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 CareAdjunct Faculty, Assistant ProfessorDepartment of Pediatrics,Case Western Reserve University
2 Current Health System Issues Health costs in US growing faster than:Employee wagesEconomy at largePreventive services are underusedLow adherence to proven-effective therapies for chronic diseasesMedical errors and safety problems remain too common, accounting for many thousands of deaths and billions of dollars in healthcare costsACO update-DartmouthProperty of PPCP: Created by KR 11/24/2010
4 How Healthcare Executive Decisions Impact the Workforce “Perfect Storm” - Economies impact on healthcareHospital administrators believe healthcare financing system is brokenGov’t payments have declined since 2000Steps to increase productivity & enhance quality by consolidating staff functionsCase management and disease managementUnderstanding & implementation of evidenced-based protocols & best practices
5 Four Key Drivers of Healthcare Reform Decrease cost of healthcareImproving the quality of care deliveredEvaluating effectiveness using outcome measuresImproving access and resource allocation
10 Chronic Conditions15 most costly medical conditions accounted for ½ of overall growth in health care spending1.5 inc Prevalence3 x the costPrevalence flat2 x the costSOURCE: 1987 National Medical Expenditure Survey (NMES) and 2000 Medical Expenditure Panel Survey, Household Component (MEPS-HC).
11 Chronic ConditionsSource: GAO analysis of Medical Expenditure Panel Survey (MEPS)
12 Financial IncentiveWorse-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 PerspectiveIn 2013, 150,000 fewer readmissions than Jan 2012Reduction in hospital-induced harms credited with saving 15,000 lives and $4 billionAll-cause readmissions rate, according to the report, has declined to 17.5%
14 Today’s PerspectiveHospital-acquired conditions declined 9% from 2010 to 2012145 / 1,000 discharges down to 132 /1,000 discharges
15 Change in FocusHospitals are in a fee-for-service world now where they're rewarded on volumeNext 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. harmEffective- evidence-basedPatient-centered- focused on needs and rights of the individual patientTimely- avoidance of delays & barriers to patient care flowEfficient- elimination of wasteEquitable- fair access to comparable health care services for all
17 IMPLICATIONS FOR HOSPITALS Achieve solid hospital-physician (clinical) alignmentMeasure, report and deliver superior outcomesReduce costsForm 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 careThe workforce will soon be asked to assume new responsibilities, and RT graduates will enter a profession with an expanded scope of practice
19 MEDICARE PATIENTS’ USE OF POST-ACUTE SERVICES THROUGHOUT AN “EPISODE OF CARE” (1) 1/3 of Medicare discharges require post-acute careBlue shows discharge destinationOrange 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?
23 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.
24 RT: “Hybrid” Clinician Revenue GeneratorsHave the ability to bill for therapies, interventions and servicesReimbursement: CPT-code based under medical directionArea specific (i.e Hospitals,Pulmonary Labs, etc…)Similar to Therapy (Physical, Occupational, etc…) ProfessionsService-relatedProvide basic care and education to patients with cardiopulmonary diseasesSimilar to nursing profession
25 Groups of Competencies: Patient Assessment Educating the Future Respiratory Therapist Workforce Competencies Required for Respiratory TherapistsGroups of Competencies:Patient AssessmentEvidence-Based Medicine and ProtocolsDisease ManagementTherapeuticsEmergency and Critical CareDiagnosticsLeadershipBarnes 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 technologyPost Acute Care and medical home will continue play an increasing important roledelivery of acute care will move progressively to the patient’s homePost 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 LOSMortality of patients was reduced by 42%Estimated Medicare cost savings were $97.9 millionMuse 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 DiseaseManagementAcute DiseaseManagementRespir Care May;55
30 Respiratory Therapist as Disease Managers Decrease in Hospitalizations and Emergency Room Visitsp < 0.001Decrease in Hospitalizationsp < 0.03Decrease in ED Visitsp < 0.001Rice KB et al. AJRCCM 2010:182
31 Disease ManagementRice 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 complexityClinical decisions will become increasingly data-drivenRespiratory care will be an important part of care in all venuesEvidence-based algorithms (protocols) will be most common way to deliver respiratory careGreater need for RTs to be involved in researchRequire RT to be adept at understanding practical ramifications of published research
34 Protocols & ConsultsProtocols have been in place in respiratory care since the early 1980’sTherapeutics, VentilationRespiratory Consult ServicesEfficient, effective, cost savingsAcross the continuum careWellness, Prevention and Education
35 “Physician Extender”AARC 2005 Human Resource Survey
38 The Future of NursingNurses 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 barriersExpand opportunities for nurses to lead and diffuse collaborative improvement effortsImplement nurse residency programstransition-to-practice programIncrease the proportion of nurses with a baccalaureate degree to 80 percent by 2020Double number of nurses with doctorate by 2020Ensure 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 RTsimportant in reducing recidivism in patients with chronic respiratory diseaseProtocolized care (best practices)Disease management and self-managementPreventive careRisk-factor modulationSmoking cessation
41 Trends for RT Future? Job Availability? Advanced degrees? Bridge programs / articulation agreementsFocus on Credentials?ExaminationsLicensure ActsExpansion outside hospital wallsIncreased 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 essentialTherapist 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 appliedEssential care of critically ill patients requires broad knowledge of monitoring approachesPharmacology: interaction with mechanical ventilation and to treat cardiovascular dysfunction
43 Areas of Opportunities Cardiopulmonary DiagnosticsSleep MedicinePost-Acute CareHome, SNFs, LTACsPulmonary RehabWellness ProgramsCase/Disease ManagementPhysician Extenders
44 Future Healthcare Trends? Multi-Skilled providerFocus on team and collaborationConsolidation of Acute Care ServicesExpansion of clinicians into other venuesMovement to Wellness/PreventionFurther payer penalties
45 Final ThoughtThe 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