The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

Pulmonary Function Testing Should be Determined by Patient-Driven Protocols, Not Package Testing'

Robert A. Brown, BS, RRT, RPFT Wednesday, November 6, 1996

As the healthcare industry appears to be changing toward managed care, we have to ask ourselves, and our administrators, how this change may impact upon the way laboratory services will be provided. In recent years, laboratory service reimbursement has declined; technical as well as professional. This shift has significantly impacted upon the way many laboratories and departments do business.

Clinical Practice Guidelines (CPGs) have been, and continue to be, developed for many areas of cardiopulmonary diagnostics. The intent behind CPGs is to provide the best available scientific evidence and authority opinion, on the indications, applications and limitations of many commonly performed cardiopulmonary diagnostic procedures. Adherence to CPG recommendations should improve testing quality by reducing variability among and between laboratories. Each AARC CPG has a reference list and often a recommended reading list. By having well developed CPGs and references, laboratorians can begin developing institution-based PFPDAP. The PFPDAP concept may be fairly new to many laboratories, particularly those who have never questioned physician requests for testing.

As with counterparts in respiratory care, Patient-Focused Pulmonary Diagnostic Assessment Plans (PFPDAP) are well defined diagnostic plans that are initiated and implemented by credentialed laboratorians. Since they are designed in concert with, and approved by, appropriate medical staff, PFPDAP result in individualized patient testing plans which promote appropriate care. Cost reduction, appropriate patient care and the potential for increased physician referrals are the focal points of PFPDAP.

Well defined PFPDAP should enhance appropriateness of care by predefining the most applicable test(s) for a given diagnosis and/ or by the clinical presentation of the patient. Services must therefore be based upon clinical indications, with expected treatment outcomes. In essence, test results must confirm, quantify, and/or rule out clinical suspicions (the reasons for ordering and/or performing a test). What occurs then, with PFPDAP, is the patient receives tests which will augment a clinical evaluation, or treatment course, and maximize patient management.

Faced with capitation and declining federal reimbursement (among other reimbursement caps), laboratorians are having to become more creative in the way they do business. Although a single "best" healthcare plan has not been adopted by the federal government, we can assume with a high degree of confidence, that health promotion and early disease detection will be front runners of any plan. Diagnostics will certainly play an important role in this process.

We must therefore develop and market PFPDAP for our area of expertise. By developing PFPDAP from CPGs, physicians and administrators should be informed that they reflect the state-of-the- art in Diagnostics. These groups should also understand, that by their design, PFPDAP are the most appropriate care plans for their patients. Incorporating PFPDAP into care packages should [theoretically] save institutions money in the long run, since patients will be evaluated more efficiently and effectively. The federal government is placing a great deal of emphasis on improving patient outcomes.

As a group, we must be proactive in designing our futures in the healthcare industry. Patient-Focused Pulmonary Diagnostic Assessment Plans may be the guiding light by which to develop that design.

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