Respiratory Patients Need Respiratory Therapists
Will They Get the Care They Deserve?
The premature infant with underdeveloped lungs, the third grader with cystic fibrosis, the teenager with asthma, the student with AIDS, the wife with pneumonia, the CEO with bronchitis, the coach with lung cancer, the coal miner with black lung, or even the veteran with emphysema--people from all walks of life are often cared for by respiratory therapists. However, more and more Medicare patients today are not afforded that necessity.
When the Medicare/Medicaid program was first developed, respiratory care was fully recognized as a viable component of hospital services. However, the scope of respiratory care services has developed significantly beyond the hospital setting. Where respiratory patients were once confined to hospital beds, they may now be cared for in skilled nursing facilities or even in their own homes. But in the past 25 years the Health Care Financing Administration (HCFA) has failed to advance coverage policies for respiratory care in those other settings. This failure to provide adequate reimbursement for respiratory services has consequently led facilities to use increasingly more lesser-skilled healthcare providers in an effort to cut costs. This decrease in utilization of respiratory therapists in Medicare skilled nursing facilities has produced poorer outcomes and ultimately higher costs.
Respiratory Therapists Save Lives
The Muse & Associates study, A Comparison of Medicare Nursing Home Residents Who Receive Services from a Respiratory Therapist with Those Who Do Not, reports evidence found in HCFA records that proves Medicare patients with lung disorders are more likely to survive when given care by respiratory therapists. Forty-two percent more those patients lived when their life-sustaining respiratory services were delivered by respiratory therapists, healthcare professionals specifically educated and trained to treat people with lung disorders.
Respiratory Therapists Save Money
The study also revealed that Medicare beneficiaries with lung disorders have lower costs and use fewer health care services when respiratory therapists are utilized. A 3.6-day shorter length of stay for those patients saved Medicare $97.9 million in just one year. That figure would rise significantly if you put a dollar amount on the 31% less utilization of emergency room and outpatient services that these patients experience--not to mention the countless patients who never have to be readmitted to the skilled nursing facility for the second and third times.
Further evidence of the respiratory therapist saving money can be found in a Gallup survey done the early 90s. This study looked at the cost of providing hospital care to chronic ventilator patients. The survey estimated there were more than 11,500 chronic ventilator patients in U.S. hospitals at the time, costing an estimated $789 per patient per day. That totaled more than $9 million a day at the time of the study--and healthcare costs have increased dramatically since then. The Gallup survey also found that once a chronic ventilator-dependent patient is medically able to be discharged, it takes an average of 35 additional days to place that patient in an alternative care site such as a skilled nursing facility. That 35-day delay translated into an excess of $27,000 per patient in additional, unnecessary hospital costs. One of the primary reasons for those placement delays, and hence the additional Medicare expenses, is that inadequate reimbursement policies can lead to "cherry picking," the practice of facilities choosing to accept only the most stable, lower-cost patients or patients whose conditions receive appropriate Medicare reimbursements.
All Providers of Respiratory Care Need to Prove Competency As evidenced by the information uncovered in the Muse study, the training and competency of all providers of respiratory care are not the same. Respiratory therapists undergo a minimum of 2 years education and training including a concentration of courses dealing exclusively with the cardiopulmonary system. They also receive extensive hands-on clinical experiences in various care settings and before they can enter into practice they undergo rigorous testing to prove their competency to deliver respiratory care. Any healthcare practitioner providing respiratory care must be able to access, treat, and monitor the responses of patients to therapy as well as provide appropriate recommendations to attending physicians. A respiratory therapist education is excellent preparation for those responsibilities.
The American College of Chest Physicians, the American Society of Anesthesiologists, the California Thoracic Society, and the National Association for Medical Direction of Respiratory Care have all released statements endorsing the necessity of respiratory therapists in the care of patients with breathing disorders.
Generally, lesser-trained caregivers simply cannot be expected to deliver the caliber of care given by respiratory therapists. According to The American Society of Anesthesiologists, "the standard of care to patients could be compromised unless these other individuals received the same extensive education, training and competency testing as required of respiratory therapists." Some healthcare practitioners do undergo education in respiratory therapy beyond what their primary training provided. In those cases, practitioners should be required to document their competency in the delivery of respiratory care in order to assure appropriate, quality care will be given. Any other healthcare practioner should not be allowed to deliver respiratory therapy under any circumstances.
The Muse study has shown that using unqualified caregivers has caused unnecessary loss of life and exhorbitant cost-of-care increases that contribute daily to the crippling of the Medicare system.
