0
Correspondence |

Board of Medical Advisors Supports HR 2619Board of Medical Advisors Supports HR 2619 FREE TO VIEW

Peter J. Papadakos, MD, FCCP
Author and Funding Information

From the Board of Medical Advisors, American Association for Respiratory Care.

CORRESPONDENCE TO: Peter J. Papadakos, MD, FCCP, Board of Medical Advisors, American Association for Respiratory Care, 9425 N MacArthur Blvd, Ste 100, Irving, TX 75063-4706; e-mail: peter_papadakos@urmc.rochester.edu


FINANCIAL/NONFINANCIAL DISCLOSURES: Dr Papadakos is chair of Board of Medical Advisors of the American Association of Respiratory Care.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(2):e61-e62. doi:10.1378/chest.14-0586
Text Size: A A A
Published online
To the Editor:

The Board of Medical Advisors to the American Association for Respiratory Care is compelled to comment on the point/counterpoint debate “Should Medicare Allow Respiratory Therapists to Independently Practice and Bill for Education Activities Related to COPD?” in a recent issue of CHEST (February 2014).1-4 As noted by Fuhrman and Aranson,1 the American Association for Respiratory Care does not advocate independent practice for respiratory therapists (RTs). The bill before Congress, HR 2619, would modify Medicare Part B, allowing provision for education in self-management and training provided by qualified RTs (bachelors or an advanced degree) employed by a physician. Medicare would reimburse physicians employing RTs who provide services to qualifying patients with chronic lung disease under direct physician supervision.

In their counterpoint side of the debate, Courtright and Manaker2 cited studies illustrating benefits of specific pulmonary disease programs:

At least three RCTs [randomized controlled trials] evaluated COPD-specific education and action plans for outpatients. An educational intervention in Canada significantly reduced both COPD hospitalizations and exacerbations among patients with COPD. A more recent study observed a 41% reduction in the composite end point of COPD hospitalization or emergency service following an educational intervention in US veterans.

From their perspective, these programs were not perfect. However, our analysis is that the programs were not perfected, which is a subtle, but very important distinction. We recommend focusing on what worked and implementing studies striving to improve clinical and financial outcomes. Courtright and Manaker2 repeatedly expressed concern about possible redundant billing driving increased costs. The physician responsible for both direct supervision of RT employee services and related billing would be unlikely (and ill-advised) to provide identical services as the RT and bill for both.

Also not fully explored in the debate is the impending physician shortage (including pulmonary physicians) coupled with the underuse of trained health-care professionals in pulmonary medicine, that is, RTs. If there are insufficient numbers of pulmonary physicians to care for patients with chronic lung diseases, how will physicians and hospitals reduce hospital readmissions? In 2012, the Centers for Medicare & Medicaid Services reported that almost 98% of readmissions were patients with two or more chronic conditions, which included asthma and COPD.5 In October 2014, COPD will be included as one of the diagnoses subject to the hospital readmissions reduction penalty. Expanding the role of RTs in patient care, including patient education, should probably be wisely and widely instituted rather than debated.

References

Fuhrman TM, Aranson R. Point: should Medicare allow respiratory therapists to independently practice and bill for educational activities related to COPD? Yes. Chest. 2014;145(2):210-213. [CrossRef] [PubMed]
 
Courtright K, Manaker S. Counterpoint: should Medicare allow respiratory therapists to independently practice and bill for educational activities related to COPD? No. Chest. 2014;145(2):213-216. [CrossRef] [PubMed]
 
Fuhrman TM, Aranson R. Rebuttal from Drs Fuhrman and Aranson. Chest. 2014;145(2):216-217. [CrossRef] [PubMed]
 
Courtright K, Manaker S. Rebuttal from Drs Courtright and Manaker. Chest. 2014;145(2):217-218. [CrossRef] [PubMed]
 
Centers for Medicare & Medicaid Services. Chronic Conditions Among Medicare Beneficiaries, Chartbook, 2012 Edition. Baltimore, MD: Centers for Medicare & Medicaid Services; 2012.
 

Figures

Tables

References

Fuhrman TM, Aranson R. Point: should Medicare allow respiratory therapists to independently practice and bill for educational activities related to COPD? Yes. Chest. 2014;145(2):210-213. [CrossRef] [PubMed]
 
Courtright K, Manaker S. Counterpoint: should Medicare allow respiratory therapists to independently practice and bill for educational activities related to COPD? No. Chest. 2014;145(2):213-216. [CrossRef] [PubMed]
 
Fuhrman TM, Aranson R. Rebuttal from Drs Fuhrman and Aranson. Chest. 2014;145(2):216-217. [CrossRef] [PubMed]
 
Courtright K, Manaker S. Rebuttal from Drs Courtright and Manaker. Chest. 2014;145(2):217-218. [CrossRef] [PubMed]
 
Centers for Medicare & Medicaid Services. Chronic Conditions Among Medicare Beneficiaries, Chartbook, 2012 Edition. Baltimore, MD: Centers for Medicare & Medicaid Services; 2012.
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543