Whether you’re a veteran of the profession or just starting out as a hospital-based RRT, one thing is certain: you are going to face change during your career, and much of that change is going to come sooner rather than later. Affordable Care Act initiatives and other factors are quickly transforming the American health care system into one aimed at preventing disease and managing chronic conditions, and that means clinicians like RTs are going to have to step outside of their comfort zones.
In the following interview, AARC members Jeffrey Davis, BS, RRT, director of respiratory care and pulmonary function at the UCLA Ronald Reagan Medical Center in Los Angeles, CA, and Cheryl Hoerr, MBA, RRT, CPFT, FAARC, director of respiratory services, the Sleep Center, and neurology at Phelps County Regional Medical Center in Rolla, MO, explain what it all means for hospital-based RRTs.
What are the main factors driving the need for the hospital-based RRT to take on new responsibilities?
Jeffrey Davis: Three words: value-based care. The progressive leader is evaluating how to make the hospital-based respiratory therapist invaluable to hospital administration. We are picking up more responsibilities, not handing them over to someone else. Our good friend, Rick Ford, showed his hospital administration how cost-effective it would be for respiratory therapists to handle the EKGs in his hospital. My respiratory therapists are valuable members of the outpatient pediatric asthma clinic and CF clinic and are currently preparing for a COPD clinic.
Cheryl Hoerr: Health care reform is driving patient volume away from expensive inpatient care to other, less expensive venues. There is a critical need for RTs to expand beyond the walls of the hospital to provide more timely interventions that keep our patients out of the hospital.
Why is it important for hospitals to be addressing these factors today and how can RT departments step forward to help?
Jeffrey Davis: With CMS payments shrinking, hospitals must find a way to reduce cost. Hospitals are being held responsible for patients after discharge, and we must find a way to assure our patients fill their prescriptions, take their medications, and follow up with their physicians. Traditionally, there has been a separation between hospital providers and home care providers. That line is blurring, and I expect to see hospital-based providers following patients through discharge to home or an alternate care facility. RT department managers need to be part of those discussions when they begin and be willing to blur the traditional lines of care within our scope of practice.
Cheryl Hoerr: Health care is moving from a fee-for-service model to a value-based payment model that requires a new way of providing care. RTs need to stop thinking in terms of episodic care (e.g., an acute care admission) and instead begin thinking in terms of population health (e.g., proactive care to avoid hospitalization). RT leaders should be investigating ways to bring education and therapy to patients instead of waiting for patients to come to the hospital for care.
What kinds of responsibilities do you believe will be added to the RT job description over the next decade and why are RTs the right people to take on these added roles?
Jeffrey Davis: RTs are experts when it comes to the cardiopulmonary system. With advanced training and degree options, RTs will be a greater part of the coordination of care, as case managers specifically, and in the transition between inpatient and outpatient care. A pulmonary disease case manager should absolutely be a respiratory therapist.
Cheryl Hoerr: RTs are experts in “high tech” as well as “high touch” care and we can provide the education and training patients need to stay healthy and out of the hospital. And our assessment and critical thinking skills mean we are perfectly positioned to become physician extenders. Hospitals are expanding outpatient services to compensate for shrinking inpatient volumes, so telehealth and home care should prove to be big growth areas for the RT.
What can RTs do now to prepare themselves to play a larger and more diversified role in hospitals and why is it important to the future of the profession for them to do so?
Jeffrey Davis: We need to be “on the radar,” not under it! We need to be proactive departments, not reactive. Many of our brethren in the field are already there. Advanced education and skills is a start. We need to take advantage of our broad scope of practice. Stop giving away responsibilities and take on more. We can prove we are a value added department and not a “cost center.” It is a big ship to turn and will take time. The changes we make today will positively impact the therapists of the future and keep our field strong.
Cheryl Hoerr: RTs need to grow their knowledge and skills; earning a BS degree will be essential to be considered for advance roles. The RT skills set should include pulmonary disease management and patient education training. Leadership skills will also be critical in a health care environment that will lean heavily on multidisciplinary coordination throughout the continuum of care.