Operating in a post-COVID-19 environment has ushered us into uncharted territories in business operations and clinical care. It feels as though a colossal “reset” button has been pressed, making us reevaluate and adapt to ensure survival. In the realm of respiratory equipment and its associated clinical care, numerous challenges await resolution. We find ourselves grappling with the intricacies of developing value-based services, a significant departure from the familiar fee-for-service payment models that have dominated for many years. In this article, we will explore the intersection of telehealth and respiratory care in this evolving landscape.
A Significant Shift
The emergence of telehealth as a prominent topic coincides with our emergence from the pandemic. This novel delivery method is being actively incorporated by numerous facilities, organizations and individuals. The Coronavirus Aid, Relief and Economic Security (CARES) Act and the March 2020 waiver to section 1135 of the Social Security Act played a pivotal role in widening the scope of telehealth and promoting its use for remote care.
Remarkably, the use of telehealth visits skyrocketed a staggering 766% during the first three months of the pandemic. Coverage rules from the Centers for Medicare & Medicaid Services (CMS) and insufficient reimbursement for physicians slowed telehealth innovation and adoption before 2020. This demonstrates that health care is poised for a transformation to align with the evolving ways in which people interact. Despite the absence of comprehensive data or clear delivery standards, legislative measures were enacted to facilitate the proliferation of telehealth. This serves as a stark reminder of the bureaucratic hurdles that stifle the potential for advancements that could benefit society as a whole.
More Changes to Come
Telehealth transcends the simple interaction between a provider and a patient over a video platform. It encompasses a multitude of variables, including (but not just encompassing) the use of checklists, workflows, applications, application program interface connections for data transfer, artificial intelligence data mining, remote patient monitoring technology, the skilled interpretation of laboratory results, patient education and the cultivation of a “webside manner.” Additionally, there are yet-to-be-defined aspects that collectively contribute to virtual patient care.
Respiratory devices and software platforms are being developed to share data more efficiently across the spectrum of caregivers. Although there is no standard of communication and companies hold to a proprietary model, these developments enhance the capabilities of health care workers to have insight into device use and other patient data.
Telehealth, therefore, is not a “one-size-fits-all” solution that can be applied and forgotten; instead, it is an ever-evolving model that needs research and attention to discover new technology and develop best practices around it.
Respiratory at the Center
In the United States, respiratory patients bear the burden of chronic diseases, with pulmonary diseases persistently ranking among the top three causes of mortality each year. The respiratory care profession is facing a concerning trend of declining enrollments in respiratory academic and training programs, leading to a shortage of professionals in the field. Furthermore, there is a significant exodus of skilled respiratory therapy professionals from the workforce.
Respiratory therapists stand out as professionals with extensive training and education in lung diseases and the associated equipment, validated through competency assessments within their programs. The scope of practice for respiratory therapists offers an opportunity for organizations to deliver optimal care, efficiently utilize resources and foster the growth of programs that require the training and licensure of professionals, whether in a physical or virtual setting. This is particularly pertinent given that pulmonary patients often encounter the most challenges in managing their diseases within the comfort of their homes.
This brings us to the concept of “telerespiratory” care, a portmanteau merging “telehealth” and “respiratory.” It is crucial to underline that in-person, one-on-one respiratory care remains the gold standard for pulmonary patients. However, considering the shrinking labor force and evolving reimbursement rates, telehealth technology has the potential to extend the expertise of respiratory therapists directly to patients.
The true value lies in the personal touch provided by a one-on-one encounter between the patient and the respiratory therapist, who can employ their assessment skills, troubleshoot issues and make informed decisions swiftly. This approach ensures that patients receive the best possible care, ultimately enhancing their quality
of life.
As CMS continues to advocate for value-based care, it is imperative to recognize that the essence of “value-based care” lies not in the monetary savings or revenue generated from a patient’s care but in the measurable outcomes experienced by the patient as a result of the care provided. It transcends mere cost savings, encouraging a shift in our approach from disease enablement towards disease prevention—a shift that is known to reduce readmissions and the financial burden of reactive measures.
Telerespiratory care, although new to the scene, has the potential to reduce business expenses by cost savings incurred by travel, increase efficiencies through well-designed workflows and provide new and innovative ways to care for pulmonary patients.
