AARC’s 2015 & Beyond Initiative:What Does it Mean?

Patrick J. Dunne, MEd, RRT, FAARC

HealthCare Productions, Inc.

Fullerton, CA 92838

Disclosure

This presentation is sponsored by Monaghan Medical.

Beleaguered US Healthcare SystemCost Drivers

Aging population Smoking, obesity Uncoordinated care Prevalence of chronic disease Non-participating patients/caregivers Archaic financial foundation Workforce fatigue, apathy

Cost Drivers

• Aging population– Population ≥ 60 yrs. Fastest growing

• Smoking, obesity• Diabetes• Hypertension• Heart disease

– Significantly higher than European countries– CDC 80% preventable!

• Poor attention to health & wellness

Cost Drivers

• Chronic disease prevalence– 2/3 of annual expenditures– Only 50% receive recommended care

• Evidence-based standards of care

• Non-participating patients/caregivers– Episodic care vs. continuing care– Exacerbations vs. disease management

• January 1, 2010 (MIPPA 2008)

Cost Drivers

• Uncoordinated care– Duplicative

– Delayed• Sicker, less stable

– Fragmented• Medical errors, misadventures

– Lack of continuity• Not a seamless transition

Cost Drivers

• Archaic hospital financial model

– Clipboard/pen vs. digital

– Unforgiving credit markets ability to raise capital

municipal/state credit worthiness

indigent care• Un-insured, under-insured

– Impact of global economic crisis

– Closures, layoffs

Other Cost Drivers

Task oriented practitioners Maintain the status quo Provincial view Profound change a threat Fatigued

Inefficient practices Inane orders v/s protocol directed care Wasted teachable moments

Other Cost Drivers

Anachronistic hospital structure Silo mentality Department v/s Service Traditional metrics of limited value

Inconsistent leadership Professional malaise Lack of vision

Limited vision w/ lacking skill set

2015 & BeyondTime Lines

• Spring 2007:– Task force formed– Health care reform inevitable!– Envision the RT of the future

3 invitation-only conference March 2008 Spring 2009 Fall 2009

Creating a Vision for Respiratory Care in 2015 and Beyond

Charles G. Durbin Jr. MD, FCCM, FAARCJohn Walton, MBA RRT, FAARC

Conference Co-chairs

March 3-5, 2008

Hilton DFW Lakes Executive Conference Center1800 Highway 26 East, Grapevine, Texas

Presented by the

AMERICAN ASSOCIATION FOR RESPIRATORY CARE9425 N. MacArthur Blvd., Suite 100

Irving, TX 75063, U.S.A.

2015 Initiative QuestionsMarch 2008 Conference

How will the “new system” respond to health care needs of patients with acute and chronic respiratory disorders?

What current and new capabilities will respiratory therapists need to effectively participate?

2015 Initiative Questions

What additional responsibilities can RTs assume to improve heath care outcomes for patients with chronic respiratory diseases?

2nd ConferenceSpring 2009

Build on proceedings of 1st conference

Define knowledge, skills attributes required to

competently provide future respiratory

services

Define the education and credentialing

systems required to support future RTs

3rd ConferenceFall 2009

Determine how we prepare RTs (existing and entry-level) for new roles and responsibilities with minimal impact on the RT workforce

Getting from here to there

Creating a Vision for Respiratory Care in 2015 and Beyond

Charles G. Durbin Jr. MD, FCCM, FAARCJohn Walton, MBA RRT, FAARC

Conference Co-chairs

March 3-5, 2008

Hilton DFW Lakes Executive Conference Center1800 Highway 26 East, Grapevine, Texas

Presented by the

AMERICAN ASSOCIATION FOR RESPIRATORY CARE9425 N. MacArthur Blvd., Suite 100

Irving, TX 75063, U.S.A.

Post- Acute Conditions

COPD

Asthma

Obstructive sleep apnea

Lung cancer

Cystic fibrosis

IPF

COPD

Prevalent yet treatable disease Affects 12-24 million

4th leading cause of death The 3rd by 2020 (if not sooner!)

More women than men 64,000 v/s 59,000 deaths in 2003

Huge economic impact $37 billion in 2004; $21 billion for hospital care

COPD

1993 2002 %

Hospitalizations 461,000 619,000 34%

Length of stay 7.2 days 5.1 days 30% Cost per stay $10,500 $15,400 47%

Recidivism the primary driver of repeat hospitalizations

Inability and/or unwillingness to adhere to prescribed maintenance medications for symptom control

Agency for Healthcare Research and Quality

Mortality After Hospitalization for COPD

P Almagro et al, Chest 2002; 121:1441-1448.

Per

cen

tag

e S

urv

ivin

g

0 180 360 540 720 900

1.0

0.8

0.6

0.4

Survival Days

114(84%)

105(78%)

94(70%)

86(64%)

75(56%)

Kaplan-Meier survival curves in 135 patients hospitalized for acute

exacerbation of COPD (DRG 088)

Asthma

22 million affected > 6 million children

497,000 admissions Failure to control symptoms

Since 1998, deaths are down < 4,000/yr

$19 billion annual expenditures > 75% for direct medical costs

12 mm lost school days; 14 mm lost work days

Cost Impact of Asthma

Influenced by degree of individual control & exacerbation avoidance

Emergent care more costly than scheduled out-patient care

Non-medical, indirect costs substantial

Guideline driven care cost-effective

Obstructive Sleep Apnea

18 million affected 6 mm with moderate to severe ≤ 10% diagnosed & treated

Morbidity-mortality data lacking 38,000 deaths due to cardio-vascular issues Direct health costs 2% of total

Drowsy driving ≥ 100,000 MVA per year 40,000 injuries; 1,550 deaths ? Work-related injuries, productivity

Respiratory Diseases

Affect millions Millions more yet to be diagnosed

Cost billions Recidivism driven Usually a critical care component

Are predominantly chronic Usually diagnosed later rather than sooner Hospital has limited impact after discharge

Chronic care different than acute care

Crossing the Quality ChasmA New Health System for the 21st Century

Chronic conditions Illness lasting > 3 months but not self-limiting Leading cause of illness, disability and death100 million Americans, two-thirds under age 65> 60% of annual expendituresCare differs from acute (episodic)

15 “top priority” conditionsEmphysema/COPD Asthma

Workforce Study

2007 by CA Respiratory Care Board Identify trends in workplace

Provide input for scope of practice purposes

Evaluate supply-demand status

Gauge perceptions/attitudes of licensed RTs

Establish data base for future decisions

www.rcb.ca.gov (key word: workforce study)

Concurrent Therapy

Protocol Care

How Widespread is Protocol Care?

Key Findings

Workplace policies - specifically the use of protocols, concurrent therapy and triage - influenced how RTs felt about their job and the quality of care they provided to their patients.

RTs using protocols were significantly more satisfied with the quality of patient care.

The use of concurrent therapy and triage was associated with lower levels of satisfaction with the quality of patient care.

Additionally, use of both was also associated with lower levels of overall job satisfaction, satisfaction with workload, and involvement in decisions.

Health Promotion & Disease Prevention

AARC Position Statement (2005)

RT as a health educator; a collaborator To instill the ability to improve a patient’s quality

and longevity of life

Not hi-tech, but huge cost impact!

Collaborative health care Those afflicted assume self-care responsibilities Activated consumers an ally

Health Promotion & Disease Prevention

Chronic disease state managementRisk factors, triggers, medication management,

symptom control, exacerbation avoidance

Pulmonary function screeningAt risk population – smokers 45 yrs or older

Tobacco controlCessation & abstinence

Community preparedness

What About Respiratory Care?

Patient demand to increase

Transformation of traditional roles From single tasks to bundles From task doer to decision-maker

Performance expectations to increase Educational preparation challenges Continuing competency issues

Novel strategic planning essential!

Today

• Acute treatment

• Cost unaware

• Professional prerogative

• In-patient

• Individual profession

• Traditional practice

• Patient passivity

Tomorrow

• Chronic disease prevention and management

• Price competitive

• Consumer responsive

• Ambulatory – Home and Community

• Team

• Evidence based practice

• Consumer engagementEdward O'Neil, Ph.D., M.P.A., Center

for the Health Professions, San Francisco, CA

The Health Care Environment

Disease Management

“A system of coordinated healthcare interventions and communications for

populations with chronic medical conditions in which patient self-care

efforts are significant to control symptoms”

Disease Management Association of America

Goals of Disease Management

• Reduce rate of disease progression

Eliminate/reduce risk factors

Control symptoms

Reduce recidivism

Facilitate activities of daily living

Enhance quality/duration of life

Provide a positive cost-benefit

AARC’s 2015 & Beyond Initiative:What Does it Mean?

Patrick J. Dunne, MEd, RRT, FAARC

HealthCare Productions, Inc.

Fullerton, CA 92838