The Science Journal of the American Association for Respiratory Care

1997 OPEN FORUM Abstracts

Managed Care Curricula

Shelley C. Mishoe, Ph.D., R.R.T., Tuesday, December 9, 1997.

Managed care is affecting many aspects of Respiratory Care including where we work, what we do, how we are paid and the skills and traits needed. Managed care is any system that manages the delivery of health care in such a way that the cost is controlled. Health care costs can be decreased by eliminating care that is not cost-effective and eliminating factors that drive consumption. Features of managed care include: the balance of demand and costs, site-neutral care, capitated system vs. fee for service, providers sharing the financial risk and assessment of outcomes. Managed care requires a different kind of respiratory therapy graduate and practitioner to meet the needs of today's health care delivery systems. Managed care also requires practitioners to know more than ever before about health care costs and effectiveness of care. It is no longer enough to know how to do something and know that it works, now practitioners need to know that the care they provide is efficient and cost-effective over the long run. It is important that respiratory care graduates and practitioners understand how managed care presents opportunities for expanded roles to those practitioners with professional skills and traits in addition to their technical expertise.

Why should managed care be incorporated into Respiratory Care Curricula? One reason is that respiratory care is the sixth largest disease category in terms of dollars spent for health care. Respiratory care changes under managed care include a decline in length of stay, reduced utilization of technical and professional services and decreased reimbursement to physicians and hospitals. Consequently, respiratory therapists are having to learn and adopt new skills to shift from the old paradigm which focused on acute care and treatment of disease to a new paradigm focused on health promotion, disease management and patient education.

What do we need to include in a managed care curricula? Our curricula today should include actual projects, discussions and courses on health care delivery systems and costs of health care. The entire curricula, especially baccalaureate curricula, should emphasize and prepare graduates for their role as resource managers and physician extenders. Furthermore, courses, labs and clinical rotations should prepare graduates with the technical and professional skills needed in acute care and alternate sites. Students and clinicians need learning opportunities to make clinical decisions and recommendations which balance the clinical and economic outcomes, with increased emphasis on quality of life. Related training requires opportunities to develop clinical decision making and problem solving skills and additional professional behaviors such as communication, teamwork, negotiating and life-long learning. The overall curricula should place emphasis on wellness, disease prevention, disease management, ethics, and age-specific care.

This talk will give suggestions for teaching students and practitioners what they need to know about managed care. Key resources on managed care, including how to use Respiratory Care and AARCTimes in the curricula, will be highlighted. Strategies to incorporate written reports, interviews, projects, presentations, debates and discussion on managed care will be described. Practical tips and student feedback on a managed care curricula will be presented. This talk will also discuss how students and practitioners can follow the news and use the Internet to become better-informed providers and consumers of health care.

AARC 50th Anniversary, December 6 - 9, 1997, New Orleans, Louisiana.

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