please answer the question rephrasing the answer in the slides and if the answers are not there please look up the answer


1. What do you think the Respiratory Therapist of the Future should look like (education level, duties) and why do you think this would be beneficial for the health care community as a whole?


1. During class we investigated what it is like to work as an RT in other countries. We discussed the UK health model and the US health model. Briefly describe the difference between the two (i.e. who performs the duties of an RT in the UK model vs US model). 


1. What steps do you have to take to work as a Respiratory Therapist in Ohio once you graduate here on May 7th?


1. In class we investigated what the licensing process is in other states. Which state has no licensing requirement? For those states that do require a license, name 4 documents that need to be submitted to gain licensure.


1. What is one leadership trait that you think is most important and why?


1. Why do you think it’s important to develop a system for establishing RT workloads?


1. Explain the difference between a HMO, a PPO, and a POS health insurance plan.


1. When it’s time to choose a health insurance policy, what features or costs of the various options will you prioritize and why?

Creating a Vision for Respiratory Care:
Future of Health Care—2015 And Beyond, Part I

AARc Initiative 2015

I. history

Profession is approximately 70 years old

Earliest therapists were not even therapists

Called “oxygen orderlies” or “oxygen technicians”

Most hospitals in mid-20th century did not have wall O2

Patients got O2 either via mask, nasal cannula or Oxygen Tent

O2 came from H-cylinders which had to be changed out every few hours

Initially all received only on the job training (OJT)

Early training programs

Hospital-based and appeared in the late 1940’s and 1950’s

Graduates called themselves “Inhalation Therapists” to separate themselves from the OJT’s

American Association of Inhalation Therapists formed in Chicago in 1954

Credentials (RRT) were first awarded in 1961 (oral exams by 2 physicians, then later by a physician and therapist). Later (1983) other credentials were added (CITT and CRTT) which could be passed by written examination. In 1978 the Clinical Simulation Exam replaced the oral examination for the RRT

Standards for the first educational programs established in 1962

All candidates for a credential had to be a graduate of an accredited education program after 1975—no more OJT’s taking the tests.

History continued…

The American Association of Inhalation Therapists became the American Association for Respiratory Therapy (AART) in 1972

AART became the AARC in 1986

Florida was the first state to gain licensure in 1984; Ohio licensure in 1988; 49/50 states now require RT’s to be licensed

All states recognize the CRT as the minimum credential required for licensure

The NBRC will only allow graduates of accredited Associate and Baccalaureate degree programs to sit for the written exam

Approximately 455 respiratory care programs are accredited in the US—a few more in Canada

History continued…

The Inhalation Therapist as a clinician began because many early inhalation therapists were interested in cardiopulmonary disease processes and their treatment and because of the support of a group of anesthesiologists—there has always been a strong bond between anesthesia and Respiratory Care

The Inhalation Therapist as a clinician also was stimulated by the appearance of new therapeutic modalities that depended on mechanical devices in the late 1940’s and 1950’s.

Patients on O2 required assessment and weaning

Earliest bronchodilators delivered by nebulization appeared in the late 1950’s.

Since nebulizers were driven by compressed gas, oxygen orderlies/inhalation therapists performed the task

Assessment skills required here to administer bronchodilators, especia

Ohio laws and licensure

What you need to do to maintain your ability to practice respiratory care

I’ve graduated, now what?

Take NBRC test to obtain your CREDENTIAL

This is your nationally recognized ability to practice

MANDATORY for all RTs practicing in the US


In order to renew you must pay a fee ($25/yr) to the NBRC (if you skip this fee, you will pay it as a lump sum at the end of 5 years)

Every FIVE years you have to prove you’ve achieved 30 credit hours of continuing ed (CEUs)

If you fail to renew or are denied renewal at 5 years, you must RETAKE THE EXAMS and will be denied the ability to practice until you’ve successfully passed again



I’ve graduated, now what?

Obtain state LICENSE

This is your state recognized ability to practice in THAT STATE ONLY

States may have different requirements (i.e. background check, specific documentation of school and work history, etc)

All states will have a FEE (around $100) and require renewal typically every TWO years

Some states also require a set number of CEUs in order to renew

If you are denied renewal or let your license lapse you will not be allowed to practice until you have an active state license!

I’ve graduated, now what?

Maintain continuing education in order to RENEW state license and national credential

CEU credits can come from a number of places:

Online courses (usually video/PowerPoint + quiz)

Conferences (national or local)


Credits must be approved through a recognized RC body (can’t use physician credits for RT licensure)


You will need to prove that you successfully completed CEUs

AARC membership makes tracking very easy



Ohio license

Does this state require a license to practice respiratory care?


What is required when you initially apply for a license?

Application form completed and notarized

Criminal Background Check

Copy of NBRC score

2×2 passport style photograph

How much money does it cost?


Transitioning the respiratory therapy workforce for 2015 and beyond

AARC Initiative 2015

What changes will be necessary to fulfill identified roles and responsibilities

In order to equip the RT of the future, we’ll need to make changes in:



Credentialing process

To determine how to best make those changes and what they might entail, surveys were sent to RT program directors, RT department directors, deans, and RT educators

These questions included:


Education level

Credentials needed

What changes will be necessary to fulfill identified roles and responsibilities

Options and opinions were evaluated by a panel of 35 stakeholders during the 3rd and final conference

After thorough discussion the following recommendations were approved by majority vote

(remember, these are recommendations, not regulations)

What changes will be necessary to fulfill identified roles and responsibilities


By 2020, ALL RT programs should be authorized to grant baccalaureate or graduate degrees

Programs currently residing in institutions that are not able to grant higher than associates either should be phased out or build a partnership with a university to award bachelor or higher

Most states have laws allowing community colleges to grant higher degrees, however, there is a great deal of red tape to get through to achieve this

Education Recommendation Rationale

Education requirements of the RT graduate have not changed in 40 years, but the role of the RT has greatly expanded

Techniques, medications, and devices have become increasingly complex

The RT of today is expected to:

Assess and quantify the patient’s cardiopulmonary status

Provide appropriate respiratory care by applying protocols

Evaluate the medical and cost effectiveness of the care delivered

Contribute to the discussion of goals and discussion of therapy on rounds

Provide evidence supporting various approaches to respiratory care used in the ICU

Discuss and recommend care for patients presenting with diseases that affect the respiratory system

The RT must achieve higher levels of education and training to respond to these increasing future demands

The profession’s current failure to demand an adequate entry-level education negatively affects the perception of our profession– namely suggesting associate level education means a more technical and less professional career

Education Recommendation obstacles

As of 2011 there were:

356 (87%) c

The Patient Protection and Affordable Care Act

What is the PPACA

No one knows: https://

Patient Protection and Affordable Care Act

Referred to as ACA or Obamacare

Signed into law in 2010 and upheld (essentially enacted) in 2012

Essentially put into law reform with these goals:

Expand coverage,

Hold insurance companies accountable,

Lower health care costs,

Guarantee more choice, and

Enhance the quality of care for all Americans.

What was the problem the ACA is trying to solve?

The government is paying too much in healthcare dollars

We’re already in debt, the government cannot afford this

There are too many uninsured citizens

When uninsured people seek care, the bill goes unpaid and the hospitals cannot afford the free care

Healthcare in general is too expensive

No matter who is paying for it (government, out of pocket, or private insurance), our system cannot sustain itself at this rate

The ACA wasn’t the first proposed healthcare reform: Brief History

1915: AALL Bill

Proposed: limited coverage to the working class and all others that earned less than $1200 a year, including dependents. The services of physicians, nurses, and hospitals were included, as was sick pay, maternity benefits, and a death benefit of fifty dollars to pay for funeral expenses. Costs were to be shared between workers, employers, and the state.

Ultimately failed, in part due to widespread fear of communism, and healthcare reform was not brought up again until the 1930s

History of Healthcare Reform

1935: President FDR passes Social Security Act

Healthcare reform was originally proposed with this Act, however, it was ultimately removed in fear that it would jeopardize the entire Act. Focus was placed on passing Social Security benefits as this was a higher priority with so many Americans out of work during the Depression

1939: FDR tries a second time with the Wagner Bill, National Health Act of 1939

Gave general support for a national health program to be funded by federal grants to states and admin

Healthcare Leadership and Management



The ability to assess and enlist the help and support of others to accomplish a common task or goal, which will meet the needs and expectations of the surrounding environment

A great leader is able to get people to believe what they believe – a shared belief or purpose is a very effective way to inspire a team toward a common goal.

Pygmalion Effect: The greater the expectation place on an employee/person, the better they perform




Vision – able to see the future and has a clear and exciting idea where the organization is going and what it is trying to accomplish

Courage – willing to take risks to achieve the vision, trust intuition

Integrity – truthfulness is the foundation for trust, and is absolutely necessary


Great leaders possess traits and qualities that transcends all types of businesses and organizations


Humility – a good leader will always give credit where credit is due, and have the self confidence to admit a mistake

Desire for service – to be a great leader, your need to help others must be a guiding principal

Strong interpersonal skills – leaders who posses, usually are more successful in their personal and professional lives


Leadership traits, cont.


The Patient Protection and Affordable Care Act (ACA), Meaningful Use, Electronic Health Record (EHR)

Reimbursement for healthcare services continues to be cut as the number of “never events” that are not covered by CMS increases

Patient satisfaction scores now affect reimbursement by CMS

Leaders must find smarter, more efficient ways to provide exceptional care for their patients


Challenges facing leaders in healthcare


Institutional and agency administrators who say they care about patients, but must reflect overriding budget considerations in every action, confuse and demoralize healthcare workers.

Most individuals in healthcare chose the occupation not because of income potential, but because they have a sense of caring and social justice.


Leaders are faced with new and ever increasing demands


Many healthcare workers, including respiratory therapists, are frustrated in their current role in hospitals.

At times, they feel overwo


Health Insurance in the US

Health insurance:

You pay a company a monthly fee

When you get sick, the hospital/physician/etc sends a bill to your insurance company and they pay for the services provided

If there is any portion of the bill left you pay for the remainder out of pocket or the physician/hospital waives the remainder

Typically, regular services (i.e. physician visit) have a “co-pay” which is a set fee ($10, $20, etc) that you pay for each visit

Health Insurance in the US

MOST US citizens fall into one of the following categories:

Employer plan

Your employer pays a portion of your monthly fee for you, to ensure they have healthy employees who can work

Typically these plans offer good coverage and you only pay $50 to $100 per month, which is taken right out of your pay check

COBRA: if you leave your job/are fired, your employer is legally obligated to offer you the ability to keep your health insurance at full price (you pay your share AND your employers share, typically upwards of $500 per month)

Private plan

VERY EXPENSIVE for the patient

Either you don’t have an employer or your employer does not offer insurance, you have to find your own plan which can run upwards of $500 per month

Government plan

Medicare: covers people 65 and older

Medicaid: covers people with disabilities and in certain low-income groups

History of Health Insurance in the US

So how did we end up with our current health insurance system?

1800s: Most workers were tradesmen, working in extremely dangerous industrial environments (i.e. steel mills)

By 1907, death and dismemberment were causing a 10% loss in the workforce

The industry recognized that people were risking their lives and livelihood without any safety net– employers and unions began offering “accident insurance” that offered disability, death, and burial benefits

Modern group insurance can be traced to about 1910

History of Health Insurance in the US

About the 1920s, doctors and hospitals started charging more than the average American could realistically pay (this gap widen as the depression grew worse)

During WWII (1940s), the government actually froze wages

Employers could not offer higher wages to attract and keep employees, so instead they tried to offer the most enticing ‘benefit package’

During their rise from 1940s to 1990s, healthcare packages continued to cover more and more expense shifting the cost of healthcare out of the patient’s pocket

1965: the government created Medicare and Medicaid to help those who were not likely to be working and therefore didn’t have access to insurance (el

Creating a Vision for Respiratory Care:
Future of Health Care—2015 and Beyond, Part II

AARC Initiative 2015

Summary of future trends in health care enterprise of the US

Primary emphasis will be on changes which will

Improve quality

Decrease cost

Increased emphasis on care of individuals with chronic conditions (e.g. COPD) since frequency of these patients will increase as baby boomers age.

There will be an increased focus on wellness and prevention, since this is more cost-effective than high-tech, episodic, acute care

An increasing proportion of health care will be delivered in lower-cost, non-acute care facilities

Increases in technology will continue to make the cost of episodic, acute care more and more effective, but also more and more expensive

Information technology will continue to play a greater and greater role in the delivery of Health care services

Electronic medical records



Increased convenient access to information (e.g. evidence based medicine)

Patients and families will be able to learn more about their conditions and participate more actively in their own care

The use of protocols will continue to expand

Respiratory care technology will continue to expand

Closed-loop mechanical ventilation

More sophisticated monitoring of patients

More sophisticated diagnostic instruments

Drugs will become more numerous and sophisticated

More delivered by aerosol including drugs for organs other than the lungs

Designer drugs

Gene therapy

Simpler and more efficient extra corporeal gas exchange devices

Summary of future trends in health care enterprise of the US

More and more respiratory care will be delivered outside the hospital arena


Physician offices


Fee for service clinics and urgent care centers

The respiratory therapist will become more and more involved in research and education

Summary of future trends in health care enterprise of the US

A Vision for the RT of the Future

The second 2015 and Beyond Conference identified the competencies that will be required of a graduating Respiratory Therapist in the future. Seven competency areas were identified:


Disease management

Evidence-based medicine and respiratory care protocols

Patient assessment


Emergency and critical care


Within each competency area specific competencies were further identified. A total 73 individual competencies were identified

How identified compe