It Is Time: Bachelor’s Degree Licensure Requirement for Respiratory Therapists

As The Centers for Medicare and Medicaid Services (CMS) expand their control and funnel their resources into new and expanding environments, respiratory care has the potential to be left behind.

This is a difficult pill to swallow for many respiratory therapists (RT), but the fact remains that CMS is driving innovation by way of keeping patients well and out of the hospital, while driving ill patients who are stable into skilled nursing facilities (SNFs). This is causing SNFs to care for much more acutely ill patients than ever before, leaving acute care hospitals mainly responsible for stabilization.

Unfortunately, CMS does not recognize Respiratory Care as a profession because RTs are not required to have a bachelor’s degree at a minimum to be licensed. And as a result, CMS does not require respiratory therapy to be provided solely by an RT.

Case-in-point: When the RUGS payment model was implemented within the skilled environment over 20 years ago, SNFs that previously paid for RTs to provide care for their residents stopped so they could remain competitive. Since all RT procedures were reimbursed the same whether provided by a nurse or an RT, administrators saw no financial advantage of having RTs on the bank role and chose to no longer employ them. This opened to the door for other professions to expand into an area where they should have clinically dominated.

If RT was a bachelor’s minimum profession, it would have more pull in its lobbying efforts to strengthen the roles of individual RTs with CMS-funded services. But this doesn’t even take into account the profession’s relative lack of engagement with the American Association of Respiratory Care (AARC) whose primary role is to lobby on its behalf.

It’s time RTs help secure the future of their profession by supporting the AARC and the bachelor’s minimum requirement to practice respiratory care.

What is Chronic Bronchitis?

Chronic Bronchitis wreaks havoc on the lung’s ability to clean themselves out. One of its hallmarks is thick, sticky mucus. This kind of mucus is made from airways that are continuously inflamed and swollen. In this condition, the airways are narrowed, so it’s not easy for the cilia to sweep mucus out of the lungs. As a result, a lot of the mucus just sits in the airways.

Mucus that sits in the lungs is a good incubator for germs that can cause a respiratory infection. Nine out of ten times that COPD flares up, it is because of a respiratory infection. It is therefore highly important to keep mucus moving up out of the lungs in order to stay well and avoid flare-ups of COPD.

With Chronic Bronchitis, not only do the airways narrow because of swelling and inflammation, they sometimes narrow even further when the muscles surrounding the airways squeeze and tighten up. This narrowing of the airways caused by the combination of swelling and squeezing is what makes COPD flare-ups so dangerous. This is why it is so important to recognize symptoms when they first begin, take medications regularly, and learn how to keep mucus flowing up out of the lungs.

How Do Lungs Clean Themselves?

The airways in the lungs are lined with a thin, watery mucus blanket. The mucus sits upon tiny, hair-like strands called “cilia.” The cilia and mucus blanket work together to keep the lungs clean and free from infection.

The lungs are very clean—even though they are directly connected to the outside air, which is full of germs and dust. The reason everyone’s lungs are not full of dust and dirt is because of the amazing job the lungs do to keep themselves clean. It happens like this: The mucus blanket catches germs and dust that make it past the nose and into the lungs. The cilia then sweep the mucus blanket, like a conveyor belt, up to the back of the throat where it is swallowed. Healthy lungs usually sweep up about a cup of mucus every day. There are also germ-fighting cells that ride this conveyor belt and attack any invading germs or other foreign particles.

So, this combination of germ-attacking cells that ride the conveyor belt, as well as any germs and dust that get swept to the back of the throat and swallowed, is the reason why people don’t constantly have pneumonia and lungs full of dust.

What is COPD?

Chronic Obstructive Pulmonary Disease, or COPD, includes respiratory conditions such as chronic bronchitis, emphysema, bronchiectasis, or all three combined. It involves the swelling and inflammation of the airways, which narrows them and produces thick, sticky mucus. These conditions hinder the air in the lungs from being exhaled completely and effectively.

This narrowing of the airways is many times the result of breathing in irritating fumes and allergens, such as perfumes, household cleaning fumes, smoke, and pollens in the air. Because these irritants are always in the air, people with COPD never get complete relief of their symptoms—even when taking medications for their breathing condition. What is more, symptoms can be worsened by other health conditions like congestive heart failure and pneumonia.

It is estimated that around 24 Million Americans have some form of COPD, but unfortunately, half are not even aware that they have it.  This is because most people neglect to mention their breathing problems to their doctor—mistakenly believing that their symptoms are only the result of being out of shape or just getting older. And for those who have been given medications to treat their symptoms, they often fail to take their medications as prescribed—stopping once they begin to feel better, or incorrectly thinking that their breathing condition is not all that serious.

Although COPD symptoms never completely go away, the disease can be effectively treated and kept from getting progressively worse. Taking the correct medications, learning to breathe and relax when short of breath, eating properly, and by staying active, a person with COPD can greatly lessen their symptoms and live a fuller, healthier life.