In July of this year, the Medicare Respiratory Therapist Access Act (H.R. 2619) was introduced in Congress. Congressman John Lewis (D-Georgia), co-chair of the US COPD Coalition, introduced the bill in an effort to ensure that expanded access to respiratory therapists beyond the walls of the hospital and into the physician practice becomes a reality.
The importance of this bill is that it allows for registered respiratory therapists with a minimum of a bachelors degree or other advanced degree in a health science field to position patients to be better self-managers of their chronic lung disease. The respiratory therapist, through disease management, will accomplish this. This action is very timely as self-management education and training is at the forefront of several important health care initiatives as seen through the Affordable Care Act (ACA).
In fact, the ACA is already changing the paradigm of care by introducing innovative payment models that emphasize the importance of primary care physicians, care coordination, bundled payments, and medical homes.
The provision of care and education for patients with chronic disease is dramatically changing. Instituting patient education and self-management during a hospital stay and post-discharge is already a recommendation made by the Medicare Payment Advisory Commission. Further, as part of its strategic framework for optimizing health and quality of life for individuals with multiple chronic conditions, the U.S. Department of Health and Human Services has set a goal to integrate self-management education programs into multiple settings.
Respiratory therapists as disease managers
The published evidence continues to demonstrate the value of the respiratory therapist in disease management. So why is this important for patients and respiratory therapists? For respiratory therapists, this will allow for a better option of extending services from the acute care arena to chronic management in the physician practice. It is important to realize that there are billing codes for education and training of self-management when furnished by a non-physician health care professional, however, Medicare does not pay separately for these services in the outpatient setting.
Currently, respiratory therapists are considered auxiliary personnel in the physician office setting and, thus, cannot provide these services. However, once H.R. 2619 is enacted, these services would be covered by respiratory therapists.
Patients with chronic lung disease including cystic fibrosis, pulmonary hypertension, pulmonary fibrosis, COPD, and asthma who are frequent users of the health care system will have a respiratory therapist as a disease manager who can work with them on an individual basis, teaching them about proper administration of aerosolized medications, as an example. It is not always as easy as it may seem to master this technique. As simple as it sounds, we are starting to see varying recommended techniques for differing aerosol delivery devices.
Some now require differing inhalation maneuvers despite using the same device to deliver the medication. This will require an astute and informed clinician to teach patients appropriately. In addition to this, when a patient has more than one type of device to use, using each of them correctly and as prescribed can become difficult. By utilizing respiratory therapists, the patient will be assured of that inhaled medication delivery is top notch.
The climate of health care, with the emerging large numbers of baby boomers entering their chronic disease years, will see a considerably large segment of the population with diagnosed or undiagnosed COPD. Couple this with the penalties hospital will receive for excessive readmissions within 30 days ( a new provision under the Affordable Care Act), and the respiratory care community is positioned to make a significant contribution.
The American Association for Respiratory Care is working hard to get H.R. 2619 passed by Congress. We are partnering with the entire respiratory community: this includes formal support from the professional societies; the American Thoracic Society and the National Association for Medical Direction of Respiratory Care and our patient partners including the COPD Foundation, Cystic Fibrosis Foundation, Alpha-1 Association, and othersbut we need YOU.
In order to succeed, we need you to reach out to your elected officials and let them know you support allowing access to respiratory therapy beyond the hospital walls and into the physicians practice. We need to build the list of co-sponsors for H.R. 2619 to get it passed!