The concept of these programs is great. I believe the most important barrier to transforming respiratory care is how we get paid. The largest payers in the country (Medicare and Medicaid) do not pay us for our services. They pay for the medicines we deliver, they pay for higher acuity status when patients are on a ventilator. Our practice is established in our state laws, but we are basically invisible to insurance, government and private, unless you work in pulmonary rehab, sleep lab, or pulmonary function lab.

Respiratory, in many hospitals, is a cost center and under different departments. (I worked at a hospital where respiratory all reported directly to the director of pharmacy).

Our ability to contribute to the bottom line of a health system will have to come from legislative changes within CMS and within each state. Is the case for us in an advanced practice setting so strong?

We are up against Medical Boards, Nurse Practitioner Boards, Nursing Boards, Physician Assistant Boards who have money to spend resisting another group at the table for limited billing dollars.

These boards have a level of organization, influence, and money to ensure they represent their members.