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Creating a Vision of Care and Beyond

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Presentation on theme: "Creating a Vision of Care and Beyond"— Presentation transcript:

1 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

2 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 ACO update-Dartmouth Property of PPCP: Created by KR 11/24/2010

3 Changes in the Economy

4 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 evidenced-based protocols & best practices

5 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

6 Future Impact

7 Cut from the Headlines

8 Cut from the Headlines

9 Chronic Medical Conditions

10 Chronic Conditions 15 most costly medical conditions accounted for ½ of overall growth in health care spending 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).

11 Chronic Conditions Source: GAO analysis of Medical Expenditure Panel Survey (MEPS)

12 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 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.

13 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%

14 Today’s Perspective Hospital-acquired conditions declined 9% from 2010 to 2012 145 / 1,000 discharges down to 132 /1,000 discharges

15 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 patient-centered care."

16 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

Achieve solid hospital-physician (clinical) alignment Measure, report and deliver superior outcomes Reduce costs Form strategic alliances

18 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

1/3 of Medicare discharges require post-acute care Blue shows discharge destination Orange shows contact with 90 days of discharge

20 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."  Teaching and learning is aimed at helping people learn and grow, change unproductive behaviors for more productive ones to increase their level of skill, capability, and performance – fundamentally to enhance quality of life both personal and professional. In my own learning experiences II was strongly influenced by American Indian culture growing up very near the Seneca Reservation in upstate New York. Typically outsiders to this culture think the chief to be the most powerful person in a tribe, but the most influential person is the storyteller. The storyteller, often a woman, was the verbal source of wisdom, history, literature, knowledge, moral instruction and learning. Through her, a vision regarding what was required to thrive emerged and was indelibly etched in the collective mind of the tribe. She moved people from interest and intellect to action through the power of story. For all our sophistication as corporate tribes, we have lost the key to sustained positive action – effective execution. Like Dr. Berwick, Quint Studer, Johnnie the Bagger, and others the power of story is driving execution and performance in patient safety. When a hospital or healthcare system is blessed with leaders who express compelling stories about things that matter — grounded in fact and reason, tied to core values that are widely embraced, constructed with logic and expressed in positive, emotionally passionate terms — people not only listen, but are moved to action. As centuries of tribal story telling and three decades of neuroscience research tells us, when people harness the power of story, bonding intellect and emotion, they make lasting change. This is the power of emotional intelligence and being intelligent about creating and using emotion to drive performance. I want to express my thanks to you all for your attendance at this symposium, for your courage to be a fire starter, a trim tab, a maverick, a gadfly sent by the gods to sting into action those needed to continue to bring about change and improve the overall level of excellence of healthcare. May you remain committed to your journey and to your God given calling. My thanks, my regards, and God’s blessing to you all.

21 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

22 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?

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.

24 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

25 Groups of Competencies: Patient Assessment
Educating the Future Respiratory Therapist Workforce Competencies Required for Respiratory Therapists Groups of Competencies: Patient Assessment Evidence-Based Medicine and Protocols Disease Management Therapeutics Emergency and Critical Care Diagnostics Leadership Barnes TA et al. Respir Care May;55(5):601-16

26 “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

27 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

28 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

29 Competency Area II: Disease Management
Chronic Disease Management Acute Disease Management Respir Care May;55

30 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

31 Disease Management Rice KB et al. AJRCCM 2010:182

32 Competency Area III: Evidence-Based Medicine & Respiratory Care Protocols
Respir Care May;55

33 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

34 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

35 “Physician Extender” AARC 2005 Human Resource Survey

36 Physician Extenders

37 We are not alone……

38 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.

39 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

40 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 Protocolized care (best practices) Disease management and self-management Preventive care Risk-factor modulation Smoking cessation

41 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

42 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

43 Areas of Opportunities
Cardiopulmonary Diagnostics Sleep Medicine Post-Acute Care Home, SNFs, LTACs Pulmonary Rehab Wellness Programs Case/Disease Management Physician Extenders

44 Future Healthcare Trends?
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

45 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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