Moving Forward

How does an RT advance? It’s a question that comes up often in the context of this checkered belt-tightening age. When ADVANCE blogger Kevin Johnson, RRT, wrote about his personal uncertainty concerning his evolving career path, a reader/fellow RT posted a stern warning:

“With reimbursements and state aid shrinking, it is only a matter of time before floor therapy becomes the RN’s responsibility. Of course hospitals won’t phase out [respiratory] positions completely, but they will reduce their departments. . PA or RN is the sad logical choice for those who want to have a more secure future in healthcare..”
However there are those who believe respiratory therapists still have some important moves to make on the chessboard of healthcare. Robert McCoy, BS, RT, FAARC, recently trumpeted a message of opportunity at a 2013 conference of the Oregon Society for Respiratory Care.
Home Care Signals Opportunity

“This it an exciting time in respiratory care,” McCoy told ADVANCE of his view of the field. “Yes, we are in a transition process. We’ve got a disaster on our hands, and respiratory therapy should step up to the plate and fix it.”

The “disaster” McCoy referred to is competitive bidding for home oxygen therapy supplies meant to drive down costs. The problem with that approach, according to McCoy, is that DMEs may well provide oxygen to home care patients, but therapy? Not so much.

“What the healthcare industry has gotten into is equipment delivery,” he stressed. “You are not getting outcomes based on a DME delivery person who knows how to turn machinery on, change filters and tell a patient how long tubing might last. This is not oxygen therapy. And it’s the therapy that ultimately will deliver better outcomes.”
McCoy believes respiratory therapists have an opportunity to step into the role of home oxygen therapy providers and supply an invaluable service at this crucial time when preventing hospital readmissions is key to reimbursements.

But that word – reimbursements – is also part of the challenge. Indeed payers, hospital administrators, discharge planners and case workers still regard home respiratory care largely as “a check-off item on their care sheet that says ‘oxygen,'” said McCoy. “It’s amazing to me – hospitals have teams of people geared toward preventing readmissions, yet they are doing it with hospital-based clinicians who know very little about the home environment. You may have visiting nurses, but they are not necessarily skilled in respiratory care. All of the equipment may appear to be in place, but the patient could be under-oxygenated, unable to move, filling up with secretions and on his way to being hospitalized with pneumonia. We need to put hefty resources into the home environment, but right now home care is the black hole of clinical care.”

McCoy said the key to finding RT job security through home care will be educating payers to value the service and place a reimbursement code on it. It will take time, and possibly pilot programs to test and prove the value of in-home therapy.

“For now, home equipment drop-offs continue, and patients are at risk,” he lamented. “But you know, until there is a fatality on the corner, you don’t get the stoplight. And until bean counters see that costs go up astronomically when patients get sick from lack of real oxygen therapy and get hospitalized, we’re still waiting for the respiratory stoplight.”

Embracing Transport
Scott Hubbell, MHSc, RRT-NPS, C-NPT, CCT, a former Kansas college RT program director, has taken his own career to new heights by becoming a member of a flight transport team. “Transport is a biggie – a specialty field that RTs often miss,” he noted. “It’s huge – any type of critical care transport is fertile ground for RTs. On most crews you have an EMS, a nurse – and while they do emergent care, what if a patient is on BiPAP? Knowing how to manage that airway in an advanced situation, and knowing how to manage that vent afterward, absolutely saves lives – you need an RT to run the respiratory side of things.”

Part of the lure of transport work, said Hubbell, is the extraordinary range of practice it allows. “There’s no other place I know of where I can practice full-scope of practice. RTs have more than 100 clinical interventions, and I’d bet in most facilities RTs handle less than 50. During flight transport I practice all of it. If a patient needs intubation, I intubate; needs an IV, I’ll start it; needs a drug push, I’ll push it. It’s challenging, demanding and extremely satisfying.”

Hubbell said RTs should also be pushing to move more robustly into the emergency department, with the same skills – intubations, IVs, drug pushes. “At some facilities there’s an implication that RTs aren’t skilled enough for those tasks – they call in some other health professional at a hefty cost. Why not utilize the RTs’ skills and competencies?”
Hubbell suggested that the more that can be assigned to RTs, the healthier the profession will be. However, he pointed a finger at the field in general as being too complacent.
“I teach professional outreach classes all over the region – 98% of the people who show up are nurses, doctors. Once in a while I’ll get a stray RT – but it’s rare. This is strictly my opinion, but I believe it’s a matter of lowered expectations on the part of respiratory. That has to change.”

A Multidisciplinary Approach

Liberation from LMV

Clinicians can liberate patients faster from long-term mechanical ventilation.

The Education Option
Joseph P. Coyle, MD, clinical associate professor, director, UNC Charlotte BSRT program and head of the North Carolina Respiratory Care Board, said an evolution in respiratory care is opening the door to increased opportunity. “The growing complexity of the profession is becoming more integrated with the use of protocols, clinical involvement in terms of consultations and collaboration with other healthcare providers,” said Coyle. But to realize that heightened role, one thing will have to come first: More education.

“RTs will have to understand more than the respiratory procedures they learn at an associate level,” said Coyle. “In its ‘2015 and Beyond’ initiative, AARC has been advocating a move to a higher level of education – to baccalaureate status – to provide the competencies that will be needed in the future. And clearly, the future is not far off.”

Coyle concurred with AARC’s stance, noting “There just isn’t enough time in a standard 22-month associate-level program to get into advanced competencies, evidence-based medicine, cardio pulmonary physiology, critical care patho-physiology, pharmacology, program management, communication skills and more.” He added that extended education will allow respiratory providers to “think, write and communicate more broadly, to assess the literature and apply it in a better fashion, and ultimately be able to communicate more as professionals and less as technicians.”

In addition to putting RTs on an even playing field with other healthcare providers, Coyle suggested that education will in time “remove the ceiling for RTs. That ceiling exists because 80% still have associate level education. So they don’t move up in management or hospital administration. But with a baccalaureate degree, they can go on to pursue a higher level of RT, an MHA, an MBA. . They will be able to advance professionally through the whole spectrum of a hospital or healthcare.”

Valerie Neff Newitt is on staff at ADVANCE. Contact: [email protected] .


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