A new imperative for asthma educators is rolling like tumbleweed in the windstorm of healthcare reform. While it may sound like much of the same teaching about the causes, impact, control and cost containment of this leading childhood disease, there are some new components being launched by respiratory crusaders. Not only are these educators charged with teaching patients and their families how to prevent costly exacerbations, they must instruct the public at large – including lawmakers, regulators, and fellow healthcare providers – about the importance of their specialty and the attendant urgency to be valued in tangible ways: funding and reimbursement.
A Time to Be Heard
A new Childhood Asthma Leadership Coalition (CALC) was convened in 2012, bringing together leading voices in asthma care. The coalition is led by The George Washington University department of health policy and by First Focus, a bipartisan childhood advocacy organization. Member organizations include American Academy of Pediatrics, American Lung Association, Association of Asthma Educators (AAE), Asthma and Allergy Foundation of America, Children’s Hospitals Association, First Focus, Joint Council of Allergy, Asthma and Immunology, Merck Childhood Asthma Network, MomsRising, Healthy Schools Network, Regional Asthma Management and Prevention Initiative, Trust for America’s Health and others.
CALC penned a letter in July 2012 directed to the EPA, HHS, HUD, the federal departments of Energy and Education, and the U.S. Consumer Product Safety Commission, declaring their shared purpose: raising awareness and improving public policy to reduce the burdens of childhood asthma through collaborative work.
Just as importantly, they voiced objection to proposed “drastic cuts or elimination of critical programs at the EPA that work to reduce asthma’s burden.” They pointed out that for two years the federal government has proposed to eliminate CDC’s National Asthma Control Program “which would have devastating consequences to people living with asthma.” The letter also expressed concern about the EPA having “zeroed out funding” for its Indoor Air Quality for Schools program.
The cuts in funding, teamed with the lack of reimbursement for asthma educators in all but a handful of states, would seem counterintuitive to a national objective of smart utilization of healthcare dollars.
“It’s a matter of getting the biggest bang for your buck,” said Ellen O’Kelley, PNP-BC, AE-C, who works for the division of pediatric allergy, immunology and pulmonary medicine at Monroe Carell Jr. Children’s Hospital, Vanderbilt, Nashville, Tenn. Also serving as AAE’s representative in the new coalition, O’Kelley added, “One would wonder why so few states offer reimbursement for asthma educators when studies show that asthma educators positively impact direct and indirect healthcare costs.” And those costs can be enormous in dollars — and in human misery.
Multiple Costs of Asthma
“First, you have costs to the patients and their families; I’ve seen parents lose jobs because of absences to take care of a sick child with asthma. I’ve seen families have to relocate from their home because of the huge expenses involved with treatment and medications,” she recounted. “And then you have costs to the healthcare system – the ED visits, the prolonged hospitalizations that cost thousands. Asthma education is a much more affordable approach.”
Additionally, as primary care providers face rising patient populations, already limited time with patients may keep them from offering the in-depth education asthma patients need to be able to manage their disease – if, indeed, those providers are well-versed enough in the complexities of asthma care to provide it. O’Kelley noted that reimbursable asthma education classes – similar to classes conducted by diabetes educators for patients with diabetes – would help take a strain off of primary offices while providing high-level asthma education to patients and their families.
And more importantly, using education helps to avoid the most devastating “cost” – diminished quality of life. “We tend to get hung up in the dollars, but I keep trying to draw people back to the need to keep kids healthy, active and in school where they can get an education that will allow them to be productive members of society,” said O’Kelley. “We have to keep this big picture in mind.”
Education Makes a Difference
Floyd Malveaux, MD, PhD, executive director of the Merck Childhood Asthma Network Inc. (MCAN), is an expert in the value of asthma education. MCAN is a non-profit organization established to address the complexities of pediatric asthma by improving access and quality of asthma healthcare, advocating for policies that “expedite implementation, dissemination and sustainability of science-based asthma care,” and increasing awareness of asthma and quality asthma care.
Malveaux noted that MCAN’s very existence is predicated on the fact that asthma-centric educational practices “can be implemented in homes, communities and in the healthcare system, and make a difference in the real world.” In 2011, MCAN launched a four-year enrollment of children with asthma and their families in an asthma education, implementation and evaluation process in target cities — Chicago, Los Angeles, Philadelphia and San Juan, Puerto Rico. The program, with nearly $4 million in funding, combines evidence-based case management and asthma trigger removal plans. Previous MCAN initiatives in the target cities resulted in a decrease in symptom days, an increase in the use of action plans for children with asthma, and a 50 percent decrease in missed school days among participating children.
“We’re amazed that people aren’t jumping on board and investing more money in science-based programs including care management and environmental mitigation of triggers after seeing the success MCAN has demonstrated,” said Malveaux. And while he said some major healthcare systems have adopted MCAN’s asthma educator model, widespread progress is frustrated by a lack of financial buy-in. “There’s no reimbursement for services provided by many certified asthma educators or asthma counselors. Most states do not have a reimbursement mechanism for asthma education provided by asthma counselors – that’s one of our biggest hurdles.”
MCAN, in concert with the other members of the new coalition, hopes to shine a spotlight on this all too dusty trail of healthcare economics. Coalition partner First Focus, part of the America’s Promise Alliance, an organization founded by Colin Powell, “does a significant amount of work on Capitol Hill in terms of lobbying and developing policy initiatives to address reimbursement issues and standardization of certification for asthma educators,” said Malveaux. “There has to be a strong advocacy initiative, a dynamic movement in order to move this effort forward. Then it will just be a matter of time before individuals — and health systems – realize quality asthma care, including education, is highly cost effective.”
Valerie Neff Newitt is on staff at ADVANCE. Contact: [email protected]
