Frank R. Salvatore Jr., RRT, MBA, FAARC Administrator Ancillary Services Greater Hudson Valley Health System Middletown, NY AARC President

Transcription

1 Frank R. Salvatore Jr., RRT, MBA, FAARC Administrator Ancillary Services Greater Hudson Valley Health System Middletown, NY AARC President Dallas, TX

2 Objectives Review the AARC Mission and Vision Statement and how it impacted the Presidential Goals. Use the AARCs Strategic Plan as our guide to review the current state and what s moving our profession. Throughout the talk, it will be shown why state affiliates will be on point and need to strengthen. Bring the information presented to a local/state level to see the impact.

3 AARC Mission and Vision Statements Mission Statement: The American Association for Respiratory Care (AARC) will continue to be the leading national and international professional association for respiratory care. Vision Statement: The AARC encourages and promotes professional excellence, advances the science and practice of respiratory care, and serves as an advocate for patients and their families, the public, the profession and the respiratory therapist.

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7 AARC Times February 205 Pages 20-23

8 Strategic Objective : Refine and expand the scope of practice for respiratory therapists in all care settings. Description- Promote advanced practice and practice expansion for respiratory therapists. Assure that the science that demonstrates the value and role of the respiratory therapist is provided to those stakeholders whose decisions and actions need to be guided by that information.

9 Patient Protection and Affordability Care Act (PPACA/ACA/Obamacare):

10 The Foundation: Why the 2,000+ Page Law?? The core issue was rising costs of health care. In 2000, health care was 7.6% of US GDP 2. In 200, US spent $2.7 trillion overall on healthcare 3. Health premiums increased % in 20 wages increased 2%

11 Where s the Money Go

12 Of the 2.7 Trillion We Spend for US Healthcare 750 billion did nothing to make anyone better

13 Changing the Health Care Paradigm Better Health, Better Care, Lower Costs Quality measures are playing a huge role in how all types of providers are paid linked to a number of ACA provisions More $ if you meet them; less $ if you don t Focus on measures for COPD began October, 204 ACA has increased Medicare s authority to incentivize hospitals, doctors, and others to increase quality of care Volume of care is out

14 Cost of Care Cutting the Fat According to Premier Inc. the average hospital could cut millions of dollars in unnecessary care, staff productivity and prevention of readmissions Labor productivity $5. million LOS $3. million Readmissions $3.0 Employee skill mix $.8 million Overtime costs $.8 million Lab tests $.7 million Respiratory therapies $.5 million

15 Hospitalizations for COPD in U.S. The Numbers 822,00 Hospitalizations Average LOS 4.7 days $7,500/hospitalization Annual cost for COPD continues to grow $49.9 billion (direct & indirect) 40% of costs could be avoided with prevention of complications and reducing hospitalizations 7.6% of Medicare patients readmitted to hospitals within 30 days of discharge Avoidable readmissions account for $7.5 billion additional Medicare expenditures annually Wier, L.M., AHRQ HCUP, Statistical Brief #06, 20 Medicare Payment Advisory Commission. Payment policy for inpatient readmissions. In: Report to the Congress: Promoting Greater Efficiency in Medicare. Washington, DC; June 2007: Available at:

16 Changing the Way We Think About Prevention One Notable Study Disease Management Program for Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial n = 743 patients Hospitalization within 2 months Oxygen Dependent Corticosteroid use Elements of DM program Results.5 hour education session Individualized action plan Monthly phone calls for RT case manager 3% fewer hospital visits 34% fewer ED visits Rice, KL et al. Disease Management Program for Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. Am J Respir Crit Care Med. 200 Jan 2

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19 Advanced Practice RT CoARC developed standards for accrediting Advanced Practice Programs in Respiratory Care As a collaborating organization, the AARC consented to the standards. AARC created an Ad Hoc Committee on Advanced Practices, Credentialing and Education. Representatives from CoARC and NBRC are on the committee as well. Committee will undertake a needs assessment for both the profession and the MDs. NBRC will be asked to begin the process of creating a credentialing program for APRT. AARC will need to take the lead on helping states get legislation/regulation to allow practice of APRT

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22 Strategic Objective 2: Advance the knowledge base and educational preparation of respiratory therapists to ensure competent patient care and to foster patient safety initiatives. Description - The AARC will promote the continuing development of the respiratory care workforce both nationally and internationally by promoting formal educational programs and continuing education in order to ensure competent, safe, and effective patient care, and to provide for the transfer of new knowledge to clinical practice.

23 Respiratory Care 205 and Beyond In 2007, President Toni Rodriguez directed the AARC Executive Director to organize a series of conferences to address the following questions: What will the future health care system look like? What will the roles and responsibilities of respiratory therapists be in the future system? What competencies will be required for RTs to succeed in the future? How do we transition the profession from where it is today to where we need to be in the future? Key Stakeholders of the profession were selected to plan and implement a series of three conferences.

24 The transition plan must: Respiratory Care 205 and Beyond Maintain an adequate respiratory therapist workforce throughout the transition. Address unintended consequences such as respiratory therapist shortages. Require multiple options and flexibility in educating both students and the existing workforce. (e.g. affiliation agreements, internships, special skills workshops, continuing education, etc.) Require competency documentation options for new graduates. Support a process of competency documentation for the existing workforce. Assure that credentialing and licensure recommendations evolve with changes in practice. Address implications of changes in licensing, credentialing and accreditation. Establish practical timelines for recommended actions. Reflect the outcomes of the previous two 205 and Beyond conferences Identify the agencies most appropriate to implement identified elements. The Board Unanimously Accepted as amended.

25 Actions on Conference Recommendations: The board recently pushed forward some 205 and Beyond initiatives that came directly from committees/groups that addressed recommendations. Two such initiatives addressed are: Conference Recommendation #4: The AARC, CoARC and NBRC are putting together a task force on competencies for Entry into Respiratory Care Professional Practice that will address 205 and Beyond. Conference Recommendation #5: That AARC encourages clinical department s educators and state affiliates continuing education venues to use clinical simulation as a major tactic for increasing competency levels for the current workforce. A Clinical Simulation Brief from a sub-committee was approved by the AARC BOD and put up on Conference Recommendation #8: That the AARC BOD explores development and promotion of career ladder education options for the member of the existing workforce to obtain advanced competencies and the baccalaureate degree. A Clinical Ladder Document was approved by the AARC BOD in April 205 and placed up on

26 Respiratory Care 205 and Beyond The 205 ad hoc committee recommended increased access to baccalaureate degrees (either Bachelors Science Respiratory Therapy {BSRT} or Bachelors Science Health Sciences {BSHS}), for both respiratory therapy students enrolled in associate degree granting programs and for associate-prepared respiratory therapists who are already in the workforce, be readily available to access by established articulation or transfer agreements by 205.

27 Courtesy: CoARC Alaska Hawaii N = 6 as of January 205 Red = No programs in that state (22)

28 Green = AS to BS Blue = BS to MS Purple = Both Types Courtesy: CoARC Alaska Hawaii N = 49 as of January 205 Red = No programs in that state (20)

29 Courtesy: CoARC Alaska Hawaii Green = Entry Only Blue = DA Only Purple = Both Types N = 0 as of January 205 Red = No programs in that state (7)

30 RRT Entry - Licensure Ohio was the first state to adopt. California just signed it into law effective //5. Looking at another ½ dozen states moving in the same direction.

31 Degree Institution City State Attrition Job Placement CRT Success RRT Success On-Time Graduation CoARC Threshold 40.0% 70.0% 80.0% N/A N/A National Average (n=435) 9.0% 84.7% 92.5% 68.0% 9.% Texas State Average (n=36) 6.9% 87.7% 90.9% 65.6% 90.8% AAS Pima Medical Institute-Houston Houston TX 6.80% 72.70% 63.60% 8.20% 00.00% AAS El Paso Community College El Paso TX 3.20% 70.80% 68.0% 35.40% 9.30% AAS Concorde Career College- Dallas Dallas TX 3.60% 64.70% 70.60% 52.90% 70.60% AS USAF School of Health Care Sciences Fort Sam Houston TX 30.70% 96.30% 7.20% 35.20% 3.90% AS Del Mar College Corpus Christi TX 3.50% 65.20% 76.0% 43.50% 93.50% AAS Midland College Midland TX 4.90% 9.40% 80.00% 45.70% 85.70% AAS McLennan Community College Waco TX 4.90% 69.70% 80.30% 47.40% 86.80% AS San Jacinto College Pasadena TX 20.50% 73.50% 82.40% 62.70% 80.80% AAS Lamar Institute of Technology Beaumont TX 7.50% 83.00% 83.00% 45.30% 85.20% AAS Texas Southmost College Brownsville TX.70% 89.0% 85.40% 40.00% 96.20% AAS Howard College San Angelo TX 44.00% 7.40% 85.70% 50.00% 92.30% AS Tyler Junior College Tyler TX 7.90% 87.30% 85.90% 50.70% 98.50% AAS Angelina College Lufkin TX 9.40% 8.60% 89.50% 28.90% 00.00% AAS Lone Star College - Kingwood Kingwood TX 2.90% 8.60% 93.0% 70.0% 9.90% AAS Lone Star College - Houston Houston TX 0.50% 8.20% 93.80% 75.00% 00.00% AAS U.S. Army Medical Education and Training Campus Fort Sam Houston TX 4.80% 93.30% 93.90% 28.90% 98.30% BS Texas State University San Marcos TX 3.60% 97.70% 94.30% 77.00% 84.80% AAS Amarillo College Amarillo TX 20.00% 86.0% 94.40% 38.90% 93.80% AS Tarrant County College Fort Worth TX 9.00% 88.90% 95.20% 85.70% 98.40% AAS Cisco College Abilene TX 2.60% 96.40% 96.40% 53.60% 00.00% AAS Victoria College Victoria TX 60.70% 96.80% 96.80% 83.90% 96.30% AS St Philip's College San Antonio TX 24.40% 95.30% 96.90% 50.00% 98.40% AAS South Texas College McAllen TX 8.0% 92.0% 97.40% 68.40% 9.90% AS El Centro College Dallas TX 7.00% 80.90% 97.90% 93.60% 97.80% AS Weatherford College Weatherford TX 27.80% 89.60% 00.00% 94.00% 00.00% AAS Temple College Temple TX 27.00% 90.00% 00.00% 80.00% 95.90% AS Alvin Community College Alvin TX 32.0% 92.90% 00.00% 88.0% 90.70% AS Collin College McKinney TX 2.30% 93.00% 00.00% 96.50% 93.00% AAS Concorde Career College- San Antonio San Antonio TX 4.00% 94.70% 00.00% 73.70% 90.00% AAS HCCS: Coleman College of Health Sciences Houston TX 24.00% 96.20% 00.00% 90.60% 98.0% BS Midwestern State University Wichita Falls TX.50% 96.40% 00.00% 87.30% 00.00% BS University of Texas Medical Branch Galveston TX 8.20% 97.60% 00.00% 00.00% 97.50% BS University of Texas Health Science Center San Antonio TX 5.90% 98.20% 00.00% 89.30% 87.50% AS Virginia College at Austin Austin TX 25.50% 00.00% 00.00% 00.00% 00.00% AAS South Plains College Lubbock TX 8.80% 00.00% 00.00% 82.0% 00.00% BS Texas Southern University Houston TX 0.00% 00.00% 00.00% 00.00% 52.20%

32 Strategic Objective 3: Support research and scientific inquiry to strengthen the scientific foundation and promote best practice for patient care. Description - Demonstrate the value of the respiratory therapist in providing respiratory care by supporting, conducting, and publishing research information. Research should compare the value of the respiratory therapist to others who may provide respiratory care services. Information generated should consider the needs of employers, legislators, regulators, other health professionals, and patients. Research efforts will, when appropriate and possible, be conducted in collaboration with other health care stakeholders.

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34 Strategic Objective 4: Establish professional standards and outcomes that are supported by scientific evidence. Description - The AARC will continue to develop and disseminate position statements, issue papers, consensus conference reports, evidence-based Clinical Practice Guidelines and other professional standards that promote safe and effective care, and provide guidance on all aspects of respiratory care.

35 Strategies to meet Objective 4:. Created a taskforce to work with UHC to develop a White Paper on Safe Initiation and Management of Mechanical Ventilation 2. Continue to review validity and accuracy of AARC White Papers and Position Statements.

36 Strategic Objective 5: Advocate for federal and state health care policies that enhance patient care, patients access to care, and professional practice. Description - Advocate at the federal and state level for health care policy that promotes access to appropriate, safe, and effective respiratory care for patients and the public. Develop and implement promotion/marketing of the respiratory therapist targeted to legislators, policy makers, and payers. Messages will emphasize the value of the respiratory therapist in controlling the utilization of services, creating cost savings, improving outcomes and patient safety, and increasing access to respiratory care as provided by a respiratory therapist.

37 Respiratory Therapists are Currently Excluded from Recognition by Medicare The Medicare law currently recognizes a number of nonphysician practitioners such as physical and occupational therapists, physician assistants, and others, but RTs are not included. Past attempts with our own bills have been unsuccessful despite the positive backing and nature of the legislation HR 269 last bill in 3 th Congress

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39 ADVOCACY Laws will only grow legs if you help it!!! Do you know what PACT is? How many know what the Virtual Lobby Day is? You need to be a part of this!

40 What about the States De-licensure. State tactic to reduce the size of government. Many states have had issues: Michigan, Indiana, Texas.. Many states also have sunset laws that will bring this up: Illinois State Societies need to be vigilant and stay on top of this. AARC will provide muscle, but can t be the face of the fight!

41 Strategic Objective 6: Partner with governmental agencies, community organizations, third party payers, professional societies and the public to promote healthy behaviors and prevent cardiopulmonary disease. Description - Promote partnerships with interested stakeholders to improve lung health, prevent cardiopulmonary disease, and identify and maximize the care of patients with chronic disease.

42 Strategic Objective 7: Broaden consumer and health care providers knowledge and understanding of the value of respiratory therapists in providing safe, competent, and evidence-based care. Description - Develop and implement promotion/marketing of the respiratory therapist targeted to health care providers, patients, and the public. Educate respiratory therapists on the importance of health promotion, effective smoking-cessation and tobacco-control programs, pulmonary health screenings, patient education, and disease management.

43 Stateside Initiatives In the early stages of developing possible demonstration projects related to the value of RT services provided to State Medicaid Recipients. Looking to states with RTs in the state hospital association and/or RTs in states who ve already begun work like this. Need to increase the value of the RT on all levels.

44 Strategic Objective 8: Assure the Association has the resources to meet the mission and strategic goals of the organization. Description - Assure that the AARC has the financial, volunteer, and staff resources needed to accomplish the implementation of the strategic plan of the Association. It is necessary to have sufficient income to support the ongoing and new initiatives of the Association if we are to accomplish the goals of the AARC. In addition to financial resources, it is essential that there be active participation of sufficient numbers of effective leaders and an effective and efficient Executive Office to support the efforts to be a leader in health care.

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46 Benefit of AARC Membership Need to continue to show value to current members. Need to get leadership of RT engaged. Stop Professional Welfare. Membership initiatives 205: Student Membership campaign. 6 mos. Before grad. - $70 (2-yrs digital level memb.) 3 mos. Before grad. - $90 (2-yrs digital level memb.) mo. After grad. - $70 for -yr or $30 for 2-yrs digital level memb.) Senior Memberships 65 or older - $25/year or $200 membership for life. Digital membership, active benefits, no CRCE tracking

47 So What Does This All Mean?

48 Exciting Possibilities A major move to Respiratory Disease Management. In Hospitals and alternative care settings! Time to advance the degree and credential needed to enter into the profession educationally and regarding licensure. Need to make sure we move purposefully, and in a manner that doesn t hurt our profession.

49 What need to do!!! Status Quo Status Quo Respiratory Therapists at all levels must get involved!! State Societies need to be more stronger than ever!

50 If You re Not at the Table, You re on the Menu Respiratory Therapy Department $ No Value $ 53

51 Which way do we go?

52 How many still need a road sign?

53 What if there was a road sign present?