The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

The Status of Respiratory Care: A National View

William H. Dubbs, MHA, RRT Sunday, November 3, 1996

The respiratory care profession has not been immune to the changes occurring in the healthcare marketplace. Market-driven reform has been driven by payor demands for lower healthcare costs of acceptable quality. Reimbursement systems are changing from the indemnity plans of the past toward capitation of the future. There is decreasing financial risk borne by insurers and increasing risk placed on providers. As healthcare employers struggle to deliver healthcare services that offer greater value than that of their competitors, they must cut their cost of doing business. To accomplish this, they have reduced FTEs, redesigned their care delivery systems, and paid closer attention to strategies that ensure appropriate utilization of expensive medical services. Organizational decision-makers have increased their interest in the application of clinical practice guidelines, the delivery of care by protocols, and the use of care maps to ensure that medical services required by patients and residents are closely matched to their changing medical condition. Integrated healthcare systems are being developed to ensure that patients are cared for in the least costly setting that is medically appropriate for their condition. This means shorter stays in expensive acute care facilities and more care being delivered in SNFs, subacute care units, homes and hospices.

The respiratory care profession, just like the healthcare industry, is in a state of flux. As patient days decrease in acute care facilities and increase in SNFs and subacute care facilities, the number of RCPs providing services is likewise decreasing in hospitals and increasing in post acute venues of care. In the current marketplace there is diminishing value in hospital-based respiratory care services that focus on providing services that patients or their caregivers can be successfully trained to provide. Successful respiratory care organizations are responding to these changes by focusing on strategies that adjust care as needed and providing services to patients and residents throughout the continuum of care. These RCPs are increasingly using clinical practice guidelines and protocols to ensure appropriate care. RCPs are also assuming nontraditional roles as case managers and becoming increasingly involved in chronic respiratory disease management programs. They are acquiring new skills to prepare themselves for the roles that will add value in current and future healthcare markets.

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