Preparing RCPs to thrive in a managed care environment is the goal of the Pulmonary Case Management Society.

If the philosophy of the Pulmonary Case Management Society (PCMS) had to be summed up in a few words, it would no doubt be “embrace change.”

Rather than viewing the sweeping revisions taking place in health care as a threat, the founders of the PCMS are looking at such changes as growth opportunities for RCPs. Preparing RCPs to find and take advantage of these opportunities is the PCMS’ goal, says Vernon Pertelle, LVN, RCP, RRT, president of the PCMS.

“Managed care is the wave of the future,” Pertelle says. “Respiratory therapy is changing so much. Jobs won’t be in acute care in the future. Most will be out [side] of the hospital.”

Pertelle, a respiratory case manager for the Graybill Medical Group, in Escondido, Calif, where he oversees asthma and pneumonia intervention, became interested in starting the PCMS while conducting a pilot study that showed how RCPs add value to chronic obstructive pulmonary disease (COPD) case management. Pertelle created the PCMS, developed bylaws, and held a mini-conference in San Diego in 1996, adopting the same mission statement as the Case Management Society of America, of which he is also a member.

“The Pulmonary Case Management Society was developed through a vision to ensure that RCPs develop the knowledge to function well in managed care organizations,” Pertelle says.


At its first annual conference in Dana Point, Calif, this past June, speakers addressed such topics as quality management, managed care organizations (MCOs), outcomes and disease management, consumer issues and respiratory market trends, health policy, information technology, data collection and management, integrated delivery systems, clinical information systems, decision analysis and utilization, and case management.

Currently, the organization, which has 400 members, is focusing on increasing enrollment. Its numbers are expected to grow to 1,000 by 1999, Pertelle says, through a direct mail campaign and word of mouth.

Members of the PCMS have access to:

  • A monthly newsletter featuring case reviews of patients in traditional versus managed care settings. The publication also addresses a variety of managed care topics, such as health care economics and disease management, topics that many RCPs may not be familiar with, Pertelle says.
  • CEUs. RCPs can earn CEUs through newsletter case study reviews.
  • An annual conference; members receive a discount on admission.
  • A quarterly magazine, In This Case. The publication features articles with a broader, more political perspective.

    Another benefit of PCMS membership is its role as a networking forum. “It is through the PCMS that professional interaction and exchange can take place, allowing RCPs to learn to practice in the ever-changing managed care environment,” says PCMS secretary Mark J. Cowan, CRTT, RCP.

    Expanding RCPs’ Skills

    In addition to boosting membership, the PCMS is also focusing on helping its members obtain the Certified Case Manager (CCM) credential from the Certified Case Management Commission (CCMC), Pertelle says.

    Pertelle views the managed care industry as fertile territory for success. Although many hospitals are moving toward patient-focused care and many others are downsizing, resulting in the elimination of respiratory care departments, there are a number of new areas opening up for RCPs in the managed care environment.

    “Managed care allows RCPs to do what they do best–educate patients on managing their condition and instruct patients on equipment and modalities,” Pertelle says. “What’s more, the managed care environment is wide open with opportunities for RCPs to flourish.”

    MCOs have a tremendous need for RCPs to direct disease management of patients with chronic pulmonary illness, Pertelle says, but many RCPs do not possess the knowledge to function well in these organizations or do not market themselves as being valuable in disease management. Yet asthma and COPD are two areas ripe for case management to be handled by an RCP, he says. Both conditions require monitoring and equipment use, and both can be controlled, thereby reducing the number of days a patient spends in the hospital and improving that patient’s quality of life.

    “Many RCPs have attempted to take the exam for the CCM credential, but have been unsuccessful,” Pertelle says. The PCMS aims to help applicants prepare for and complete each step of the application process. “We get them set up to apply to the CCMC, and assist them with the process and with study guides,” Pertelle says.

    A New Way Of Working

    Pertelle sees a variety of other roles RCPs can play in the managed care setting. Another possible concept is that of the respiratory chest clinic, he says. The clinic would be set up and run by an RCP in a physician’s office, and supervised by one of the primary care physicians in the office. The RCP would perform assessments on COPD, asthma, and other pulmonary patients, make recommendations for treatment, and follow up with the patient on an as-needed basis.

    In the urgent care setting, RCPs can be used to set up and run asthma-management programs–setting up nebulizer and oxygen delivery for patients and performing basic diagnostic studies such as arterial blood gas puncture, analysis, and oximetry, for example.

    RCPs are currently using their skills in subacute facilities, skilled nursing facilities, and outpatient pulmonary rehabilitation programs. The home care and hospice settings also have been thriving areas for RCPs, Pertelle says. The future holds an almost unlimited supply of jobs for RCPs willing to expand their horizons, wear new hats, and view the changes occurring in health care as opportunities rather than threats, he says.

    RCPs need to move from a treatment-based mentality to a more comprehensive patient-management focus, says Cowan, a Missouri-based RCP with 15 years’ experience in acute care and rehabilitation settings. “Working in a rehabilitation setting has given me a new perspective on how other allied health professionals practice,” he says. “RCPs can apply a lot of the same principles. By turning away from treatment boards and into the areas of client assessments, objectives, and goals to develop care plans, we can promote optimum patient outcomes.”

    Cowan’s vision puts the RCP in a role much like that of a physical therapist–a practitioner who works alongside an orthopedic surgeon to improve patient outcomes. “Under a pulmonologist or medical practitioner, RCPs can be an asset in a nonthreatening way through our teaching of pulmonary rehabilitation techniques in conjunction with therapeutic intervention,” he explains.

    Pertelle encourages RCPs to expand their knowledge of nursing, physical therapy, occupational therapy, and speech and language pathology. “The horizon holds changes for the RCP, but how we embrace that change will determine our survival,” Pertelle says. “RCPs who develop the basic knowledge to prepare themselves to function in managed care organizations are poised for success in the future.”

    Alejandro Paz, MD, MPH, FAAFP, medical director of the PCMS and a family practitioner with Graybill Medical Group, in Escondido, is also familiar with the opportunities awaiting RCPs. “The more hats you wear, the more effective role you can play in a medical group,” he adds.

    “If you believe managed care will continue to expand and grow,” Paz says, “and if you believe federal and state programs will continue to get more involved in managed care, then the Pulmonary Case Management Society can play an important role in bringing new information to respiratory therapists to show them how to thrive in this field.”

    Grace Hammerstrom is a contributing writer for RT.