If the pandemic has taught us anything about where patients like to receive care, they want to receive it at home whenever they can.
That is especially true for those with chronic conditions and the elderly, who often have difficulty traveling to a health care center. In addition, many of these patients suffer from respiratory conditions, so it makes sense we need respiratory therapists in this setting.
Four RTs who specialize in the home care environment explain the challenges and rewards in respiratory homecare — and how they believe the demand for RT services in the home will only grow over time.
Education, training, and more
June Sorensen, CRT, SAE, is a staff therapist at PromptCare Respiratory in Lexington, KY. She works directly with patients daily to provide them with education about their disease process and training on using their prescribed equipment and therapy.
She performs clinical assessments when ordered. She also works closely with physicians, case managers, and home health nursing agencies to ensure ongoing follow-ups take place and care plans are updated to meet the needs of each specific patient. In addition, she’s on call for troubleshooting and equipment malfunctions, and she also assists with getting patients from the hospital to their homes.
Sorensen sees an excellent future for respiratory home care.
“I feel the need will grow due to the increasing geriatric population and technology, and increases in the number of respiratory-related diseases, sleep-disordered breathing, and COVID,” she said. “After all, every patient in the hospital always wants to get home ASAP.”
The downside is — and always has been — that RTs do not receive reimbursement for their services in the home.
“Homecare equipment companies know very well they bill for the actual rental/sale of the equipment, not the RT visit,” she said. “If and when, like the PT/OTs, the homecare companies are allowed to bill for the RT visit along with billing for the actual equipment — wow! Then the demand will double or triple.”
Focusing on patient outcomes
Whether or not that will happen is anyone’s guess, but others in the homecare sector believe there are ways around that problem. For example, several years ago, Encore
Healthcare was established by Founder and CEO Zach Gantt, RRT. Encore Healthcare developed respiratory outcomes software that helps home medical equipment (HME) providers transition from an equipment-focused model to one focused on patient outcomes.
“The need for reimbursement for RT services is becoming less important when you can wrap the services into a value-based model that drives revenue in reductions in spending,” said Gantt. “The population of patients is growing quickly, and the home care market is going to see massive growth over the next ten years, creating a need for RTs like never before.”
Evidence that these programs pay off for HMEs is evident in the outcomes Gantt and his colleagues at Encore have seen. Through the partnerships they’ve set up, they have achieved a reduction in readmissions of more than 71% nationwide, with more than 10,000 hospitalizations averted by using RTs in the home to intervene during exacerbations.
“We work with the elite HME providers to change the model and create partnerships with hospitals and payers to get paid for respiratory therapists in the home,” he said.
Gantt believes homecare is the future.
“The industry is at a tipping point, where we will see growth in numbers and in the value we can offer in the home,” he said
PAP is driving demand
Jason Morin, MBA, RRT, CDME, is president and CEO of the Home Medical Equipment and Services Association of New England (HOMES), representing more than 120 HMEs. The organization advocates for the best interests of the HME community and the people who rely on their services.
“HOMES is actively engaged in a number of policies, reimbursement, payer relations, and legislative activities throughout New England and nationally,” said Morin.
He believes respiratory homecare today is being driven by the demand for positive airway pressure (PAP) therapy but admits PAP reimbursement is challenging.
“PAP providers moving forward are going to have to leverage technology, along with efficient clinical strategies, to remain successful,” he said.
However, the recent reopening of the CMS National Coverage Determination (NCD) for home oxygen is a bright spot on the horizon.
“Among the suggested revisions to the NCD, the most notable is the proposal to expand coverage to include acute and chronic conditions,” said Morin. “If adopted, this would increase access to home oxygen therapy for a number of conditions not currently covered by Medicare.”
That could bode well for RT services in the home, and it would come at a great time since the profession has gotten so much positive press during the pandemic that has raised awareness of RTs across the board. So the push to increase telehealth services is a plus too.
“As telehealth policies continue to evolve, they will have a large impact on the demand for clinical RT services in the home,” said Morin. “It’s crucial that the RT community be involved in state and federal discussions in this area to ensure that the RT’s role in telehealth is not minimized.”
(Telehealth is at the top of the AARC’s legislative agenda. See what we’re doing here.)
Steve DeGenaro, RRT, has his fingers in several different homecare pies. He owns and operates a medical equipment company that specializes in portable oxygen for travel. He also serves as an accreditation inspector for a CMS-approved DME accreditation body and a consultant for DME accreditation preparation.
He offers his services as a compliance officer to DME organizations, working with them on their compliance and quality improvement initiatives.
These varying perspectives have led him to believe that several factors are converging to impact the market for respiratory home care.
“Demographics show an aging population, and baby boomers are retiring at astronomical rates,” he said. “Also, the technological advancements with sleep disorder testing and treatment have increased the need for respiratory therapy in the home tremendously. This creates a perfect storm of products and patient needs.”
Here’s what it takes
While reimbursement remains an ongoing issue in respiratory homecare, all four of these therapists believe respiratory therapists are essential in the setting. So, what does it take to be a good homecare RT?
There are several characteristics on the must-have list. First and foremost, you must have confidence in your skills and the ability to act independently because, in homecare, it’s you alone — there isn’t a colleague down the hall who can come to your aid if you need help. Two or three years of acute care experience is essential to ensure you have the chops to work solo in the patient’s home.
Secondly, therapists who work in the home must be fully versed in the equipment they will be using with the patient and knowledgeable in disease management and patient education.
And third, you need to be a genuine “people person” who relishes the chance to work closely with patients, families, and other informal caregivers to ensure they are educated on the condition, equipment, and care needed for the best possible outcomes.
Before you jump in, though, these RTs say you should take some time to consider your decision carefully.
“Working in home care is not for everyone,” notes Jason Morin. “Ask yourself if you feel comfortable working in people’s homes. If you’re not sure, reach out to a colleague in homecare and get feedback, or connect with a local home care company to discuss their expectations.”
Steve DeGenaro agrees.
“First, find a mentor,” he said. “You don’t learn about how to do good homecare respiratory therapy from a textbook. A good mentor who has been in the industry for many years will speed up the learning process tremendously.”
A per diem position with a local HME might not be a bad idea either — that way, you can test the waters without committing to a full-time job.
“Try it on for size,” he said. “And if you love it, jump in and enjoy.”
Zach Gantt believes it’s essential to vet any homecare company you might be considering too thoroughly.
“There are good companies, great companies, and bad companies,” he warns.
The upside is, chances for advancement are real.
“I worked my way up from staff RT to the chief clinical officer of a national company after being out of school six years,” he said. “And to CEO in less than 10 years.”
Taking the plunge
June Sorensen believes therapists who work in homecare must realize the home setting can be unpredictable and, at times, troubling since every home and family situation is different and some are not ideal.
But the rewards that come from helping people remain in their own homes are priceless.
“Every day is different, as well as every patient,” she said. To her, it’s all about “meeting wonderful people in their hour of need, actually being able to make a long-term difference in your patient’s life vs. a quick in and out at the inpatient bedside, and freedom, on the road and in the homes vs. hospital walls.”
For some therapists, those advantages are worth taking the plunge into the home care setting.
You can learn more about respiratory home care and find seasoned veterans to help you better understand the setting by joining the AARC’s Ambulatory and Post-Acute Care Specialty Section.