How Healthcare Executive Decisions
Impact the Workforce
• “Perfect Storm” - Economies impact on
healthcare
• Hospital administrators believe healthcare
financing system is broken
• Gov’t payments have declined since 2000
• Steps to increase productivity & enhance
quality by consolidating staff functions
– Case management and disease management
– Understanding & implementation of evidencedbased protocols & best practices
Four Key Drivers of
Healthcare Reform
• Decrease cost of healthcare
• Improving the quality of care delivered
• Evaluating effectiveness using outcome
measures
• Improving access and resource allocation
Future Impact
Cut from the Headlines
Cut from the Headlines
Chronic Medical Conditions
Chronic Conditions
• 15 most costly medical conditions accounted for ½ of
overall growth in health care spending 1987-2000.
1.5 inc Prevalence
3 x the cost
Prevalence flat
2 x the cost
SOURCE: 1987 National Medical Expenditure Survey (NMES) and 2000 Medical Expenditure
Panel Survey, Household Component (MEPS-HC).
Chronic Conditions
Source: GAO analysis of Medical Expenditure Panel Survey (MEPS)
Financial Incentive
Worse-case scenario is a 1% Medicare payment reduction
across all DRGs in fiscal year 2013, increasing to 2% in 2014
and 3% in 2015. For example, if a hospital’s total inpatient
payments from Medicare totaled $50 million in FY 2012, the
hospital would lose $500,000 (1% of $50 million) of its inpatient
operating payments in FY 2013.
Today’s Perspective
• In 2013, 150,000 fewer readmissions than Jan 2012
• Reduction in hospital-induced harms credited with saving
15,000 lives and $4 billion
• All-cause readmissions rate, according to the report,
has declined to 17.5%
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Today’s Perspective
• Hospital-acquired conditions declined 9% from 2010
to 2012
– 145 / 1,000 discharges down to 132 /1,000 discharges
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Change in Focus
• Hospitals are in a fee-for-service world now where
they're rewarded on volume
• Next step is how to focus on cost and outcomes under
a reimbursement model that doesn't reward volumes.
• It has to be about more efficiencies and patientcentered care."
IOM Six Aims for Improvement
• Patient care that is:
• Safe- avoidance of unintended pt. harm
• Effective- evidence-based
• Patient-centered- focused on needs and
rights of the individual patient
• Timely- avoidance of delays & barriers to
patient care flow
• Efficient- elimination of waste
• Equitable- fair access to comparable
health care services for all
IMPLICATIONS FOR HOSPITALS
• Achieve solid hospitalphysician (clinical) alignment
• Measure, report and deliver
superior outcomes
• Reduce costs
• Form strategic alliances
Healthcare Executive
Decisions Impact Workforce
• A competent RT workforce in 2015 and
beyond must focus on:
– Improving quality & reducing costs through
utilization of evidence-based practice
protocols & improving patient movement
across the continuum of care
• The workforce will soon be asked to
assume new responsibilities, and RT
graduates will enter a profession with an
expanded scope of practice
MEDICARE PATIENTS’ USE OF
POST-ACUTE SERVICES THROUGHOUT
AN “EPISODE OF CARE” (1)
Sir Winston Churchill (1874-1965)
“ To every person there comes in life that
special moment when one is tapped on the
shoulder and offered the chance to do a
very special thing. What a tragedy if that
moment finds you unprepared or
unqualified for the work which would be
your finest hour."
AARC’s 2015 Initiative
The Charge
• To determine changes required by the profession
of respiratory care to meet the evolving demands
of the medical community and to position
respiratory therapists (RTs) as a vital
member of the medical community in the
future
Questions for Profession
• How will patients receive healthcare services
in the future?
• How will respiratory therapy be provided?
• What knowledge, skills, and attributes will
RTs need to provide care safely, efficiently,
and cost-effectively?
• How do we get from the present to the future
with minimal impact on the respiratory therapy
workforce?
Pew Health
Professions Commission
LINKAGES BETWEEN PRACTICE AND EDUCATION
• The respiratory care practitioner of the future will have skills
necessary to work in acute, subacute, and long-term care
settings.
• This means that practitioners will continue to have a firm
foundation in the basic sciences and technology, but will also
have the critical-thinking skills necessary to use patient-driven
protocols.
• They will serve as adjuncts to physicians in the management
of health care delivery.
• They will assume the role of patient educators and care
coordinators.
• They will play an active role in disease management.
• RCPs will effectively follow a patient across the entire
spectrum from acute care to subacute care and into home care.
RT: “Hybrid” Clinician
• Revenue Generators
– Have the ability to bill for therapies, interventions and
services
– Reimbursement: CPT-code based under medical
direction
– Area specific (i.e Hospitals,Pulmonary Labs, etc…)
– Similar to Therapy (Physical, Occupational, etc…)
Professions
• Service-related
– Provide basic care and education to patients with
cardiopulmonary diseases
– Similar to nursing profession
Educating the Future Respiratory Therapist
Workforce Competencies Required for
Respiratory Therapists
Groups of Competencies:
1. Patient Assessment
2. Evidence-Based Medicine and Protocols
3. Disease Management
4. Therapeutics
5. Emergency and Critical Care
6. Diagnostics
7. Leadership
Barnes TA et al. Respir Care. 2010 May;55(5):601-16
“Rather than uncoordinated, episodic care, we
need to offer care that is well organized,
coordinated, integrated, characterized by
effective communication, and based on
continuous healing relationships”
-Eric Larson
Predicted Changes in Health Care
• Hospitals will provide expensive,
episodic care and house cutting-edge
life-support technology
• Post Acute Care and medical home
will continue play an increasing
important role
– delivery of acute care will move progressively to the
patient’s home
– Post acute and chronic care will increase in volume
and complexity
Benefits of RT’s in Skilled
Nursing Facilities
• Patients had a 3.6 day shorter LOS
• Mortality of patients was reduced by 42%
• Estimated Medicare cost savings were
$97.9 million
Muse and Associates. Executive Summary. In: A Comparison of
Medicare Nursing Home Residents Who Receives Services from a
Respiratory Therapist with Those Who Did Not. Washington DC:
Muse and Associates; 1999:1-3
Competency Area II: Disease
Management
Chronic Disease
Management
Acute Disease
Management
Respir Care. 2010
May;55
Respiratory Therapist as
Disease Managers
Decrease in Hospitalizations
and Emergency Room Visits
p < 0.001
Decrease in Hospitalizations
p < 0.03
Decrease in ED Visits
p < 0.001
Rice KB et al. AJRCCM 2010:182
Disease Management
Rice KB et al. AJRCCM 2010:182
Competency Area III: Evidence-Based
Medicine & Respiratory Care Protocols
Evidence-Based
Medicine
Respiratory Care
Protocols
Respir Care. 2010 May;55
Changes Expected in
Respiratory Care
 Science of respiratory care will continue to
evolve and increase in complexity
 Clinical decisions will become increasingly data-driven
 Respiratory care will be an important part of
care in all venues
 Evidence-based algorithms (protocols) will be
most common way to deliver respiratory care
 Greater need for RTs to be involved in research
 Require RT to be adept at understanding practical ramifications of
published research
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Protocols & Consults
• Protocols have been in place in
respiratory care since the early 1980’s
– Therapeutics, Ventilation
• Respiratory Consult Services
• Efficient, effective, cost savings
• Across the continuum care
• Wellness, Prevention and Education
“Physician Extender”
AARC 2005 Human Resource Survey
Physician Extenders
We are not alone……
The Future of Nursing
• Nurses should practice to the full extent of their
education and training.
• Nurses should achieve higher levels of
education and training through an improved
education system that promotes seamless
academic progression.
• Nurses should be full partners, with physicians
and other health care professionals, in
redesigning health care in the United States.
• Effective workforce planning and policy making
require better data collection and an improved
information infrastructure.
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The Future of Nursing:
Recommendations
• Remove scope-of-practice barriers
• Expand opportunities for nurses to lead and
diffuse collaborative improvement efforts
• Implement nurse residency programs
– transition-to-practice program
• Increase the proportion of nurses with a
baccalaureate degree to 80 percent by 2020
• Double number of nurses with doctorate by
2020
• Ensure that nurses engage in lifelong learning
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Recognized methods to improve
health and reduce costs
• Education of patients, professionals, and each
other is an essential skill for RTs
– important in reducing recidivism in patients with
chronic respiratory disease
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Protocolized care (best practices)
Disease management and self-management
Preventive care
Risk-factor modulation
– Smoking cessation
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Trends for RT Future?
• Job Availability?
• Advanced degrees?
– Bridge programs / articulation agreements
• Focus on Credentials?
– Examinations
– Licensure Acts
• Expansion outside hospital walls
• Increased scope of practice
Respiratory Care Delivered to
Critically Ill Patients by Respiratory
Therapists
• Critical thinking & communication skills to discuss
patient care during rounds and advocate for patient
specific, best approach to care are essential
• Therapist relied upon as an expert source of
information on when and how invasive, non-invasive and
high frequency ventilation and the need for ECMO should
be applied
• Essential care of critically ill patients requires broad
knowledge of monitoring approaches
• Pharmacology: interaction with mechanical ventilation
and to treat cardiovascular dysfunction
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Areas of Opportunities
• Cardiopulmonary Diagnostics
• Sleep Medicine
• Post-Acute Care
– Home, SNFs, LTACs
• Pulmonary Rehab
• Wellness Programs
• Case/Disease Management
• Physician Extenders
Future Healthcare Trends?
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Multi-Skilled provider
Focus on team and collaboration
Consolidation of Acute Care Services
Expansion of clinicians into other venues
Movement to Wellness/Prevention
Further payer penalties
Final Thought
The road of life twists and turns and
no two directions are ever the same.
Yet our lessons come from the
journey, not the destination.
Don Williams, Jr.
American Novelist
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