AARC Congress to Feature Respiratory Field’s Finest

The American Association for Respiratory Care (AARC) promises the latest technology, along with respected speakers, at its 44th International Respiratory Congress, scheduled for November 7-10 in Atlanta. During the 4-day conference, attendees will be able to choose from more than 60 quality programs of lectures covering a range of respiratory-related themes. This year’s topics include hemodynamic waveforms, nitric oxide, pulmonary rehabilitation, and transtracheal oxygen therapy.

Distinguished presenters at the conference include James K. Stoller, MD; Michael Meehan, JD; Susan Blonshine, RRT, RPFT; Sharon Ehrmeyer, PhD, MT; Dean R. Hess, PhD, RRT; Luca M. Bigatello, MD; Robert M. Kacmarek, PhD, RRT; John J. Marini, MD; and William Hurford, MD. AARC expects thousands of medical professionals from around the world to attend. For more information on the conference or AARC, a 36,000-member professional society for respiratory care practitioners, visit www.aarc.org, or call (972) 243-2272.

NPPV Regulations Considered Punitive

A draft policy outlining new DMERC regulations for noninvasive positive pressure ventilators (NPPVs) has been criticized by the HME industry as being “punitive,” “ludicrous,” and “ridiculous.” The requirements raise concerns about beneficiary access to NPPV therapy, as well as the potential for increased Medicare costs. According to NAMES, the greatest concern with the draft is that it exceeds recommendations that were developed during the consensus conference on clinical indicators for NPPVs earlier this year.

Essentially, the new regulations require beneficiaries to undergo tests in a facility-based sleep study laboratory; they must have a particular arterial blood gas level according to their diagnosis; and the treating pulmonologist is required to order NPPV services and monitor the patient. DMERC officials are concerned with the dramatic increase of Medicare expenditures on NPPVs–from $27 million in 1996 to $79 million in 1997–a jump of 200 percent. It is feared that this increase is due at least in part to HME suppliers trying to compensate for last year’s cuts in oxygen payments.

Nevertheless, there are legitimate concerns with the new requirements, including the practicality of implementing this system in rural areas. For example, the required sleep test (polysomnography) must be performed in a special sleep laboratory, which may not be accessible to all patients. Furthermore, if the test for chronic obstructive pulmonary disease (COPD) finds obstructive sleep apnea to be the primary cause of patients’ breathing troubles, the physician is required to prescribe a continuous positive airway pressure (CPAP) device rather than an NPPV. HME suppliers claim that by the time patients have the high level of arterial blood gas and overnight desaturation required to qualify for an NPPV, they will have been suffering for years, and their condition will be irreversible–most likely resulting in hospitalization or even more expensive invasive ventilator treatments.

San Diego Residents to Head State Health Organizations

Two San Diego residents have been selected to head statewide health organizations that are leading the fight against lung disease. The American Lung Association of California recently named San Diego Deputy City Manager Bruce Herring board chairman, while its medical section, the California Thoracic Society, named Cecilia Smith, DO, president. Smith is the medical director of the Medical Center at the University of California, San Diego. This year, the American Lung Association of California sponsored legislation that would establish a comprehensive statewide program to address asthma through community interventions. The organization also supported policies to reduce diesel exhaust and raise the cigarette tax.

Research Reports

  • The administration of continuous intravenous (IV) sedation keeps ICU patients on mechanical ventilation far longer than is necessary, according to a recent report in Chest, the journal of the American College of Chest Physicians. A study of 242 ICU patients showed that patients who were on continuous IV sedation were on mechanical ventilation significantly longer than those who were on other or no sedation regimes.
  • Prenatal exposure to tobacco has adverse effects on infant lung function up to 2 months before most babies are born, according to a recent study by the American Lung Association. The study, which found that preterm infants whose mothers smoked during pregnancy have significantly diminished lung function compared with preemies whose mothers do not smoke, suggests that the adverse effects of prenatal tobacco exposure on babies’ lung function are not limited to the last weeks of pregnancy, as was previously thought.
  • In 1996, Bellevue Hospital in New York City spent more than $1 million to test 10,378 sputum samples for tuberculosis (TB) from which only 83 cases of TB were diagnosed. A new study conducted at the hospital has discovered a way to eliminate at least half of these unnecessary test samples. When a pulmonologist conducted a simple 2-minute patient examination, it reduced the need for TB sputum tests by 50 percent, with a potential yearly savings of more than $500,000 in hospital laboratory costs. Two expert pulmonologists independently spent 1 to 2 minutes checking the chest radiographs of nearly 100 patients who were being evaluated for TB before deciding whether a costly sputum examination was needed. According to the specialists, after the screening, the tests were warranted in about half the cases.
  • A new antibiotic drug has proven more effective in fighting respiratory infections, according to preliminary data in a study being conducted by Creighton University School of Medicine, Omaha, Neb. The antibiotic BAY 12-8039 (proposed INN name, moxifloxacin) was found to be very effective against all six strains of a common respiratory pathogen. The rate at which moxifloxacin killed Streptococcus pneumoniae bacteria exceeded that of currently prescribed levofloxacin and sparfloxacin.

    Future of Respiratory Market Sits in the Hands of a Few

    The future of mom and pop respiratory companies does not look promising, according to a recent report that predicts industry giants will soon dominate the respiratory care market. Managed care and Medicare oxygen cuts are driving independent home respiratory companies into mergers and acquisitions with industry giants such as Apria Healthcare Group, Costa Mesa, Calif, and Lincare Holdings Inc, Clearwater, Fla.

    According to research findings by the New York Investment firm Warburg Dillon Read LLC, by the year 2005, 83 percent of the home respiratory market will be possessed by just seven giant respiratory companies. All other small companies will be represented by the remaining 17 percent, compared to the 54 percent market share currently held by more than 2,000 small respiratory companies.

    The study predicts that in 7 years, Lincare will maintain the majority of the market, with a 29 percent share. Along with Apria, other major players include Integrated Health Services, Owings Mills, Md; American HomePatient Inc, Brentwood, Tenn; European-based Air Liquide; and Praxair, Danbury, Conn.

    Not everyone in the industry agrees with this severe outlook, however. The market’s top 10 companies are more likely to maintain just 67 percent of total revenues, and could be entirely different players than the industry giants of today, says Scott Bartow, vice president of Milwaukee-based Ventilatory Care Management. According to Bartow, many corporations that are keeping a low profile are buying up existing providers and could play an important role in the future market.

    The good news for all respiratory care companies is that the entire market is expected to grow–driven by new respiratory drugs and new equipment–for the next 7 years, reaching $5.6 billion (a 7 percent gain) by 2005.

    International Endowment FundCreated to Facilitate Global Care

    The American Respiratory Care Foundation (ARCF) recently established an International Endowment Fund that now allows individuals and organizations to contribute funds for the globalization of respiratory care. The fund will complement the International Council for Respiratory Care of AARC, comprising governors from around the world. The council–which addresses issues affecting educational, medical, and professional trends in the international respiratory care marketplace–has indicated that a $1 million goal for the endowment would enable and expand the International Fellowship Program, the establishment of additional exchange programs, and provide education related to respiratory care throughout the world.

    The International Fellowship Program currently allows allied health care professionals from other countries to practice in the United States. In the future, it is hoped that Americans will be able to undergo medical training in other countries as well. This year’s recipients of the International Fellowship Program include participants from Panama, India, Israel, Slovenia, and China. For more information about the program, contact AARC at (972) 243-2272.

    Tracing the Roots of the Flu Virus

    Researchers at the University of Wisconsin-Madison have identified how some flu viruses become lethal. By studying a descendant of the 1918 influenza virus that killed at least 20 million people worldwide, university virologists have discovered a new molecular trick some viruses use to transform themselves from dangerous pathogens to deadly ones. Influenza infection is normally limited to respiratory systems, but this previously undetected process gives the virus the deadly ability to attack many organs in the body as well. Research was funded by the National Institute of Allergy and Infectious Diseases, a component of the National Institutes of Health.

    AARC to HCFA: Reevaluate SNF Billing

    The American Association for Respiratory Care (AARC) is openly opposing HCFA’s interim final regulations on the PPS and consolidated billing for skilled nursing facilities (SNFs) with a list of proposed changes to the system. In a letter to HCFA, AARC recommends the following changes:

  • HCFA should immediately amend the RUG-III classification system to include respiratory therapy in the rehabilitation classification group, and develop a factor for establishing the SNF payment rates to allow for respiratory coverage in all groups.
  • Until the reclassification has been made, the agency should establish an outlier policy for Medicare beneficiaries who need intensive respiratory care services.
  • HCFA should recognize that respiratory therapy must be provided by trained, highly skilled professionals who have been tested for competency. The services provided must be fully funded to ensure that positive patient outcomes are achieved and that savings of the Medicare program are maintained.
  • HCFA should extend the effective date for implementing the SNF PPS at least 6 months to allow time to incorporate them.
  • The agency should make several definition revisions in the resident assessment instrument, including the definitions for “respiratory therapy,” “respiratory therapists,” and “trained nurse.”
  • Finally, HCFA should revise the Minimum Data Set (2.0) to include an expansion of data collections fields to more accurately identify critical respiratory therapy diagnosis and medication requirements.

    Letter to the Editor

    To the Editor:

    I was delighted to see in the latest issue of RT International magazine a well-written article by Joe Sadusky on the Institute of Tuberculosis and Lung Diseases in Warsaw. I was especially happy that the issue, including the above article, was presented to more than 7,000 participants of the European Respiratory Society Annual Congress recently held in Geneva.

    I wish your journal many further successes in spreading important messages in respiratory medicine.

    Jan Zielinski, MD, PhD
    Warsaw, Poland

    Welcome to Thoracic Park

    Bronkie the Bronchiasaurus and his female counterpart, Trakie the Trachiosaurus, are paving the way for pediatric education that is fun for kids with asthma. In this video game, designed for use in pediatric clinics, the player guides the two asthmatic dinosaurs through a video world of allergens such as dust, smoke, and pollen. Bronkie, made in the Super Nintendo format by Click Health Inc, Mountain View, Calif, is part of a series of games designed to teach children how to manage health problems. A study is being conducted by Stanford’s asthma center to see if the game actually reduces the number of asthma attacks in children who use it as a learning tool. One concern: The game contains a number of product placements by drug or medical device companies, which has raised the issue that it is being used simply as a promotional tool. The funds generated by the endorsements, however, are necessary to help fund the development of the game, says Click Health CEO Alan Miller.

    Specialists Cut Mortality Rate in Half

    Lung cancer patients generally have a lower death rate when their surgery is performed by a thoracic surgeon as opposed to a general surgeon–particularly when the patient is from a rural area, is more than 65 years old, and/or must have an entire lung, rather than just a lobe, removed. According to the American College of Chest Physicians, the mortality rate nearly doubles when a patient is treated by a general surgeon, rather than a thoracic surgeon. This discrepancy could be attributed to the fact that general surgeons are usually younger and less experienced, and perform significantly fewer numbers of these surgeries on a regular basis than do thoracic surgeons.

    New RT Master’s Program Available in Canada

    The Michener Institute for Applied Health Sciences, Toronto, recently announced the availability of a master’s program in respiratory therapy, accessible to RCPs around the world. The program, offered by Charles Sturt University, Australia, will be available by distance education through The Michener Institute. This is the first time a program of this type has been offered in Canada.

    Renowned for delivering continuing and distance education, the Michener institute is the only publicly funded post-secondary educational institution in Canada solely dedicated to educating health care professionals. Charles Sturt University was voted the Australian University of the Year in 1997. For more information on the respiratory therapy master’s program, call The Michener Institute, (416) 596-3101, or email, [email protected].

    Early Bird Gene Identified

    A gene mutation may be the reason people either loathe or love waking up early in the morning, according to researchers from Stanford University and the University of Wisconsin. The researchers have identified a mutation on the “clock” gene that seems to be an indicator for what they call morningness-eveningness, or a person’s preferred time of day for being active.

    A Good Reason for Wheezin’

    Americans will cough up more than $1 billion this year for treatment of the nation’s most common medical complaint–the cough. According to the American College of Chest Physicians, the cough is the single most common reason patients seek medical attention.

    Although people are quick to rid themselves of a cough, they may not realize that coughs can save lives. The coughis actually an important defense mechanism for the body;it clears the airways of excessive secretions or foreignmaterials. Also, when individuals are stricken with life-threatening arrhythmias, cough can help maintainconsciousness and may even restore the arrhythmias toa more normal cardiac rhythm.

    Secondhand Smoke a Drag for Women

    Seventy-five percent of Ohio women do not smoke but may encounter secondhand smoke in the home, at work, or while visiting businesses where smoking is permitted, according to Tobacco-Free Ohio, a statewide network of local tobacco-control coalitions. Secondhand smoke, which can cause eye irritation, lung cancer, heart disease, and/or breathing difficulties (especially for women with asthma), is of particular concern for pregnant women. Tobacco-Free Ohio has launched a statewide effort to raise awareness of these issues as they apply to women.

    “Meet Me at the O2 Bar”

    Health enthusiasts lining up to visit trendy oxygen bars, which promise a breath of fresh air (at an average cost of $20 for a 20-minute session) may be inhaling more than they bargained for. These bars typically use industrial or aviation grade oxygen–used for welding equipment or by pilots–which is available for purchase without FDA approval, thereby bypassing regulations that screen out contaminants such as hydrogen cyanide and certain cleaning compounds. Not only can long-term use of contaminated oxygen prove harmful, if not fatal, but just one session could be enough to kill someone with chronic obstructive pulmonary disease. Besides these health risks, researchers say there is no medical proof that a temporary increase in blood-oxygen level would benefit a healthy person. N