RTs Realize Change Is Ahead

• By Deborah Cooper
• Sep 01, 2006

Respiratory therapists working in the HME industry are facing their own upheavals as a result of reimbursement cuts. The providers’ drive to preserve the bottom line may go head-to-head with the need to maintain patient services and a high level of care. The profession may need to adjust its strategy for survival in the years ahead.

Shifting Sands
No one knows quite what the landscape will look like in the short term. Some believe it’s a case of becoming more efficient with current practices, such as focusing on clinical skills and not spending time on something a delivery technician could do. Others hope for a shift in payment methodology: “The role of the RT in home care will grow and change. We’re going to need reimbursement in some way to support that—whether it will be subsidized through payments for HME as it is today, or whether we’ll break through the barrier for looking at direct payment for certain home care services,” says Joe Lewarski, VP clinical and governmental affairs, Inogen.

The trend toward more responsibility on the patient side is likely to grow, believes Jim Steadmire, RT for Aregiant Medical in Ohio. “More of the patients will come to the RT at the DME office. Certain areas have already embraced that wholeheartedly. You are cutting costs by cutting the drive time, and you can schedule three or four patients in the same amount of time by seeing them in the office.” While he recognizes that the idea of patient self-care is anathema to some, it may be the trend in the long run: “If you want the client to get the care, it’s the solution.”

Service Reductions
While some providers have already cut back on routine respiratory visits, and certainly others may find themselves facing the same decisions, the need for RTs is not going to go away. No one underestimates the vital skills and care that RTs bring to the industry.

“There will always be a need for RTs in the home health care industry,” says Lloyd Barnes, president, HealthCare Dynamics. “But the day of sending an RT out just for an evaluation or initial setup is long past because there is no provision for it. However, RTs will always play a significant and important role especially in the area of pediatrics, ventilator-dependent patients, patients on Bi-PAPs and other areas that require a great degree of skill,” he adds.

RTs themselves are confident about the future: “I’m not worried. There’s a certain basic level you need RTs to provide,” says Jim Steadmire, RT. “The sky has been falling since 1989. RT services are always going to be under threat, but I truly believe they have been cut as far as they are going to get cut.”

Speaking Up
Lobbying efforts are in full swing in the respiratory industry, and RTs have a part to play in this. One way that RTs can combat the threat of cuts is to speak up about their own usefulness: “RTs have to be proactive,” says Harold Davis, clinical consultant, Nationwide Respiratory, VGM. “We have to prove our value to the industry. RTs should step back and look for ways to improve the owner’s bottom line, as well as improve patient care.”

In the Trenches: Mark Enloe, Respiratory Therapist
Respiratory therapist Mark Enloe works for Mediserve Medical Equipment, an HME provider in eastern Tennessee, and he also manages the Knoxville location. Enloe started out delivering oxygen cylinders in 1979, and has been with Mediserve for five years.

Why did you choose to work in DME?
As an RT I’ve always been in the home care industry. I get the most satisfaction helping people take care of themselves in the home and always have. What we do as an HME provider or as an RT makes a tremendous difference. That’s my motivating factor every single day.

What are the biggest challenges you face as an RT right now?
I think as an RT, and as an administrator, the biggest challenge is trying not to be an expense to the company, but being part of something that’s going to generate revenue. In this industry we are looking at cuts, and really have to evaluate whether we have the right people doing the right things. I ask myself, “Is this a necessary expense, and is there revenue and growth that’s going to be associated with the effort?”

How do you choose between clinical needs and business needs?
You have to walk the tightrope. Over the long haul you will always grow the business by choosing patient care first. Then, everything else will take care of itself.

As a branch manager, what are you doing to improve efficiency?
We use a computer call-back system, which has a two-fold purpose. It verifies compliance, and the computer can make a lot more calls than a staff member. It saves me time; on a good night I might get through three to four calls in an hour, whereas a computer calls a lot more patients, and if they have a problem it comes out in the daily exception report. We can then decide how to follow up.

How do you think the role of the RT will change in the next few years?
The RTs in a lot of companies have to realize that they may need to wear many hats. Being a clinician, you also have to be a good salesperson as well. That’s something we as a company are doing more of. We want the RT to be involved in the call to the physician. That’s a bit of a departure, but it’s important because when you talk about the common link, the patient, who better than the RT, the person seeing them in the home, to follow up?

How vital is the RT to compliance?
The RT plays a tremendous role in patient compliance. And one of the important skills is good people skills. If you don’t have good people skills, you won’t have compliance. You can’t just walk into a home and tell patients what to do. You have to make them understand the benefit of the therapy.

Are you worried that with issues such as the oxygen rental cap and the general trend to cut reimbursement in all areas of the industry, that providers will cut RT services?
Yes, definitely, I have to think about that. I’ve started thinking, OK, let’s focus our efforts on other areas we can grow that aren’t dependent on Medicare dollars, and still utilize good clinical experts and services. We haven’t made any wholesale changes yet. That’s the focus.

What’s your strategy to stay profitable?
It’s very simple. We ask ourselves in everything we do across the board, “Is it valid and necessary?” One of the biggest costs is always traveling to see the patient. Can we use somebody else, or a lower-cost employee, or can we mail supplies? Let’s send the RT to make the assessment, and then use them to help in the marketing effort of our program—that’ll drive revenue to the business. We don’t want to have to let someone go.

This article originally appeared in the Respiratory Management Sept/Oct 2006 issue of HME Business.