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Thomas M. Fuhrman, MD, MMSc, RRT, FCCP; Robert Aranson, MD, FCCP
Author and Funding Information

From the Bay Pines VA Healthcare System (Dr Fuhrman); and the Maine General Medical Center (Dr Aranson).

CORRESPONDENCE TO: Robert Aranson, MD, FCCP, 20 Lookout Dr, Freeport, ME 04032; e-mail: aransonr@comcast.net


FINANCIAL/NONFINANCIAL DISCLOSURES: Dr Fuhrman represents the American Society of Anesthesiologists and Dr Aranson represents the American College of Chest Physicians on the Board of Medical Advisors to the American Association for Respiratory Care. Drs Fuhrman and Aranson serve on the American College of Chest Physician’s board of regents.

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):e63-e64. doi:10.1378/chest.14-1028
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To the Editor:

We thank Messrs Kallstrom and Gaebler and Dr Papadakos for their thoughtful letters about our point/counterpoint debate1-4 on whether Medicare should allow respiratory therapists (RTs) to independently practice and bill for educational activities related to COPD.

We appreciate the poignant comments by Messrs Kallstrom and Gaebler, dispelling the myths and clarifying the facts of HR 2619, the Medicare Respiratory Therapist Act of 2013.5

We agree with Dr Papadakos’ illuminating statement that the ability to reduce hospital readmissions for patients with chronic lung disease will be challenging in the face of reduced physician numbers. However, contrary to Dr Papadakos’ claim that the “impending physician shortage (including pulmonary physicians)” was “not fully explored in the debate,” we, indeed, stated the dire forecast of physician shortages in our side of the debate, including those in pulmonary and critical care medicine. We also mentioned the ever-enlarging caseload of increasingly complex patients with chronic lung disease, whose care is laborious and time intensive, not to mention the added burdensome regulations imposed by the Affordable Care Act (ACA).

As noted by Messrs Kallstrom and Gaebler, HR 2619 proposes a logical and appropriate use of RTs in physicians’ offices, who would render patient care and education only as determined by the physician. Readers would be well served to remember this debate, and Messrs Kallstrom’s and Gaebler’s concise description of HR 2619, on October 1, 2014, when the ACA’s hospital readmission penalty is implemented.

Under the ethics of transparency, we are obligated to disclose that we are both active members of the Board of Medical Advisors (BOMA) to the American Association for Respiratory Care: Dr Fuhrman as an American Society of Anesthesiologists representative and Dr Aranson as a CHEST representative. Before and during the writing of the point/counterpoint debate articles, we informed our fellow BOMA members what we had been asked to discuss, but did not seek or receive their input. Nor did any member of the BOMA review the article before its submission.

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]
 
H.R.2619: Medicare Respiratory Therapist Access Act of 2013: 113th Congress (2013-2014). Congress.gov website. http://beta.congress.gov/bill/113th-congress/house-bill/2619. Accessed April 25, 2014.
 

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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]
 
H.R.2619: Medicare Respiratory Therapist Access Act of 2013: 113th Congress (2013-2014). Congress.gov website. http://beta.congress.gov/bill/113th-congress/house-bill/2619. Accessed April 25, 2014.
 
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