Abstract:
:Pulmonary rehabilitation (PR) is the standard of care for patients suffering chronic obstructive pulmonary disease (COPD). This report describes and defines PR and reviews the evidence regarding the efficacy of PR. COPD management guidelines that include PR have been published by the European Respiratory Society, the American Thoracic Society, and the British Thoracic Society, and those guidelines were supported by evidence-based guidelines published jointly by the American College of Chest Physicians and the American Association of Cardiovascular and Pulmonary Rehabilitation. The Global Initiative for Chronic Obstructive Lung Disease, which is also evidence-based, included the recommendation for referral to PR. Despite those recommendations, the availability of comprehensive PR programs (defined as being compliant with national practice standards) is limited. In the United States the lack of a national policy for PR reimbursement has led to differences in compensation among insurance providers, based on differences in the Local Medical Review Policies established by the "fiscal intermediaries." Since 1998 the American Association for Respiratory Care, the American College of Chest Physicians, the American Thoracic Society, and the National Association for Medical Direction of Respiratory Care have jointly lobbied for clear, consistent guidelines from the United States Health Care Financing Administration (HCFA, which was recently renamed the Centers for Medicare and Medicaid Services [CMS]). In 2002 new Medicare/Medicaid billing codes ("G codes") became available for billing PR procedures, but unfortunately the instructions for the use of those codes differ among the Local Medical Review Policies. There has been little success in the effort to establish a national coverage policy for PR. The respiratory therapist holds a unique role in PR. In the respiratory therapist's training curriculum PR is specifically addressed, making the respiratory therapist an asset to the multidisciplinary PR team. With their many clinical opportunities for making contact with COPD patients and physicians, respiratory therapists can be effective advocates for PR.
journal_name
Respir Carejournal_title
Respiratory careauthors
Fahy BFkeywords:
subject
Has Abstractpub_date
2004-01-01 00:00:00pages
28-36; discussion 36-8issue
1eissn
0020-1324issn
1943-3654journal_volume
49pub_type
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