Vol. 18 •Issue 15 • Page 27
Is There a Specialty Asthma Clinic in Your Future?
Airway diseases in the United States create some major health care problems. It has been estimated there are 17 million Americans with asthma and an additional 10 million with chronic obstructive pulmonary disease. Left untreated, both conditions can result in disabling symptoms, a high cost of care and substantial mortality.
Studies show that a significant proportion of asthmatics and COPDers are sub-optimally controlled and consume a disproportionate share of health care resources. Needless to say, this void has caught the attention of some.
Floating around are buzz terms like “disease state management” and “revenue-generating potential.” Both have made the opening of specialty clinics for airway disease increasingly popular.
Indeed, specialty clinics for airway disease management can be a good thing. Such a clinic can provide a patient with access to specialists who have the skills and experience necessary to assist them in managing their condition. The key is adequately staffing your clinic with knowledgeable personnel, ensuring you are sufficiently stocked to manage the patients and defining the scope of your practice before the first patient arrives at your door.
To therapists, it would seem obvious that respiratory care practitioners should staff the clinic. This is a matter for considerable debate, however, and arguments pro and con vary from state to state, depending on the licensure laws in effect.
Certified Asthma Staff
What about holding the certified asthma educator credential? The requirement to take the National Asthma Educator Certification board (NAECB) exam is that the individual must be a licensed or credentialed health care professional or have at least 1,000 hours of experience providing asthma education, counseling or coordination services.
Among the professionals who qualify to take the exam are physicians, physician assistants, nurse practitioners, nurses, pharmacists, social workers, health educators, physical therapists, occupational therapists, RCPs and pulmonary function technologists.
If these individuals are knowledgeable in asthma management, which is what the exam is designed to determine, this is OK. But a clinic managed by someone who “plans on taking the exam” could be of concern. In addition, it is wise to note that non-health care professionals who meet the 1,000-hour criteria also qualify to take the asthma educator exam.
Sadly, the people needed to staff a clinic may be determined on the basis of those who can bill and generate revenue. Asthma education is reimbursable by the Center for Medicare and Medicaid Service (CMS) and subsequently most insurance companies. The question may come down to who has prescriptive rights in your state and who can bill at what level.
Altruistically, we would like to think this will not be the driving force behind the establishment of the clinic. We would like to assume patient care and safety would be of primary concern. But we have to be realistic.
From a patient safety perspective, clinical staff should address a reality that patients with comorbidites will present themselves for care and these individuals may go so far as to use the clinic as their sole health care provider. So be prepared for that!
Stocking the clinic can also be a matter of discussion. Standard stock should include the obvious: patient education materials, nebulizers, spacer devices and peak flow meters. Not so obvious are other vital wares like a spirometer and resuscitation equipment. The later is especially important if you are a stand-alone clinic or are affiliated with a private practice.
You may believe you will not see critically ill patients and you will refer them to the ED if you do. But in reality, they may see you. The patient may arrive in a life- threatening exacerbation and you may not have a choice. So you need to consider the following as well: Do you have O2 available? Can you intubate patients if required? Are your personnel qualified and skilled to do so?
Defining the scope of your clinic and preparing for contingencies is vital to the success of the endeavor and most importantly the safety of your patients. This is of particular concern to those establishing clinics associated with private practices which may be located in physicians’ office buildings. If you are in this situation, the legal waters can be pretty murky.
Is the physician’s practice a separate entity which merely rents office space from the hospital? Does the practice already have an agreement for certain services? If so, you may be able to expand that agreement to include the needs of your clinic. If not, a contractual agreement should be established to define services, liability and emergency responses.
If the physician is an employee of the hospital or a health care system, other rules may apply, depending on the relationship between the physician and the hospital or system.
Plan for Emergencies
Hospital-affiliated clinics need to define their emergency plans. It is in vogue for these clinics to be set up as separate legal entities, primarily for revenue and billing purposes. However, as a separate entity, the specialty clinic may have to contract and purchase services from the hospital. This is not new or uncharted territory. In fact, it is a twist on the long-term acute care model.
Many LTAC centers are located within or adjacent to a hospital and contract needed lab and radiology services from the parent facility. By following this model, individuals eyeing the establishment of a specialty clinic may be able to set up their clinic in such a way as to ensure that their patients’ needs will be met in an emergency.
The bottom line is clinics that are established to provide quality patient care services are needed in the United States. But we also need to recognize that since “specialty clinics” do have the potential to be the next great revenue generator, we need to protect our patients from the unscrupulous.
It would not be surprising to find an “asthma clinic” set up in the mall in a store that sells air filters and allergen-reducing sprays. It is even conceivable a chain of such stores could be set up across the United States. There are millions of Americans who need help managing their airway disease. If we as health care professionals don’t step up to the plate and provide the service, someone else will.
Margaret Clark is a Georgia practitioner.