2015 and Beyond

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2015 and Beyond

• Charting a Future for the Respiratory Therapy
  Profession

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Questions to Be Addressed

• How will patients receive healthcare services in
  the future?
• How will respiratory therapy be provided?
• What skills, knowledge and attributes (KSAs) will
  respiratory therapists need to provide care
  safely, efficiently and cost-effectively?
• What educational and credentialing systems are
  needed to provide these KSAs?
• How do we get from the present to the future
  without having an adverse impact on the
  respiratory therapy workforce?

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Strategies to Find AnswersBlue Ribbon Planning
Committee

• Blue Ribbon Planning Committee Representation
• Respiratory therapy director
• Respiratory therapy educator
• Administrator (acute care hospital)
• Administrator (healthcare system)
• Healthcare workforce expert
• Patient/consumer
• Physician (critical care) Physician (chronic
  care)
• 2 year college representative
• 4 year college representative
• Federal government representative
• Military representative

• Planning Committee Members
• Bob Kacmarek (Mass General)
• Tom Barnes (Prof Emeritus- NE)
• Karen Stewart (CAMC)
• John Walton (Resurrection Health Care)
• Ed ONeal (Cntr for Health Profess)
• John Walsh (Alpha One)
• Charles Durbin (SCCM Past Pres)
• Woody Kageler (Disease Mgt)
• Jolene Miller (NN2)
• David Gayle (ASHAP)
• Judy Blumenthal (HHS)
• COL Michael Morris (Brooke Army Med Center)

Writing Committee
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Strategies to Find AnswersInvolve Stakeholder
Organizations

• Over 50 organizations within the following
  stakeholder groups were invited to participate
• Employers
• Insurers
• Professional Organizations
• Foundations
• State and Government Agencies
• Educators
• Patients and Consumers
• Credentialing and Accrediting Agencies
• State and Federal Government Agencies

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Strategies to Find AnswersThe Conferences
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Strategies to Find AnswersResponsibilities
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Strategies to Find AnswersConference Structure

• During each conference
• Conference is moderated by the co-chairs
• Speakers present topics to faculty, planning
  group and stakeholder representatives
• Each presentation is followed by discussion in
  which all attendees have the opportunity to
  participate
• All presentations and discussions are recorded
  for later transcription and distribution to the
  writing committee
• After all presentations, co-chairs summarize
  proceedings which are distributed to all
  attendees
• Attendees provide feedback to co-chairs and leave
  conference with a summary conference document

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Strategies to Find AnswersConference Structure

• Following each conference
• Writing committee chair assigns conference topics
  to each member of the writing committee
• Transcript of each presentation and discussion
  along with copies of presenters slides are
  provided to the writing committee
• Writing committee members draft summaries of
  assigned individual presentations and discussions
  and submit them to the writing committee chair
• Using these summaries, the writing committee
  chair incorporates them into a draft a paper
  describing the findings of the conference and
  presents it to the planning committee
• Planning committee provides review and comment to
  the writing committee chair who then submits
  paper for publication in a peer-reviewed journal

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Creating a Vision for Respiratory Care in 2015
and Beyond

• First conference was held March 3-5, 2008
• examined the characteristics of the current
  healthcare delivery system and how it is likely
  to evolve as we move into the future
• projected what and how respiratory therapy
  services will be delivered in the future
• identified the future roles and responsibilities
  of respiratory therapists
• Co-chaired by Charles Durbin and John Walton.
• All stakeholder groups invited to participate.

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20 Stakeholder Organizations Represented by 37
Participants (see handout)

• Alpha 1 Foundation
• American Association for Cardiovascular and
  Pulmonary Rehabilitation (AACPR)
• American Association for Respiratory Care (AARC)
• American College of Chest Physicians (ACCP)
• American Thoracic Society (ATS)
• California Board for Respiratory Care
• Center for Health Professions
• Commission on Accreditation of Allied Health
  Education Programs (CAAHEP)
• Committee on Accreditation of Respiratory Care
  (CoARC)
• COPD Foundation
• National Association for Medical Direction of
  Respiratory Care (NAMDRC)
• National Board for Respiratory Care
• National Heart Lung and Blood Institute
• National Home Oxygen Patients Association
• National Network of Health Career Programs in Two
  Year Colleges (NN2)
• North Carolina Board for Respiratory Care
• Society of Critical Care Medicine (SCCM)
• The Association of Schools of Allied Health
  Professions (ASAHP)
• The Joint Commission

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Conference Topics and Speakers

• Opening Presentation -Conference Overview
• A Vision of the Healthcare System in 2015 and
  Beyond Planning Assumptions and Questions To
  Be Addressed
• Charles G. Durbin, Jr, MD, FCCM, FAARC, Immediate
  Past President SCCM, University of Virginia,
  Charlottesville, VA
• John Walton, MBA, RRT, FAARC, Resurrection Health
  Care, Chicago, IL

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Conference Topics and Speakers (continued)

• Current Status and Evolution of the Health Care
  System
• Edward O'Neil, Ph.D., M.P.A., Center for the
  Health Professions, San Francisco, CA
• Gordon D. Rubenfeld, MD MSc, University of
  Toronto, Toronto Canada
• Current Status of Respiratory Care within the
  Health Care System
• Patrick Dunne, MEd., RRT, FAARC, Healthcare
  Productions, Fullerton, CA
• What Respiratory Patients Need
• John W. Walsh, President of the COPD Foundation
  and President CEO of the Alpha-1 Foundation

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Conference Topics and Speakers (continued)

• Special Considerations Impacting Healthcare and
  Respiratory Therapy Demand
• Military
• COL Michael J. Morris, MC, USA, Brooke Army
  Medical Center, Fort Sam Houston, TX
• Public Health
• Karen Lohmann Siegel, PT, MA, Captain, USPHS,
  Health Human Services, Washington, DC
• Discussion of Current and Future Human Resource
  Issues
• Bill Dubbs, MEd, MHA, RRT, FAARC, American
  Association for Respiratory Care

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Conference Topics and Speakers (continued)

• The Impact of Biomedical Innovation on the
  Responsibilities of the Respiratory Therapist
• Neil MacIntyre, MD, FAARC Duke University,
  Durham, NC
• What Should Respiratory Therapists Be Doing in
  the Future?
• John Walton, MBA, RRT, FAARC, Resurrection Health
  Care, Chicago, IL
• Role of the Future Respiratory Therapist Across
  the Spectrum of Care
• Robert Kacmarek, PhD, RRT, FAARC, Massachusetts
  General Hospital, Boston, MA

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Conference Topics and Speakers (continued)

• Disease Management What Skills Do Respiratory
  Therapists Need?
• Woody Kageler, MBA, MD, FACP, FCCP, Tarrant
  County College-Northeast Campus, Hurst TX
  Nurtur, Dallas
• ------------------------------------------
• Development of Summary Conference Document
• Development of a Vision of Future Role
  Description for RT 2015 and Beyond
• Charles G. Durbin, Jr, MD, FCCM, FAARC,
  University of Virginia, Charlottesville, VA
• John Walton, MBA, RRT, FAARC, Resurrection Health
  Care, Chicago, IL

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Summary Conference Document

• Predicted changes in healthcare
• More patients will be diagnosed with chronic and
  acute respiratory diseases
• The percentage of people 55 years or older in the
  population will continue to increase
• There will be increased effectiveness of
  diagnosis
• Treatment will be aimed at management and
  avoiding hospital admission
• Increasingly co-morbid conditions associated with
  chronic illness will be identified. These will
  also require management/treatment.
• Health rather than illness treatment will
  become the goal of care.

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Summary Conference Document

• Predicted changes in healthcare (cont.)
• Cost increases in care will continue to grow and
  individual, corporate and public payers will find
  it increasingly difficult to meet these
  challenges.
• Personal Electronic Health Records will be more
  widely accepted and used in all care settings
  including the home.
• Health care consumers will pay a greater
  percentage of costs and will have new options for
  obtaining care.
• Retail store healthcare and other mass marked
  care will stimulate consumer-driven cost
  competition.

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Summary Conference Document

• Predicted changes in healthcare (cont.)
• Acute care hospitals will continue to provide
  expensive, episodic care and will house
  cutting-edge respiratory life support technology,
  however, subacute and home care providers will
  continue to play important roles in the delivery
  of care.
• The delivery of acute care will move
  progressively from the hospital through the
  entire health care system and ultimately, to the
  patients home.
• Subacute and chronic care will increase in amount
  and complexity.

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Summary Conference Document

• Predicted changes in healthcare (cont.)
• The disconnect between prevention and acute care
  treatment (specifically in acute care hospitals)
  will lessen but not disappear. The increased
  complexity of care will heighten the need for
  better communication among all providers of care
  as well as the patient and his/her family members
• Medical care treatment will undergo increasing
  scrutiny for quality and this will be linked to
  reimbursement with initiatives such as pay for
  performance.
• New models of healthcare delivery (such as the
  Hospital at Home and Medical Home) will
  emerge with increasing emphasis on coordination
  of care through the healthcare system including
  the home
• Reimbursement and costs will influence the
  development and success of these new models

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Summary Conference Document

• Changes likely to occur in the healthcare
  workforce
• There will be a national (and regional) shortage
  of healthcare providers in all sectors including
  those that frequently interact directly with
  patients including physicians, nurses,
  respiratory therapists, as well as those who have
  less intense patient interaction such as
  diagnostic and laboratory technicians
• There will be a long-term competition for all
  healthcare professionals throughout the US
  economy
• The rise in clinical demand will increase at a
  faster pace than the healthcare workforce will be
  able to expand
• This imbalance in jobs and available workforce
  will be aggravated by the retirements of aging of
  current providers

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Summary Conference Document

• Changes likely to occur in the healthcare
  workforce
• Brutal work hours requiring 24/7 staffing in
  inpatient and other settings will dissuade many
  individuals from pursuing health care careers
• Shortage of teaching faculty and the limited
  number of programs will limit the number of
  entrants admitted into and graduating from allied
  health professional schools
• Clinical sites are limited in number and variety
  and will need to be expanded to include new
  venues such as office practices and patients
  homes
• New technological resources for educational
  delivery and knowledge access will challenge
  traditional education
• Care delivery organizations will find a
  reinvestment in education to be an attractive way
  to secure workers, reduce the time between
  initial employment and full productivity, and
  provide education and career ladders for existing
  employees

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Summary Conference Document

• Changes expected in respiratory care
• The science of respiratory care will continue to
  evolve and increase in complexity, clinical
  decisions will become more data driven
• Respiratory care delivery will be an increasingly
  important part of care delivered in all venues
• Scientifically supported algorithms (protocols)
  will be the most common way to deliver
  respiratory care
• Increased complexity of care and use of protocols
  will stimulate an even greater need for more
  practitioners to be involved in research and
  require the average respiratory provider to be
  adept at understanding the practical ramification
  of published research

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Summary Conference Document

• Changes expected in respiratory care
• Care teams will become the standard for
  healthcare delivery in and outside the
  traditional hospital.
• Members of the team will have different roles and
  responsibilities at different times but respect
  and collaboration will be the hallmark of
  effective team function
• Patients and their families will be important
  members of the healthcare team and must be
  informed, empowered and engaged in personal
  health management.
• Cultural differences among patients will require
  the respiratory care provider to develop new
  skills and adopt differing approaches to care for
  different groups.

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Summary Conference Document

• Changes expected in respiratory care
• Information management will become an important
  tool in selecting a therapy and evaluating the
  effects of treatment decisions.
• New respiratory life support technologies will be
  developed and deployed.
• Research on their clinical effectiveness and cost
  effectiveness by the respiratory community will
  be necessary.
• Reimbursement changes will be the most important
  drivers of changes in health and disease
  management.
• Public health issues, military and disaster
  response concerns will continue and require new
  skill sets for respiratory care providers.

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Summary Conference Document

• Knowledge, socialization, training, and skills of
  those providing respiratory care will need to be
  aligned with the factors and changes detailed
  above.

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What Is Happening Now?
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What Will Happen Next?
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Second Conference

• Will be held in late January/early February 2009
• Will be based on the information gleaned and
  possibilities identified from the first
  conference and published in the paper.
• Identify the KSAs required by respiratory
  therapists to provide future services.
• Will describe the educational and credentialing
  systems needed to assure respiratory therapists
  have the requisite KSAs

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Third Conference