Major Medicare Initiative Launched by AARC

February 14, 2007

A new initiative aimed at expanding reimbursement opportunities for respiratory therapists under Medicare’s Part B program is being launched by the AARC. AARC will be seeking Congressional sponsors for legislation that will allow respiratory therapists with an RRT and a bachelor’s degree to deliver respiratory care services without the physician being present when the services are being furnished.

Because the Medicare law currently does not recognize respiratory therapists, their work outside of the hospital is generally covered by a Medicare provision known as “incident to a physician’s professional service.” This limits the areas in which a respiratory therapist can work because the physician has to provide direct supervision when the respiratory therapist furnishes the service a physician would otherwise perform directly. “Direct” supervision means the physician has to be physically present in the office suite.

The AARC is proposing to change the law to permit the respiratory therapist to work under the general supervision of the physician. The main distinction between our Initiative and current law is the physician would not be required to be in the office, although he or she would have to be available by phone for consultation if needed. This makes a big difference because now the respiratory therapist could furnish a service to a Medicare beneficiary while the physician is making hospital rounds or visiting a patient at home.

This would open the door to expanded opportunities such as:

• having more flexibility in offering office-based spirometry or smoking cessation
• performing home visits for ventilator and oxygen use
• contracting services to a number of physicians for disease management programs or lung testing

Those are just a few of the situations in which a respiratory therapist might find an opportunity under this Initiative.

Medicare affords a number of advanced-level allied health care providers the privilege of working without direct physician supervision, such as physician assistants, nurse practitioners, and clinical nurse specialists. The AARC Medicare Respiratory Therapy Initiative will give respiratory therapists with an RRT and bachelor’s degree similar recognition that they do not now have.

Who Would Be Eligible
A respiratory therapist would need to have an RRT and bachelor’s degree to be eligible to participate under the AARC Initiative. Because other allied health professionals recognized by Medicare have a minimum of a bachelor’s degree, or in a number of cases, advanced professional credentials, the AARC feels strongly that it is important to make a niche for the advanced practice respiratory therapist so that the initiative is more likely to be supported on Capital Hill.  The initiative will not change the status or impact the employment of respiratory therapists who do not meet these qualifications.

As the Political Advocacy Contact Team approaches their meeting in Washington, DC in March, this will be the initiative they will be “selling” as they visit their legislators.

AARC Executive Director Sam Giordano explained that limiting this plan to bachelor’s-prepared RRTs only will help this initiative lift off. He explains that by placing that limit on the program the following benefits are gained:

• Because we are playing in a field where only other more highly prepared individuals are currently recognized by Medicare, we have a better chance of getting this passed if our education and skills are on par with those other health care professions.
• We are creating an incentive for respiratory therapists to achieve higher education and more advanced credentials. This will benefit the profession.

“We cannot stress enough that this does not change any current reimbursement practice,” said Sam Giordano. Respiratory therapists regardless of credential earned or level of education achieved are still eligible to practice in all current health care settings. “We are trying to open new avenues, new opportunities for this profession.”

Other Benefits of this Plan
Most importantly, adoption of this Initiative would help the pulmonary patient. A pathway would be created for the respiratory therapist to provide services in a more independent fashion than is currently permitted.

“Medicare simply has not kept pace with advances in pulmonary medicine and services,” said Cheryl A. West, MHA Director of Government Affairs for the AARC. Disease management programs, specifically those dealing with asthma and COPD, have a real chance for helping patients help themselves. Other kinds of patient education, such as smoking cessation or better education on aerosol devices and delivery are needed. Ventilator patients at home need management and assessment. “Yet,” says West, “inadequate services exist for these kinds of patients. This Initiative would help expand the opportunities for respiratory therapists to provide those services.”

And not only would better patient care result from a change in the Part B statute, cost savings are possible, too. Physicians who are currently providing these services are paid an amount based on 100% of the Medicare fee schedule. If respiratory therapists were permitted to provide these services without the physician having to be physically present, Medicare would pay the physician a reduced amount based on 85% of the physician fee schedule. The physician practice will enjoy more flexibility in the utilization of the physician's time. And Medicare will enjoy lower reimbursement costs.

Every RT Benefits
While it may appear that only an RRT with a bachelor’s degree stands to benefit from this change, that’s only on the surface. Every respiratory therapist, regardless of credential or level of education, benefits.

Passage of a measure such as this would assure that data and facts are gathered showing the value of the respiratory therapist. That data, coupled with an enhancement of the profession’s image and its impact on patient care, will advance this profession like no other Initiative has. Reinforcement of our unique value outside of the hospital will help pave the way to even broader access to services provided by respiratory therapists.

How You Can Help
For this initiative to get off the ground legislation must be introduced in Congress.

PACT members will be working their members of Congress when they take to the streets in Washington March 6.

All AARC members can help. By writing your members of Congress  to support legislation for this initiative you will be helping your PACT member by paving the way.

“We’re sponsoring a major writing campaign Feb 15 to March 5.” said Cheryl West, Director of Government Affairs for the AARC. She explains that AARC members as constituents can help the Senators and Representatives visited by PACT members on March 6 understand the importance of this issue.

• To write to your congressman go to Capitol Connection and follow the prompts.
• To understand this issue in more depth, read the Frequently Asked Questions posted on our site..