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Beyond the Hospital PFT Lab

Portable pulmonary function testing portends to reduce readmissions for COPD.

At Charlotte, N.C.-based Carolinas HealthCare System, respiratory therapists are embedded in key primary care offices to identify, enroll and treat patients at risk for Chronic Obstructive Pulmonary Disease. These RTs are part of a multi-pronged strategy that has dramatically reduced the rate of COPD readmissions to the system's hospitals from 21.8% in 2010 to 13% in 2013.  

In the next several years, I believe we will see a growing number of healthcare organizations redoubling their efforts to better diagnose and treat respiratory illnesses in outpatient settings-whether it's pulmonary, cardiology or internal medicine offices-as a key strategy to keep patients out of the hospital.  And they'll be aided in their efforts by increasingly sophisticated portable PFT tools-which will also be appearing more and more at the clinic and hospital bedside.

Why am I bullish on portable pulmonary function testing? Let's begin with Medicare's Readmissions Reduction Program: as of October 2014, COPD is now on the list of illnesses that will trigger a fine for hospitals when the readmission rates for those diseases are unduly high.  

Today's accurate, small, low maintenance PFT devices can aid in adhering to American Thoracic Society (ATS), European Respiratory Society (ERS) and GOLD guidelines, which indicate that testing is useful on a population level in predicting development of COPD exacerbations and can help inform treatment decisions.1

Other reasons I believe more PFT testing will move out of the hospital and into the community (or to the hospital bedside) include:
  • Continuing development of small, portable, accurate and affordable PFT
  • Testing equipment that rival the functionality of PFT labs
  • Preciousness of hospital space
  • Inconvenience of inpatients and outpatients traveling to and from hospital labs
Reducing Readmissions

Carolinas HealthCare System 2010 COPD readmission rate was not an anomaly. Across the country, COPD hospital readmissions within 30 days for "all causes" range from approximately 17% to 25%, according to the National Association for Medical Direction of Respiratory Care (NAMDRC). In one year, Carolinas HealthCare RTs touched 5,000 COPD patients in five primary-care offices, 10 times the number they typically reach in the hospital.  But if primary care offices are to be enlisted in the campaign to reduce COPD readmissions, they need the right tools to better diagnose patients with COPD and identify and manage exacerbations, and that's where affordable, mobile solutions enter the picture.

Improving Technology, Patient Convenience

Spending on all types of mobile point of care solutions is increasing at a compound annual growth rate of almost 10 percent and is expected to reach $4.4 billon in 2015, according to IDC Insight. And pulmonary function testing is right in the middle of this trend. Why? Until fairly recently, physicians were limited in what pulmonary function testing they could perform outside the hospital because of the large capital expense of equipment such as body plesthysmographs.

But thanks to the development of highly sophisticated portable PFT devices, testing once performed only in full-service hospital labs is now being done quickly and accurately in physician offices and at the patient bedside. Specifically, there are now very affordable lunchbox-sized instruments on the market that RTs use to quickly and easily perform the majority of tests done in a PFT laboratory, including DLCO measurement, spirometry and full lung volumes.

Portable testing saves patients time.  They can do the tests in the comfort of their physician's office and the results can be reviewed at the same visit, streamlining disease management.

"Patients prefer to do the testing in the doctor's office," said Betty Marcus, RT, RPFT, a respiratory therapist who works with portable EasyOne PFT devices in a private practice and at a Georgia hospital, where the equipment is used at bedside for inpatients. "If patients have the option to be tested at their physician's office, they don't have to register, pay to park, go through the admissions process and walk what can be long distances to the pulmonary area." And for claustrophobic patients who are loathe to climb into a body box, these portable instruments are a good alternative and can serve as a powerful differentiator for a practice.

Concomitant with the miniaturization of the pulmonary function testing laboratory and the affordability of the equipment, we are also beginning to see entrepreneurial pulmonary therapists purchasing these devices, then contracting with multiple physician offices to perform onsite testing on a regular basis-the circuit riders of pulmonary function testing.

Bedside Testing

In many hospitals, square footage is at a premium. The initial capital cost of hospital space can range from $600-$800 per square foot and the average annual operating cost can run from $15-$20 per square foot.2 With reimbursements averaging $150 for a 20-minute test including DLCO and spirometry, portable testing can be a highly profitable use of limited clinical space in hospitals and other settings.

Point-of-care solutions also address the sometimes thorny issue of how to improve the movement of patients and equipment through a facility. An entire industry has grown up around the challenge of tracking hospital assets-like wheelchairs-and improving patient flow. In one 367-bed hospital, it was determined staff spent 10 hours a day searching for wheelchairs to transport patients at a cost of $73,000 per year.3 It's far easier to bring a small PFT device to a patient, than to move the patient to a distant PFT laboratory, especially if the patient is connected to several IVs or monitoring devices.  And portable PFT device manufacturers have invested much research and development into materials. For example, highly flexible tubing attached to mouthpieces enables these devices to easily and comfortably reach the patient no matter how cramped the bedside space.

The full-service pulmonary function testing lab will not be going away any time soon. But as portable testing options become better known, be prepared to see these nimble instruments pop up in more and more healthcare settings.

George Harnoncourt, is the CEO of ndd Medical Technologies, a worldwide leader in pulmonary function testing instrumentation.  For more information, visit  http://www.nddmed.com.

References
1. Celli, BR, MacNee, W, et al.  Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper.  Eur Respir J 2004; 23: 932-946.
2. Durham, J. Ending the Ear of Super-sized Health Care Facilities. Beckers Hospital Review, January 28, 2013.
3. Michelot, X and Shafi Hussain, Patient Transport & Nurse Productivity.  Advance for Nurses, April 12, 2013.



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