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November 2006—Issue 3
Editor House of Delegates Officers: Debbie Fox, MBA, RRT/ Speaker-elect Lynn Lenz, BS, RRT/ Secretary Frank Salvatore, Jr., BS, RRT, FAARC Claude Dockter, RRT/Past Speaker |
In This Issue... | |
John Blewett Denise Johnson Debbie Fox Lynn Lenz Frank Salvatore, Jr. Claude Dockter Will Beachey
Tom McCarthy
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Final Fall 2006 Record John Blewett, RRT This, the last Record of the year, has much to offer the reader. All of the officers of the house have timely information and/or advice to share: Past Speaker Dockter provides an update of the status of the resolutions considered at the last HOD meeting and Madam Speaker Johnson provides a look ahead at the upcoming meeting, applauds the elections committee and executive office staff for the first-ever electronic elections for the AARC Board of Directors and extends yet another plea for members of the House to submit photographs for the roster. Madam Secretary Lenz remarks on the poll vote process; the Treasurer of the House, Mr. Salvatore expounds on the feeling of being stretched a little thin—a subject we can all relate to—and offers a remedy as well. Madam Speaker-elect and former delegate from Kansas, Ms. Fox reports on two equally implausible events that actually occurred in that great state: a Rolling Stones concert and a Senator from Kansas sponsoring Medicare legislation. Really. In addition to the articles from the leadership of the House, there are several other articles worthy of a look. AARC Executive Director, Sam Giordano, provides timely information related to revenue-sharing contract renewals. Tom McCarthy, a member of the AARC State Government Affairs Committee, extends some excellent advice related to maintaining credibility in the eyes of state legislators–a must-read for all state society board members, and finally, North Dakota delegate Dr. Beachey makes a case for raising the minimum education requirement of respiratory care practitioners to the Bachelor Degree level. This issue also contains biographical information on those individuals running for office in the HOD elections to be held at the fall meeting. Please take a few minutes to read all of these thoughtfully written items submitted for this issue of the AARC Record. [Top] |
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Speaker’s Report Denise Johnson, BS, RRT As I begin to write this article, I am thinking of the awesome group the House of Delegates is to work with and how quickly my year as Speaker is going by. The preparations have begun already for the December meeting. Once again Pat Lee is trying to keep me on track! The scurry of activity is upon us. Air and hotel accommodations are being made. We are beginning to review the agenda and the committee chairs are actively working on their duties for the meeting. I was excited to see that several resolutions have been submitted and are being reviewed as I write this. I am sure it will prove to be another busy and productive meeting as Phoenix was in July. I would like to take a moment to thank and congratulate the Elections Committee and the staff at the Executive Office who have made the dream of voting online come true. I was impressed with the professional look to the ballot, biographies and photos and the ease to use this new system for the first time. I am certain our members will appreciate the effort that went into creating the online ballot. It was my distinct pleasure and honor to be asked to speak at the Idaho Society for Respiratory Care fall conference in Lewiston, Idaho in September. They had an excellent program with informative topics and speakers. I want to thank Chad Rye, President of the ISRC and his Director, our old House pal, Bob Roselle for their warm Idahoan hospitality. I recently went to the House website and took a look at the HOD photo roster. I noticed a lot of camera shy delegates! This delegate roster is for all of you to use to introduce or remind yourself of the delegates you have and will be working with in the upcoming House meeting. If you have not turned in a photo of your self for the online delegate roster, please do so to Joe Horn at jhorn@irgstaffing.com. You can take a peek at the roster by going to the following link. http://www.aarc.org/members_area/contacts/hod_roster/index.html. Thank you to Joe Horn and Roy Wagner! Plans are in the works for networking opportunities when we are together for the House meeting. Details will be sent out as arrangements are firmed up. Please feel free to call or email me with your concerns, questions and ideas. I look forward to seeing you soon. [Top] |
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Speaker-Elect’s Report Debbie Fox, MBA, RRT-NPS When hell freezes over…when the Rolling Stones perform in Kansas…when a Kansas Senator sponsors important Medicare legislation… All of these expressions that could be used when the likelihood of an event occurring is remote, even darn near impossible. Well, guess what…hell froze over in Kansas this past week, when one of the biggest rock bands ever, the Stones on their Big Bang tour, performed in Wichita. (Of course the concert didn’t completely sell out and no alcohol was allowed on campus or the stadium—but after all, this is Kansas!) And imagine my shock when I discovered a Kansas Senator had introduced a key piece of Medicare legislation. This happened a few weeks ago as I prepared for my PACT report at our Western Kansas Seminar. As I checked for the latest updates on our key Congressional bills I was pleasantly surprised to discover that on August 3rd Senator Pat Roberts from Kansas had introduced Senate Bill 3814, the companion bill to HR 5513. These bills would repeal the Medicare 36-month rent-to-own oxygen equipment provision and “restore the Medicare treatment of ownership of oxygen equipment to that in effect before the enactment of the Deficit Reduction Act of 2005.” I was shocked because during the Washington PACT visits, his aides were sympathetic and listened to our concerns, but really did not hold out any hope that stronger support would be forthcoming. His office had received our letters and emails from our activation of the 435 Plan, but was preoccupied with the Budget bill and Senator’s responsibilities as Chair of the Intelligence Committee. Medicare concerns were on the back burner. Obviously activation of our 435 Plan in January and the work of other groups had an impact. Now we can only hope that HR5513 and S3814 will be part of the legislation addressed by Congress after the elections. The House bill introduced by Rep Joe Schwarz (MI) in May is gaining momentum and already has 74 sponsors. The Senate Bill introduced in August has 6 sponsors. I would urge all of you to check the Thomas website www.thomas.gov to see if your Congressmen have signed onto these bills. Ask your PACT members to write and urge them to co-sponsor these important bills. The AARC Capitol Connection has a template letter that can be easily personalized and sent to your Congressmen. Perhaps we have a chance to make a difference in the lives of our patients who require oxygen in the home. I like to end with one item of House business. I am currently working on my 2007 Committee assignments. I will be sending out a preliminary list by the end of October for your review. I am looking forward to seeing everyone in Las Vegas. [Top] |
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Secretary’s Report Lynn Lenz, BS, RRT This is my final article as Secretary of the House of Delegates and I have really struggled with what to say. My struggles led me to thinking not only about my responsibilities as House Secretary, but also about our responsibilities as a body. In Phoenix we voted to re-open discussion on a resolution that was passed the previous day. The outcome of the resolution was ultimately determined by a poll vote. I am confident that we handled that situation in compliance with Robert’s Rules, but an interesting question was raised in the process. According to House Rules (HD003) “a poll vote may be taken on any matter directly concerning the AARC membership”. The question of course, was whether or not the issue before us “directly” concerned the AARC membership. Some present, argued that everything we do concerns the membership of the AARC. Others were not so sure. In the end, the decision was made to allow the poll vote and I believe it was the right decision. I would point out that the purpose of the HOD is clearly defined in the Association Bylaws. The Bylaws state that the HOD “shall serve as a representative body of the general membership and the representative body of the Chartered Affiliates of the Association”. Our biggest challenge is to ensure that the work we do is meaningful to our members and the patients that they care for. At the same time being fiscally responsible to the AARC. As of this writing five resolutions have been submitted to the Resolutions Committee for review. I don’t know if all of them will make it to the floor for consideration, but I do know that those that do will lead us into some lively discussions. As Secretary I will be sending those resolutions to you 42 days prior to the HOD meeting. It will be your job to discuss them with your Affiliate Boards in order to represent their interests and those of your members in Las Vegas. It will be a pleasure to listen to the discussion that follows and I look forward to the professional interactions of the members of the House. [Top] |
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Treasurer’s Report Frank Salvatore, Jr., BS, RRT, FAARC I hope everyone has had a good summer. The HOD meeting in Phoenix was productive and quite an eye opening experience from the head table. I learned a lot this summer, especially the fact that I can’t nominate someone for a House Officer or committee position from the head table. I have to tell you, I have been banging my head against the wall to come up with something to write for this issue of the AARC Record. Things have been quiet on the Treasurer front. I continue to receive the AARC financial report monthly and the Association continues to be in good financial shape. I thought about writing to you about where we stand in regard to the Government Affairs Committee, but those of you who are aware know that this year Congress is doing more of its share of nothing with it being an election year. There has been no movement on any of our bills. In the background though, the AARC continues to be vigilant in watching what is going on in regard to the regulatory front. Miriam and Cheryl continue to be tireless workers on behalf of our profession in regard to the federal and state level. With all of the above said, that leads me to my actual topic. How many of you are feeling the pinch at work? It seems that our employers are beginning the annual, “Let’s squeeze blood out of a stone approach.” Knowing many of you who are reading this, you are the ones that have a can do attitude and the word “no” is not readily available in your vocabulary. In my hospital, we have begun working on a culture change known as Lean-Six Sigma. It is a business model that has slowly crept into the service industry and is now making its way into healthcare. It is a way to decrease waste (Lean) without sacrificing quality (Six Sigma). Now my intent is not to discuss Lean-Six Sigma, but what happens to our “volunteer” side when our employer’s needs/demands outweigh our ability to volunteer. I have spent a lot of time this past year taking my Political Advocacy talk on the road. I have talked at four state society meetings and have spoken to people from at least eleven states. What has surprised me the most is the lack of knowledge about our legislative agenda (HR964, etc.), as well as the fact that we have a 435 plan. I would also like to point out (without actually naming states), that I was in a couple of states that I feel have some of the most active PACT/HOD representatives in the country. So where are we going wrong? The only thing I can come up with is we might be asking too much of our precious few “volunteers”. I know many of you become invigorated when you attend either the PACT meeting and/or the HOD meetings. You leave with a high sense of pride in what you need to do and your ambitions to achieve the goals are high. Then, you get back home. Reality sets in. Your employer’s needs take priority and everything you wanted to do from the meeting you attended falls by the wayside. I know, because I have and am there! Can we fault you? NO! What do we do about this? In my opinion, we need to focus on priority goals and limit what we ask of our volunteers to the absolute necessary work that is needed to meet the goals. This I feel is the key to our growth and success in the near future. I think we also need to begin grooming our replacements. When it comes to membership, we ask our members to “ask one person to join”. Well as leaders of our profession, shouldn’t we “ask one person to join” also? I am not talking about joining the AARC, I am talking about asking a member of the AARC to join in at the state level. Mentor them to get involved in working for and shaping the future of our profession. The more we bring others into the fold, the more voices we will have to get our message out and achieve our goals. So what is my message here? Advocacy…it isn’t just for our political agenda. We need to advocate for our profession and its continued advancement by bringing along protégé’s, so to speak. In a time where our job and/or personal needs dictate how much time we have to volunteer, we need more of the movers and shakers such as you. I hope you will join me in asking someone to get involved. In the long run it serves two purposes: brings in new blood to your state society boards, and adds voices to get our message out. I look forward to seeing everyone in Las Vegas. Have a Happy Thanksgiving and a safe trip out. [Top] |
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Past Speaker’s Update Claude Dockter, RRT Here is my report on the most recent resolutions which are still in process. The following information is the most recent that I have since the July meeting in Phoenix. House Resolutions Cheryl is working with the VA central office. No additional information available to report at this time. Resolution 44-06-01 Referred to the Executive Office for implementation. Resolution 22-06-02 This resolution was still being considered by the HOD on the last day of the HOD and BOD meetings. Since it was not submitted to the BOD prior to their adjourning board action is still pending. A follow up report will be provided to the House of Delegates during the Las Vegas meeting. Conclusion I look forward to our winter meeting in Las Vegas. [Top] |
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On Becoming A True Profession Will Beachey, PhD, RRT About once every year during the last decade the same question surfaces on the AARC respiratory therapy education list serve: What is appropriate entry-level education for the profession? This question was the subject of considerable discussion and debate among educators during the summer of 2006, and it is an equally vital and pertinent question for the leadership of the profession. A common error among those not directly responsible for educating the next cadre of therapists is to separate this question from issues such as Medicare reimbursement and governmental recognition of respiratory therapy as a profession, and to ascribe higher priority to them. In fact, these issues are inextricably linked with entry-level education in the profession. The fact that the respiratory therapy profession perennially struggles with professional recognition is not divorced from the reality that the associate degree is the norm for entry into practice. An argument for a baccalaureate entry level is based not only on the professional recognition issue. Modern demands of respiratory therapy practice have caused many in the profession question the appropriateness and adequacy of the associate degree. This is an inherently controversial and emotionally charged subject because most respiratory therapy educational programs in the United States are at the associate degree level. Understandably, many faculty members in these programs are concerned about the personal implications of a baccalaureate entry-level. At the same time there seems to be universal agreement among educators, regardless of the degrees their programs offer, that students should be encouraged to pursue the baccalaureate degree. To better understand the controversy surrounding entry-level education in respiratory therapy, it is helpful to see the question from a historical, evolutionary perspective. Respiratory therapy has slowly evolved over the last three decades from a technical task-oriented occupation to an increasingly sophisticated assessment-based profession. The shift from the “task-doer” model to the “assess and treat” model was spurred by the development of protocol-driven, assessment-based therapy and clinical practice guidelines in the early 1990s. Educational programs have struggled to meet the challenge of preparing students to function at this level within the constraints of the AS degree. Although many programs have found a way to meet the challenge (mostly by adding a semester or two to the curriculum), as long as the associate degree is granted the non-professional aura lingers. In the world of evidence-based medicine and ever-increasing societal diversity, it is incumbent on educational programs to produce graduates who value life-long learning, use the scientific literature to improve practice, appreciate ethical and cultural issues, communicate effectively, understand physiological mechanisms behind therapy, and constantly think in terms of best evidence; in short, education must produce graduates with professional—not only technical—competence. Professional education should create in students a predisposition to question the unquestionable in a respectful, diplomatic way. It should produce graduates who constantly seek new learning, always in a spirit of intellectual humility. If we expect healthcare and governmental communities to recognize respiratory therapists as professionals, then education must focus on the broad development of the whole person—on developing individuals who function effectively, not only as respiratory therapists but also as knowledgeable, ethical, participating members of society. Is it possible to bring a high school graduate to this level in two years? Some educators maintain that the profession should wait to consider the baccalaureate entry level until the NBRC national task analysis demonstrates that practice demands it. Such an approach is consistent with the idea that respiratory therapy is a task-oriented technical occupation. The national task analysis survey is by its nature insensitive to the presence of non task-oriented professional attributes—the development of which is the chief reason for a baccalaureate entry-level. A task analysis documents the status quo for the purpose of validating a credentialing examination; it cannot call for future change. It is important to understand that the value of a baccalaureate entry level is not to increase task-oriented skills, nor to improve performance on the NBRC examinations. It is not inherently logical to assume that a BS graduate should automatically outperform an AS graduate on an objective multiple choice examination. (The clinical simulation exam falls into this category as well; it is merely an elaborate multiple choice examination offered in a convoluted way.) Simply stated, the reason for the baccalaureate entry level is to get the student to think and behave like a professional. A baccalaureate-level education makes it more plausible that we can teach students to value life-long learning, to motivate them to read the literature to improve practice, to make them sensitive to ethical and cultural issues, to develop sound treatment plans, effective communication skills, and to think in terms of best evidence. Doesn’t it make sense that such preparation is the norm for rank and file respiratory therapy staff? We as leaders in the profession need to answer some serious questions: does the associate degree accurately represent the level of professional competence we expect today’s graduates to possess? Does the associate degree send the appropriate message to third party payers, especially to Medicare? Is the associate degree a fair reward for graduates who complete up to three years of a rigorous curriculum? Such questions should be the focus of a national consensus conference on entry level education and the future of the profession. The last consensus conference of this kind occurred about 15 years ago, the results of which were published in October, 1992. At that time none of the major organizations in the profession had taken a stand on what constituted entry-level education. The conference’s most unequivocal finding—that the associate degree should be the minimal requirement for entry into practice—was not instituted until the year 2000. In a 1992 follow-up Delphi study in which 90 respiratory therapy experts across the country participated, 75% believed entry into the profession should require 3 or more years of post secondary education. Sixty-four percent believed the baccalaureate degree was appropriate. These opinions were based on the competencies required of therapists at that time and projected competencies needed by the year 2001. The striking thing about the 1992 consensus conference report is how little the debate has changed since then. The 1992 conference report stated that an impasse remained on the issue of program length and degree awarded. That impasse remains today. It is past time to convene a national consensus conference on the future of respiratory therapy and to move forward (rather than standing still) in developing as a true profession. [Top] |
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It’s Contract Renewal Time Again Sam Giordano, MBA, RRT, FAARC Over the next few weeks, we’ll be mailing chartered affiliate revenue sharing contracts to each state society President with a request that the contract be executed and returned no later than December 31st. The effective period for the contract is from January 1, 2007 until December 31, 2007. Nothing in the contract has changed from previous years. In a nutshell, AARC is asking that as a condition of revenue sharing, the state society agree not to compete either directly or indirectly with AARC. This assures that the revenue AARC needs to generate, and the portion that it distributes to all state societies will not be threatened or undermined. You may also recall that the AARC has intended that the contract serve as a gateway to additional partnerships between it and state societies for the purpose of generating additional revenue for all parties. These additional partnerships, if the state society decides to participate, will include opportunities to co-market certain products and afford the state society the ability to earn additional revenue above the traditional revenue sharing levels. These additional partnerships are not mandatory and are only available to those state societies that have executed the revenue sharing agreement first. Over the past two years, we have been working on development of products that are now ready, or will soon be ready, to go to market. State societies who execute their contract by December 31st will be eligible to participate in marketing partnerships with AARC to help promote its RRT exam preparation course and a physician office spirometry tutorial. If your state society is interested in earning additional revenue by assisting AARC in marketing these products, it will be given credit for all customers purchasing the product within the boundaries of your state society. We feel this endeavor is just the beginning, and over time, other opportunities to partner with AARC for the purpose of increasing revenue for both the state societies and AARC will grow. I want to take this opportunity to encourage you to get the contract signed expeditiously so that your state will become eligible for these additional opportunities to generate revenue. You may be interested in knowing that over the last couple of years since the contracts have been in effect, we have experienced absolutely no problems or issues related to the states that have executed an agreement. We now have the states set to proceed as collaborators and partners with an eye on fulfilling our mission while simultaneously assuring the financial well-being of our national and state associations. [Top] |
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State Society Boards of Directors: Legislative Impact of Board Behavior Tom McCarthy, RRT Most state Respiratory Care societies are tax exempt, not-for-profit 501 (c) (6) corporations. Being incorporated as a 501 (c) (6) as opposed to a 501 (c) (3) allows a state Society to have a legislative presence and lobby various political agendas and positions while maintaining a tax exempt status. Subsequently, a state society can be a force to maintain licensure standards, advocate for patients and have reasonable input into other health care related legislation. The forefront of any state society is its elected board of directors (BOD). These are the individuals who are charged with managing the affairs of the Society within the confines of the society’s articles of incorporation and its by-laws. The BOD develops positions and implements policy relative to finances, membership, medical issues and legislative agendas. A Respiratory Care Society BOD is generally comprised of dedicated, well meaning individuals intent on furthering the profession and improving patient care. While these individuals are well versed on clinical and patient care issues, oftentimes their understanding of a legislative process and/or a BOD process may be fairly limited. Some important structures and processes within a BOD may be poorly defined as well. Legislative success or failure can entirely depend on the level of structure and function within a BOD. How well a BOD discharges its duties can directly effect how much credibility a society will have in a state legislature. Poor judgment, conflicts of interest or other breaches of fiduciary responsibilities can invite public censure or legal action that will, among other things, seriously impair the credibility of the organization. In order to successfully pursue legislative positions and agendas, a society must have a high degree of credibility with both legislators and the public. This is especially true in states where societies may have as few as 500–600 members and a very limited budget with which to fund legislative initiatives. A small society with damaged credibility has little or no chance of forwarding a legislative agenda in a state legislature. Additionally, legislatures have long institutional memories so that lost or damaged credibility may never be fully regained. So how can a BOD for a state Society avoid some of these procedural pitfalls? The first thing that an active or potential board member should understand is that BOD members owe three basic fiduciary duties to a Society and its members. A fiduciary duty is defined as a legal relationship between two or more parties and is the highest standard of care imposed at either equity or law.[1] A fiduciary must conduct themselves at a level “higher than that trodden by the crowd.”[2] These three fiduciary duties are:
Should the BOD or one of its officers breach any of these duties, it can be considered a wrongful act and is actionable under the law. A lawsuit alleging breach of fiduciary duty could be brought by a Society member, a concerned citizen, a state regulator or the Attorney General.[3] The costs associated with defending an allegation of a wrongful act can easily exceed $50,000 and the publicity associated with the defense could potentially destroy the credibility of the Society. Some examples of wrongful acts are:
It is imperative that the BOD of any state society strictly abide by its articles of incorporation and by-laws, have a clear and unambiguous code of ethics that is adhered to and conduct the business of the BOD in a transparent manner. Otherwise, the BOD may find itself at odds with its general membership, its parent organization, the Attorney General for that state[4,5,6,7] and, among other things, jeopardize the Society’s tax exempt status.[8] One of the most common, and potentially harmful, wrongful acts that a BOD will deal with is a conflict of interest. A conflict of interest arises when an individual has competing professional, personal or financial interests. An individual accused of a conflict of interest might deny that a conflict exists because there is no evidence of them acting improperly. “In fact, a conflict of interest does exist even if there are no improper acts as a result of it.”[9] A BOD should exercise the utmost vigilance to guard against conflicts of interests, especially when developing and forwarding legislative positions and strategies. State legislators are an extremely perceptive group that can spot “self interest” a mile away. One of the advantages that most Respiratory Care societies have is that their members are not directly reimbursed for services. This situation takes financial self interest out of the equation whenever a society BOD develops a position on a piece of legislation. That being said, a society can put financial self interest right back into the equation and diminish the society’s credibility by having conflicted individuals involved in the process or, worse yet, by having conflicted individuals representing the society’s position. Subsequently, although the society may be forwarding a piece of legislation as a “patient care” or “patient safety” initiative, legislators will view the society as supporting a self interest “industry bill”. Since almost all health care legislation is always assigned to the same committee in the legislature, a society’s credibility can be diminished for quite some time once they are identified as being conflicted by financial self interests. There are several strategies that a BOD can and should employ to mitigate the possibility of conflicts of interests arising:
A poorly structured BOD without a strong code of ethics may easily find itself publicly at odds with its membership, patient advocates or the Attorney General and destroy the Society’s legislative credibility. A well structured proactive BOD with a strong code of ethics will ultimately represent its membership well in any legislature and become a resource for respiratory related healthcare issues. References
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HOD Officer Nominees The following are nominees for HOD officer positions to be voted on during the HOD meeting in Las Vegas: Frank R. Salvatore Jr., BS, RRT, FAARC
John Blewett, BUS, RRT, RCP
John M. Hughes
Lynn Lenz
Dawn Rost, BS RRT-NPS
Camden J. McLaughlin
Lori Salonen
Joe Horn
James Lisenbey
Ross Havens
Bill Lamb
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Membership Figures (as of 10/30/06)
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For Your Information The Calendar of Events can be found in the Delegate Handbook as well as the Chartered Affiliate Handbook, located at: Review this site for other HOD information as well. [Top] |
