Top Issues for 2012

Nearly 250 respondents to ADVANCE’s Top Issues for 2012 survey pegged personnel and department management the top concern for the coming year. But that’s not all that has your stethoscopes in a bunch. Reduced finances and health care reform implementation came in close as the biggest challenges. Get a jumpstart on tackling these stressors with tips from health care management experts who shared their best practices.

Staff management

At a recent presentation to respiratory care managers, Stan Holland, MS, RRT, FAARC, found that nearly everyone in the audience has been sending staff home because of low census. Changes in payer mix as laid-off workers switch from private pay insurance to Medicaid are reducing hospitals’ income. Also, many potential patients remain uninsured and aren’t coming to hospitals unless they’re desperately sick. To compensate for lost revenue, hospital administrators are looking for ways to trim labor costs because it’s their biggest expense. It’s up to department managers to balance necessary cuts to full time equivalency (FTE) with safe patient-staff ratios.

So it’s no surprise that 28 percent of respondents who identified personnel/department management as a top concern were worried about staff satisfaction. Poor levels of engagement or morale can be costly to health care organizations in terms of increased turnover, decreased productivity, and inattentiveness to patients.

Holland encouraged department managers to share with staff the financial pressures facing the department. For example, as director of pulmonary services at Rockingham Memorial Hospital in Harrisonburg, Va., Holland was challenged to increase staff productivity to 100 percent and maintain it while adding a third person to the night shift. As a result, employees have used more than 600 hours of vacation time to cover for called-off shifts. But because Holland shared the goal with his staff and trusted staff team leaders and charge therapists to decide when the department needed a higher staff-patient ratio, the department has seen no turnover for the last 18 months.

“I told them: ‘I need your expertise, because you are going to see things that I will not and patient safety can never be compromised,’” Holland said. He has also assured staff that he’ll bring concerns over the stringency of the goals to administration.

Validating respiratory staffing levels can be difficult because about 85 percent of respiratory services do not have a current procedural terminology code. Respiratory therapists attend complicated labor and delivery cases to give preemies’ their first breaths. They avert dislodged intubation tubes while transporting ventilator patients to radiology for computed tomography scans. Or they avoid full blown codes by participating on rapid response teams. Yet these important tasks can make the department appear less productive because fewer minutes are being spent on direct bill procedures.

“You have to approach it from a safety standard,” advised Scott Leonard, director of respiratory therapy, EEG, neurophysiology at The George Washington University Hospital in Washington, D.C. “A sentinal event or lawsuit could easily cost upwards of $20 million dollars,” he said. The hospital’s risk management committee can help quantify RTs’ role in preventing these events by using statistics on ventilator days, intensive care unit length of stay and hospital stay, ventilator-associated pneumonia rates, intrahospital transport incident rates, and other benchmark goals. Leonard also encourages staff to document any missed treatments because they will help to show administration the necessity of increasing FTEs.

Finances and health care reform

Nearly one-third of survey respondents concerned about finances pointed to changes to Medicare and Medicaid reimbursement as a source of alarm for 2012 – and with good reason. Medicare plans to decrease reimbursement for the physician fee schedule by 27.4 percent Jan. 1.

“Any time a payer – especially one as big as Medicare – reduces what they are going to pay a hospital, it sends shivers through an organization,” said John Sestito, MS, RRT, associate executive director of clinical practices of the University of Pennsylvania in Philadelphia.

Looking for potential revenue sources outside of the department can help improve the department’s budget. Staffing pulmonary function laboratories, teaching pulmonary rehab, and assisting in outpatient bronchoscopies are a few services within the RT’s scope of practice that are reimbursed on their own.

Respiratory and sleep departments also should prepare for more careful inspection of the way care is delivered because hospitals are being pressured to determine the exact costs of providing services. One way for department managers to accomplish this is to identify redundancies in their delivery model.

For example, when a chronic patient with asthma improves and no longer needs regular albuterol treatments, was the order ever cancelled by the physician? Are there other therapies or interventions that can be used to shorten a length of stay, prevent further exacerbations, or reduce unnecessary therapies/testing?

Stay Tuned

    Keep an eye out for digital workbooks addressing 12 issues identified as top concerns by respondents to our Top Isues for 2012 survey, beginning in January.

Such strategies will be increasingly important as the Centers for Medicare & Medicaid Services begins accepting applications for accountable care organizations in January. These networks of doctors and hospitals will share in Medicare cost savings in exchange for being accountable for the quality, cost, and overall care of Medicare beneficiaries. The billion dollar question is whether this will improve or further burden health care delivery.

“The problem is that we don’t know,” Sestito said. “The system is so complicated that we don’t know if we are giving tests unnecessarily.”

Sestito’s best advice is for respiratory and sleep department managers to keep in touch with health care systems that already follow the ACO model. “Keep informed about what is happening in the market out there, not just what is happening in your hospital,” Sestito said. “You really have to be ahead of the curve and say, “If this were happening here, what would I do?”

Kristen Ziegler can be reached at [email protected].