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

1. AARC’s 2015 & Beyond Initiative:What Does it Mean? Patrick J. Dunne, MEd, RRT, FAARC HealthCare Productions, Inc. Fullerton, CA 92838

2. Disclosure This presentation is sponsored by Monaghan Medical.

3. 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

4. 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

5. 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)

6. Cost Drivers • Uncoordinated care • Duplicative • Delayed • Sicker, less stable • Fragmented • Medical errors, misadventures • Lack of continuity • Not a seamless transition

7. 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

8. 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

9. 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

10. 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

11. Creating a Vision for Respiratory Care in 2015 and Beyond Charles G. Durbin Jr. MD, FCCM, FAARC John Walton, MBA RRT, FAARC Conference Co-chairs March 3-5, 2008 Hilton DFW Lakes Executive Conference Center 1800 Highway 26 East, Grapevine, Texas Presented by the AMERICAN ASSOCIATION FOR RESPIRATORY CARE 9425 N. MacArthur Blvd., Suite 100 Irving, TX 75063, U.S.A.

12. 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?

13. 2015 Initiative Questions • What additional responsibilities can RTs assume to improve heath care outcomes for patients with chronic respiratory diseases?

14. 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

15. 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 hereto there

16. Creating a Vision for Respiratory Care in 2015 and Beyond Charles G. Durbin Jr. MD, FCCM, FAARC John Walton, MBA RRT, FAARC Conference Co-chairs March 3-5, 2008 Hilton DFW Lakes Executive Conference Center 1800 Highway 26 East, Grapevine, Texas Presented by the AMERICAN ASSOCIATION FOR RESPIRATORY CARE 9425 N. MacArthur Blvd., Suite 100 Irving, TX 75063, U.S.A.

17. Post- Acute Conditions • COPD • Asthma • Obstructive sleep apnea • Lung cancer • Cystic fibrosis • IPF

18. 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

19. COPD 19932002% 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

20. 1.0 0.8 0.6 0.4 114(84%) 105(78%) 94(70%) Percentage Surviving 86(64%) 75(56%) 0 180 360 540 720 900 Survival Days Mortality After Hospitalization for COPD Kaplan-Meier survival curves in 135 patients hospitalized for acute exacerbation of COPD (DRG 088) P Almagro et al, Chest 2002; 121:1441-1448.

21. 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

22. 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

23. 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

24. 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

25. 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 death • 100 million Americans, two-thirds under age 65 • > 60% of annual expenditures • Care differs from acute (episodic) • 15 “top priority” conditions • Emphysema/COPD • Asthma

26. 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)

27. Concurrent Therapy

28. Protocol Care

29. How Widespread is Protocol Care?

30. 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.

31. 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

32. Health Promotion & Disease Prevention • Chronic disease state management • Risk factors, triggers, medication management, symptom control, exacerbation avoidance • Pulmonary function screening • At risk population – smokers 45 yrs or older • Tobacco control • Cessation & abstinence • Community preparedness

33. 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!

34. The Health Care Environment • Tomorrow • Chronic disease prevention and management • Price competitive • Consumer responsive • Ambulatory – Home and Community • Team • Evidence based practice • Consumer engagement • Today • Acute treatment • Cost unaware • Professional prerogative • In-patient • Individual profession • Traditional practice • Patient passivity Edward O'Neil, Ph.D., M.P.A., Center for the Health Professions, San Francisco, CA

35. 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

36. 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

38. AARC’s 2015 & Beyond Initiative:What Does it Mean? Patrick J. Dunne, MEd, RRT, FAARC HealthCare Productions, Inc. Fullerton, CA 92838