Vol. 14 •Issue 20 • Page 24
At Ease with Home Care * At Ease with Home Care
Pennsylvania RTs Help Patients Negotiate Dilemmas in Care
By Frank Gladysz, BS, RRT, CPFT
There are some common dilemmas all therapists face. They frequently begin with a scenario like having a three-day-old nocturnal oximetry report and an order for home oxygen. Does this order qualify the patient? If not, what should be done? Similarly, if Mr. Smith is ordered home on BiPAP, what does it take to get this approved by his insurance carrier?
Here is another familiar question: Does the DME company a patient wants accept the patient’s insurance?
These are tough questions for a case manager trying to juggle many different patients and insurance companies. Try those same questions on a respiratory therapist moving on typical rounds from Point A to Point Z during a routine day.
At the Washington Hospital, a 255-bed community hospital in southwestern Pennsylvania, the Respiratory Care Department came up with a unique and effective way of handling these situations.
NEW POST CREATED
In May 2000, we created the position of “home care” therapist. A core group of six therapists rotate through the assignment to provide coverage Monday through Friday from 9:30 a.m. to 6 p.m. The individual assigned to the job for the day handles all of the respiratory home care arrangements ordered.
Currently the six people filling the “home care” therapist role are Susan Berardi, RRT; Stephanie Duffey; Judy Fenton, RRT; Gene Fordyce, RRT; Eric Martos, RRT; and Jennifer Taggart, RRT.
By having these key people specializing in such a service, many of the common problems often associated with home DME are eliminated. Not only that, we are able to offer a better service to our patients. By knowing each DME company well, we can tailor the patient’s requirements to the strengths of any particular firm.
Take, for example, an elderly patient with a prescription for multiple medications for home aerosols. Or the patient who likes to travel.
No problem. By knowing which DME companies offer pharmacy programs that will premix the medications for the patient and knowing which DME companies have a national oxygen service, we can provide that information to our patients so they can make a more informed choice.
Through our “home care” therapists, we have also helped many patients with problems they encounter after being discharged. Although we instruct our patients to call the DME provider with problems, they still often contacted us with questions concerning everything from where to get a new cannula to billing problems.
By using our special knowledge and contacts with DME providers, our staff are often able to help them solve the problems.
We can also apply our expertise in a completely different direction. Because our hospital has a family practice residency program, our “home care” therapists in-service first-year residents on indications for home oxygen and Medicare requirements that must be met to qualify the patients. This ensures their orders are written correctly, in turn speeding up the discharge process.
FURTHER EXPANDING ROLE
While first envisioned as a position that would deal only with oxygen and aerosol arrangement, the therapists have expanded their role into the realm of sleep medicine too and are now using their special knowledge to help make home CPAP and BiPAP arrangements. They also help with scheduling tests, troubleshooting and making follow-up phone calls. If this is not enough, when there are no set-ups to be arranged, the therapists have been trained to assist with special procedures like pulmonary stress tests and bronchoscopies.
To keep up with changing insurance requirements, new DME equipment and providers and to exchange ideas and concerns, the six “home care” therapists meet every other month to discuss areas of concern. They also make a lot of follow-up phone calls to make certain oxygen, aerosol and other services are being provided as ordered.
What began as an idea to relieve staff therapists from having to do a time-consuming task in the middle of all their other work has blossomed into a position that encompasses several different and challenging areas. The excellent job our six therapists have done is a tribute to them and the commitment of the department to make a difference in the care of our patients.
Frank Gladysz is the director of respiratory services, the sleep center and EEG at The Washington Hospital, Washington, Pa.