Setting the RT standard: AARC spotlights excellence

Saturday, December 31, 2005

The American Association for Respiratory Care held its annual meeting last month in San Antonio, and as usual speakers covered a host of topics pertinent to HME providers. One topic, however, received particular attention: standards.
Recognizing the importance of standards, the AARC has created a task force to develop and recommend a set of home respiratory care standards for approval by its board of directors and to be published in its publications. The standards will be voluntary for organizations and individuals, and the AARC will list those groups or individuals that comply with these new standards for clinicians, consumers and payers to review prior to using HME services. This can be a starting point for the rational use of products and services based on the best science and evidence for respiratory care.
The task force has an aggressive schedule for the development, approval and publishing of these new standards. By next year's AARC congress, we may be able to see what the task force has developed and how to identify individuals that meet the standards.
Standards have been used in medicine for years. Yet home care evolved so quickly that strong standards, based on clinical evidence and effective of outcomes, have never been developed. That is about to change, thanks to competitive bidding for HME, which CMS must kick off in 2007. Standards must be written to protect the public from providers who might submit a bid below a level of service acceptable to clinicians and patients.
In discussing the need for clinical-based standards, consider the following:
- State license standards focus on protection of the public interest with no consistent approach or language regarding homecare respiratory therapists. Some states limit "procedures" that cannot be done by non-clinicians, but in states with specific language regarding home respiratory therapy, enforcement is inconsistent
- Reimbursement driven standards focus on making sure the payers get what is being paid for, usually defined by the contract. The payer may provide standards for RT clinical services related to number and timing of visits, scope of services provided and reporting requirements.
- Clinical Practice Guidelines focus on "best evidence" research or experience. The AARC and ACCP have a few that relate to home care which have a scientific basis, yet most are based on common sense and experience.
- Patients want access to RTs in the home, more visibility of RTs in the community and a greater understanding of what RTs can contribute to their respiratory care. Consumers can establish their own standards in that an informed, capable patient may only use HME providers that meet their personal standards.
The science of respiratory care is the foundation that will be needed in home care to establish minimal service levels, understanding of products used in the home and payments necessary to provide for these standards of care. Participation is critical from all respiratory therapists as we cannot take a wait-and-see attitude toward clinically appropriate/effective respiratory care.
This year's AARC meeting, with strong attendance and excellent participation from home care respiratory therapists, showed that we are up to the challenge and look forward to better care and service for our patients.

Bob McCoy, managing director of Valley Inspired Products, presented at the AARC's annual meeting in San Antonio.