1. COPD A NEW PARADIGM FOR AN OLD DISEASE Bill Cohagen RRT, MHA, FAARC Respiratory Care Services Manager Salem Hospital

2. Disclosures I DO NOT have proprietary, financial, professional or other personal interest with any Association, Foundation, medical equipment manufacturer, pharmaceutical company, or other applicable organization

3. Objectives  A review the history of COPD care over the ages.  Why we are at these crossroads due to the AHA.  New paradigms and ideas to improve COPD care.

4. History of COPD Care  Late 1950s – Antibiotics for pneumonia, potassium iodide used as a mucus thinner, and combination products containing ephedrine, a small amount of theophylline, and a minor amount of sedative to deal with the side effects of ephedrine.  1957 - The technique of Lung Volume Reduction Surgery (LVRS), introduced by Brantigan and Mueller  Early 1960s - Inhaled isoproterenol began to be used. In that era, oxygen was considered contraindicated, and exercise was prohibited for fear of straining the right heart. Corticosteroids were almost never used, even in cases of exacerbations of COPD.

5. History of COPD Care  Early 1960s – patients with COPD began to be saved with the use of mechanical ventilators for the management of acute respiratory failure.  January 1965 – The development of systematic therapy for non-hospitalized patients can be traced to the 8th Aspen Emphysema Conference.  Early 1980S - The Nocturnal Oxygen Therapy Trial and the Medical Research Council Clinic Trial established the scientific basis of long-term oxygen therapy, which is the only treatment that has been proven to alter the course of disease and prognosis of patients with advanced COPD.

6. History of COPD Care  Early 1980s – Pulmonary rehabilitation evolved.  Early 1990s – The systematic use of drugs to restore pulmonary function, including Broncho active drugs (i.e., bronchodilators and corticosteroids) began to gain popularity. These included Albuterol and combo meds like Duoneb.  Mid 1990s - An emphasis on the importance of smoking cessation became a feature of treatment.  1993 - The National Lung Health Education Program (NLHEP) was founded by Dr. Petty.

7. History of COPD Care  1996 - The technique of Lung Volume Reduction Surgery (LVRS), was resurrected by Cooper and others.  Late 1990s – Formation of COPD Patient/Caregiver/Provider Groups are founded. (COPD Foundation, NECA, National COPD Coalition, Alpha 1, etc.)  2001 - the Global Initiative of Obstructive Lung Disease (GOLD) was launched by the WHO and NHLBI

8. COPD Care Today  With the some of the changes in CMS and the AHA there is a shift from treating the exacerbations (crisis management) to preventative (education).  Heavier focus on lifestyle that includes nutrition, exercise, holistic and non- traditional medicines.  Support groups (Better Breathers Clubs) are gaining popularity.

9. COPD Care Today  CMS penalties for readmissions within 30 days od discharge.  Respiratory Discharge Managers/Navigators becoming a new departmental tool.  The AHA and insurance intermediaries have changed the face of healthcare, AGAIN.

10. The Affordable Healthcare Act Crossroads  The ACA represents the most significant regulatory overhaul of the country's healthcare system since the passage of Medicare and Medicaid in 1965.  Additional reforms aim to reduce costs and improve healthcare outcomes by shifting the system towards quality over quantity through increased competition, regulation, and incentives to streamline the delivery of healthcare.  Big shift for penalties for readmissions within 30 days for several DRGs. COPD went into effect October 2014.

11. The Affordable Healthcare Act Crossroads  The new name of the game … QUALITY

12. The Affordable Healthcare Act Crossroads  Reimbursement is drastically changing.  More questions on Acute vs Chronic states.  Bigger focus on OUTCOMES not PROCESSES.  More penalties.

13. The Affordable Healthcare Act Crossroads  Research and Evidence Based Practice is the key.  Change the train; proactive instead of reactive.  Family care idealism.

14. New Paradigms  Improve customer service. Make Respiratory Care known.  Convert to RT Eval and Treat Protocols. (do whatever it takes) Track results and then convert to BEST PRACTICES.  Navigators, Navigators, Navigators!

15. New Paradigms Darkside.  Come to the Darkside.   Create outpatient programs like Better Breathers.  Establish an Outpatient COPD/Asthma clinic.  Re-establish and/or grow your Pulmonary Rehab (try to own it). Earn physician autonomy!  Earn physician autonomy!

16. New Paradigms  National Telehealth Parity Act. NEEDS YOUR SUPPORT!  New COPD GOLD Standards – See them, learn them, be them!  Outside community support and volunteering.

17. Untapped Resources  Pharmaceutical Resources and coupons.  DME assisted programs.  Team-up programs with Pulmonology offices.  Early intervention ED “Hit Squads”.

18. Untapped Resources  System and professional networking (AARC, National COPD Foundation, etc.).  Finding “SOFT MONEY”.  Advanced protocols and best practices.  Enhanced Navigators.

19. Questions?

20. Thank You Thank You BILL COHAGEN RRT, MHA, FAARC MANAGER OF RESPIRATORY CARE SERVICES AT SALEM HOSPITAL 890 OAK ST SE, BLDG A. SALEM, OR. 97309 503-814-3110 AZRRT980@AOL.COM