The PRAXIS Nexus The PRAXIS Nexus

Guest Perspective: RCPs -- Essential to Your Success

Posted on November 16, 2015   |   

Respiratory Therapist Mike Hess

This post was written by Michael Hess, BS, RRT, RPFT, a respiratory therapist and COPD advocate living in Michigan. 

America, we’ve got a problem.

Traditionally, COPD care and management has consisted of throwing some inhalers at someone, telling them to quit smoking, maybe going to a pulmonary rehab clinic, if they’re lucky. Then we would wait for the person to inevitably have an exacerbation, truck them off to the ED, pump them up with steroids and antibiotics, and send them back home to start the cycle again. We didn’t really see anything wrong with “frequent flyers;” that was just the nature of the COPD beast, and it was good enough.

Of course, ‘good enough’ rarely is. Existing practices have dug the healthcare system a $50-billion-a-year financial hole, not to mention the human costs of reduced mobility, isolation and increasing mortality rates. Over the past decade, a variety of initiatives have started modernizing COPD care. Perhaps most notably, the Affordable Care Act brought forth CMS’s Hospital Readmission Reduction Program (HRRP). HRRP is intended to force hospital systems to manage chronic disease conditions like COPD in a more creative way by hitting them where it hurts: penalizing Medicare reimbursements for ‘bounce-back’ patients.

So, in an era of overbooked primary care providers who don’t have time to provide enough instruction on the myriad elements of good COPD management, slashed reimbursement levels making pulmonary rehab programs disappear, and increasing demands for high quality care at relatively low costs, what’s a hospital to do?

It’s simple. You call for backup. You call in the RCPs.

Respiratory Care Practitioners have a proven track record of providing innovative care in a variety of settings, efficiently and economically. As recognized experts in cardiopulmonary pathology, pharmacology and physiology, RCPs are able to extend lung health services to a wide audience at a fraction of the cost that building additional specialty practices would entail. Using RCPs as part of a comprehensive, cross-continuum pathway can have a major impact on outcomes and bottom lines alike.

Just ask Dr. Jean Wright, Chief Innovation Officer at Atrium Health (formerly Carolinas Healthcare). Faced with what amounted to a COPD epidemic, Carolinas overhauled their entire management philosophy. Using a multidisciplinary approach that included input from every level, from the IT department to primary care offices, Carolinas began actively managing their COPD population at every point of contact with the system. Respiratory therapists were integrated through the entire pathway, from a dedicated respiratory educator in the emergency department, to RCPs embedded in outpatient clinics and offices to provide screening, to an RCP/case manager team that tracked each patient as they made their way through the ADT process, not to mention their more traditional roles on inpatient units and in pulmonary rehabilitation. The setup has worked remarkably well; after initiating this program, Carolinas saw their COPD readmission rate drop from nearly 22% down to an impressive 13% in only three years.

In addition, RCPs have a tradition of innovation that often leads them to practice in unusual settings. As of this posting, for 18 months, I have administered a COPD education and support group on Facebook called COPD Navigator. While this may seem like an odd venue to provide this sort of education, it has been surprisingly effective. As I presented on a poster at this year’s COPD9USA conference in Chicago, I surveyed the group’s members after the first year of service, and found statistically significant improvements in 8 out of 18 areas, covering both quality of life and psychosocial metrics. RCPs have begun to integrate themselves throughout the social media sphere, including the COPD Foundation’s COPD360social and PRAXIS networks, providing useful information to the patients who need it most.

As the healthcare system continues to evolve from a one-size-fits-all scheme to a value based model driven by providing the most effective treatment in the most efficient manner at the most appropriate time, administrators (and payers) are going to be looking for new and creative solutions. Fortunately, they won’t have to look very far. Integrating respiratory care practitioners into your system’s COPD paradigm can keep costs down, improve access to services, and improve outcomes in your community. To paraphrase the late, beloved sci-fi icon (and COPD sufferer) Leonard Nimoy, it’s the logical thing to do.

This page was reviewed on March 5, 2020 by the COPD Foundation Content Review and Evaluation Committee


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  • I totally agree regarding your comments on integrating Respiratory Care Practitioners as backup in the care of those of us who have COPD. I have thought the same many times... as you stated one size does not fit all and it would bring great comfort to have respiratory care available. I was so impressed with the therapists who conducted the Pulmonary Rehab I attended, almost six years ago. I tried finding a program that would give me similar encouragement and education. My options.... join a health club...but this isn't the same help I was looking I have resorted to using Copd Exercise tapes... which is alright...but, without feedback.
    I too agree the cost of care would show a great improvement in all departments of health care.
    And yes, it is the logical thing to do!

    Thank you Mike Hess, for a very insightful article.
    • Thank you for your feedback! I'm glad the PR therapists took good care of you. Unfortunately, with those cuts in reimbursement, it's harder and harder to find quality pulmonary rehab programs across the country. We need to start encouraging a shift in thinking from paying for how many procedures are done to paying for procedures that work. Hopefully, that will start improving patient care all around.