2015 and Beyond

1. 2015 and Beyond Charting a Future for the Respiratory Therapy Profession

2. Questions to Be Addressed • How will patients receive healthcare services in the future? • How will respiratory therapy be provided? • What skills, knowledge and attributes (KSAs) will respiratory therapists need to provide care safely, efficiently and cost-effectively? • What educational and credentialing systems are needed to provide these KSAs? • How do we get from the present to the future without having an adverse impact on the respiratory therapy workforce?

3. Blue Ribbon Planning Committee Representation: Respiratory therapy director Respiratory therapy educator Administrator (acute care hospital) Administrator (healthcare system) Healthcare workforce expert Patient/consumer Physician (critical care) Physician (chronic care) 2 year college representative 4 year college representative Federal government representative Military representative Planning Committee Members Bob Kacmarek* (Mass General) Tom Barnes* (Prof Emeritus- NE) Karen Stewart (CAMC) John Walton*(Resurrection Health Care) Ed O’Neal* (Cntr for Health Profess) John Walsh (Alpha One) Charles Durbin (SCCM Past Pres) Woody Kageler* (Disease Mgt) Jolene Miller (NN2) David Gayle (ASHAP) Judy Blumenthal (HHS) COL Michael Morris (Brooke Army Med Center) Strategies to Find AnswersBlue Ribbon Planning Committee *Writing Committee

4. Over 50 organizations within the following stakeholder groups were invited to participate: Employers Insurers Professional Organizations Foundations State and Government Agencies Educators Patients and Consumers Credentialing and Accrediting Agencies State and Federal Government Agencies Strategies to Find AnswersInvolve Stakeholder Organizations

5. Strategies to Find AnswersThe Conferences

6. Strategies to Find AnswersResponsibilities

7. Strategies to Find AnswersConference Structure During each conference: • Conference is moderated by the co-chairs • Speakers present topics to faculty, planning group and stakeholder representatives • Each presentation is followed by discussion in which all attendees have the opportunity to participate • All presentations and discussions are recorded for later transcription and distribution to the writing committee • After all presentations, co-chairs summarize proceedings which are distributed to all attendees • Attendees provide feedback to co-chairs and leave conference with a summary conference document

8. Strategies to Find AnswersConference Structure Following each conference: • Writing committee chair assigns conference topics to each member of the writing committee • Transcript of each presentation and discussion along with copies of presenter’s slides are provided to the writing committee • Writing committee members draft summaries of assigned individual presentations and discussions and submit them to the writing committee chair • Using these summaries, the writing committee chair incorporates them into a draft a paper describing the findings of the conference and presents it to the planning committee • Planning committee provides review and comment to the writing committee chair who then submits paper for publication in a peer-reviewed journal

9. Creating a Vision for Respiratory Care in 2015 and Beyond • First conference was held March 3-5, 2008 • examined the characteristics of the current healthcare delivery system and how it is likely to evolve as we move into the future • projected what and how respiratory therapy services will be delivered in the future • identified the future roles and responsibilities of respiratory therapists • Co-chaired by Charles Durbin and John Walton. • All stakeholder groups invited to participate.

10. 20 Stakeholder Organizations Represented by 37 Participants (see handout) • Alpha 1 Foundation • American Association for Cardiovascular and Pulmonary Rehabilitation (AACPR) • American Association for Respiratory Care (AARC) • American College of Chest Physicians (ACCP) • American Thoracic Society (ATS) • California Board for Respiratory Care • Center for Health Professions • Commission on Accreditation of Allied Health Education Programs (CAAHEP) • Committee on Accreditation of Respiratory Care (CoARC) • COPD Foundation • National Association for Medical Direction of Respiratory Care (NAMDRC) • National Board for Respiratory Care • National Heart Lung and Blood Institute • National Home Oxygen Patients Association • National Network of Health Career Programs in Two Year Colleges (NN2) • North Carolina Board for Respiratory Care • Society of Critical Care Medicine (SCCM) • The Association of Schools of Allied Health Professions (ASAHP) • The Joint Commission • United States Public Health Service

11. Conference Topics and Speakers Opening Presentation -Conference Overview: A Vision of the Healthcare System in 2015 and Beyond: Planning : Assumptions and Questions To Be Addressed Charles G. Durbin, Jr, MD, FCCM, FAARC, Immediate Past President SCCM, University of Virginia, Charlottesville, VA John Walton, MBA, RRT, FAARC, Resurrection Health Care, Chicago, IL

12. Conference Topics and Speakers (continued) Current Status and Evolution of the Health Care System Edward O'Neil, Ph.D., M.P.A., Center for the Health Professions, San Francisco, CA Gordon D. Rubenfeld, MD MSc, University of Toronto, Toronto Canada Current Status of Respiratory Care within the Health Care System Patrick Dunne, MEd., RRT, FAARC, Healthcare Productions, Fullerton, CA What Respiratory Patients Need John W. Walsh, President of the COPD Foundation and President & CEO of the Alpha-1 Foundation

13. Conference Topics and Speakers (continued) Special Considerations Impacting Healthcare and Respiratory Therapy Demand Military COL Michael J. Morris, MC, USA, Brooke Army Medical Center, Fort Sam Houston, TX Public Health Karen Lohmann Siegel, PT, MA, Captain, USPHS, Health & Human Services, Washington, DC Discussion of Current and Future Human Resource Issues Bill Dubbs, MEd, MHA, RRT, FAARC, American Association for Respiratory Care

14. Conference Topics and Speakers (continued) The Impact of Biomedical Innovation on the Responsibilities of the Respiratory Therapist Neil MacIntyre, MD, FAARC Duke University, Durham, NC What Should Respiratory Therapists Be Doing in the Future? John Walton, MBA, RRT, FAARC, Resurrection Health Care, Chicago, IL Role of the Future Respiratory Therapist Across the Spectrum of Care Robert Kacmarek, PhD, RRT, FAARC, Massachusetts General Hospital, Boston, MA

15. Conference Topics and Speakers (continued) Disease Management — What Skills Do Respiratory Therapists Need? Woody Kageler, MBA, MD, FACP, FCCP, Tarrant County College-Northeast Campus, Hurst TX; Nurtur, Dallas ------------------------------------------ Development of Summary Conference Document Development of a Vision of Future Role Description for RT 2015 and Beyond • Charles G. Durbin, Jr, MD, FCCM, FAARC, University of Virginia, Charlottesville, VA • John Walton, MBA, RRT, FAARC, Resurrection Health Care, Chicago, IL

16. Summary Conference Document • Predicted changes in healthcare: • More patients will be diagnosed with chronic and acute respiratory diseases • The percentage of people 55 years or older in the population will continue to increase • There will be increased effectiveness of diagnosis • Treatment will be aimed at management and avoiding hospital admission • Increasingly co-morbid conditions associated with chronic illness will be identified. These will also require management/treatment. • “Health” rather than illness treatment will become the goal of care.

17. Summary Conference Document • Predicted changes in healthcare (cont.): • Cost increases in care will continue to grow and individual, corporate and public payers will find it increasingly difficult to meet these challenges. • Personal Electronic Health Records will be more widely accepted and used in all care settings including the home. • Health care consumers will pay a greater percentage of costs and will have new options for obtaining care. • “Retail store healthcare” and other mass marked care will stimulate consumer-driven cost competition.

18. Summary Conference Document • Predicted changes in healthcare (cont.): • Acute care hospitals will continue to provide expensive, episodic care and will house cutting-edge respiratory life support technology, however, subacute and home care providers will continue to play important roles in the delivery of care. • The delivery of acute care will move progressively from the hospital through the entire health care system and ultimately, to the patient’s home. • Subacute and chronic care will increase in amount and complexity.

19. Summary Conference Document • Predicted changes in healthcare (cont.): • The disconnect between prevention and acute care treatment (specifically in acute care hospitals) will lessen but not disappear. The increased complexity of care will heighten the need for better communication among all providers of care as well as the patient and his/her family members • Medical care treatment will undergo increasing scrutiny for quality and this will be linked to reimbursement with initiatives such as pay for performance. • New models of healthcare delivery (such as the “Hospital at Home” and “Medical Home”) will emerge with increasing emphasis on coordination of care through the healthcare system including the home • Reimbursement and costs will influence the development and success of these new models

20. Summary Conference Document Changes likely to occur in the healthcare workforce There will be a national (and regional) shortage of healthcare providers in all sectors including those that frequently interact directly with patients including physicians, nurses, respiratory therapists, as well as those who have less intense patient interaction such as diagnostic and laboratory technicians • There will be a long-term competition for all healthcare professionals throughout the US economy • The rise in clinical demand will increase at a faster pace than the healthcare workforce will be able to expand • This imbalance in jobs and available workforce will be aggravated by the retirements of aging of current providers

21. Summary Conference Document Changes likely to occur in the healthcare workforce • Brutal work hours requiring 24/7 staffing in inpatient and other settings will dissuade many individuals from pursuing health care careers • Shortage of teaching faculty and the limited number of programs will limit the number of entrants admitted into and graduating from allied health professional schools • Clinical sites are limited in number and variety and will need to be expanded to include new venues such as office practices and patients homes • New technological resources for educational delivery and knowledge access will challenge traditional education • Care delivery organizations will find a reinvestment in education to be an attractive way to secure workers, reduce the time between initial employment and full productivity, and provide education and career ladders for existing employees

22. Summary Conference Document Changes expected in respiratory care: • The science of respiratory care will continue to evolve and increase in complexity, clinical decisions will become more data driven • Respiratory care delivery will be an increasingly important part of care delivered in all venues • Scientifically supported algorithms (protocols) will be the most common way to deliver respiratory care • Increased complexity of care and use of protocols will stimulate an even greater need for more practitioners to be involved in research and require the average respiratory provider to be adept at understanding the practical ramification of published research

23. Summary Conference Document Changes expected in respiratory care: • Care teams will become the standard for healthcare delivery in and outside the traditional hospital. • Members of the team will have different roles and responsibilities at different times but respect and collaboration will be the hallmark of effective team function • Patients and their families will be important members of the healthcare team and must be informed, empowered and engaged in personal health management. • Cultural differences among patients will require the respiratory care provider to develop new skills and adopt differing approaches to care for different groups.

24. Summary Conference Document Changes expected in respiratory care: • Information management will become an important tool in selecting a therapy and evaluating the effects of treatment decisions. • New respiratory life support technologies will be developed and deployed. • Research on their clinical effectiveness and cost effectiveness by the respiratory community will be necessary. • Reimbursement changes will be the most important drivers of changes in health and disease management. • Public health issues, military and disaster response concerns will continue and require new skill sets for respiratory care providers.

25. Summary Conference Document Knowledge, socialization, training, and skills of those providing respiratory care will need to be aligned with the factors and changes detailed above.

26. What Is Happening Now?

27. What Will Happen Next?

28. Second Conference • Will be held in late January/early February 2009 • Will be based on the information gleaned and possibilities identified from the first conference and published in the paper. • Identify the KSAs required by respiratory therapists to provide future services. • Will describe the educational and credentialing systems needed to assure respiratory therapists have the requisite KSAs

29. Third Conference