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National Summit

By Phil Porte

Posted on: November 5, 2012

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In April 2013, the National Association for Medical Direction of Respiratory Care (NAMDRC), in cooperation with the American Thoracic Society (ATS), American College of Chest Physicians (ACCP), American Association for Respiratory Care (AARC), COPD Foundation and the National Home Oxygen Patients Association (NHOPA), will convene the Pulmonary Medicine Health Policy Summit in Washington, D.C. The goal of the summit is to address pulmonary medicine issues that lend themselves to regulatory and/or legislative solutions. A detailed strategic roadmap will be developed and shared broadly within the pulmonary medicine community.

The issues to be addressed have been vetted by the respective societies and will involve several hours of discussion from experts, including members of Congress and their staffs, representatives of regulatory agencies and nationally recognized experts in the respective specific issues. These initial discussions are open to physicians, allied health professionals, patients, policy experts and representatives of industry.

Discussion topics will include:
Performance measures for pulmonary medicine: The societies agree that pulmonary medicine is not moving forward as swiftly as other segments of the medical community and that this slower pace might lead to other entities, such as the American Medical Association or the National Quality Forum, developing performance measures without direct, coordinated input from the pulmonary medicine community. By itself, this situation may not be too problematic, but as the healthcare delivery system shifts away from the traditional fee-for-service model to one significantly more focused on quality measures and payment tied to identifiable outcomes, it is critical that the pulmonary medicine community immerse itself in these broad initiatives. As we look forward to the likelihood of COPD hospital readmissions as a quality measure, it is incumbent upon pulmonary medicine to take an active role in planning for its own future.

COPD as a public health issue: When comparisons are made to the impact of COPD on the economy compared to other chronic diseases such as diabetes or AIDS, most would agree that research to address COPD, the third leading cause of death in the United States, is woefully inadequate.

However, integral to any discussion of COPD research is actual management of the disease. There is a problematic lag time from the onset of symptoms to the diagnosis of COPD. With an estimated 12 million undiagnosed patients, management of COPD is a public health issue that does not lend itself to easily recognized or implemented solutions by the public or private sectors.

Telemedicine for pulmonary-related diseases: The broad issue of telemedicine is regarded as part of larger solutions to rising healthcare costs and access to healthcare services. It is the view of the societies that pulmonary medicine needs to focus on telemedicine applications unique to pulmonary medicine, crossing a wide spectrum of settings including the critical care unit, nursing home and home. The growing issue of readmissions creates significant pressure to develop home monitoring strategies for pulmonary-related health issues, and patient compliance with in-home treatment plans is integral to the discussion. It is critical that the pulmonary community move this facet of medicine forward with aggressive and direct initiatives.

Documentation/EHR: The pulmonary community must deal with documentation issues that have surfaced across various clinical settings, including the hospital inpatient, hospital outpatient and home care settings. For example, documentation requirements imposed on physicians ordering oxygen, CPAP, and nebulized drugs have raised serious access concerns. While some solutions, such as broad implementation of an electronic health record, might alleviate problems with the corollary audits tied to apparent lack of documentation, pulmonary issues warrant specific attention.

Oxygen payment reform: Medicare expenditures for long-term oxygen therapy account for the largest single item under the durable medical equipment benefit. The current payment methodology is more than 25 years old and has not kept up with new technologies, some of which have been available for more than a decade. The current payment system awards the greatest payment for the cheapest devices (stationary concentrators) and the lowest payment for newer, standard-of-care, portable devices. This can lead to problematic access issues as providers find it difficult to shift their inventories of large cylinders to more clinically appropriate systems.

Improving this situation is complicated by the realities of competitive bidding and a structure that requires providers to bid on payment for specific codes. Any change to payment formulas would unquestionably be chaotic to that program, but serious questions surrounding access and clinical appropriateness of device selection are driven by the current payment dichotomy.

For more information and to register for the Pulmonary Medicine Health Policy Summit, call (703) 752-4359 or visit www.namdrc.org.

Phil Porte is executive director of the National Association for Medical Direction of Respiratory Care (NAMDRC).

This column is a joint venture of ADVANCE and NAMDRC. For information, write to NAMDRC, 8618 Westwood Center Dr., Suite 210, Vienna, VA 22182, visit their website at www.namdrc.org, or call the staff at (703) 752-4359, by fax at (703) 752-4360, or by email at execoffice@namdrc.org.

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