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| Vernon Pertelle |
When reviewing the article
regarding the changes that were announced: KentuckyOne cuts respiratory therapists
from emergency rooms; a few thoughts came to mind. First and foremost
is the fact that the health system is a Market Based Organization (MBO) of
Catholic Health Initiatives (CHI) of which, I was employed as the Vice
President of Clinical Operations at another one of CHI's MBOs. So I understand fully the period of
discernment that occurs when making difficult decisions. Second is the
fact that respiratory therapists (RTs) are essential to meet the complex
medical needs of patients with emergent and acute conditions of the lungs.
Third, is that the perceived value relative to the actual benefits of the
expertise RTs offer, was not clearly understood or articulated during the
deliberations that concluded with the removal of respiratory therapists in the
emergency rooms.
The administrators of KentuckyOne
made a decision that I'm sure they believed was in the best interest of Stewardship
and possibly Growth; however may not have considered the potential negative
impact on Quality and People. Each of the aforementioned [People, Quality,
Stewardship and Growth] are core strategies of CHI and their MBOs. Based
on my understanding of those strategic pillars, having experienced them first
hand (and selected as Top Talent in 2011 by demonstrating them); it is
difficult to understand how respiratory therapists would be eliminated from the
emergency rooms.
The Centers for Medicare and
Medicaid Services (CMS) has included Chronic Obstructive Pulmonary Disease
(COPD) as one of the conditions that the Hospital Readmission Reduction Program
(HRRP) will penalize hospitals for readmission. Respiratory therapists
represent the single best resource to mitigate penalties for readmissions of
patients with COPD. The impact on Quality and frankly the patient's
perceptions of care and their experience will be negative and ultimately will
affect Growth, Stewardship and People. Nurses in the emergency room will be
required to take on the role of respiratory therapist. The learning curve
that the nursing staff will experience is difficult to quantify because it is
possible (although not likely) that the nurses had begun a training program in
anticipation of the change. While nurses, based on their scope of
practice are licensed to perform the procedures; their competence and skills
may be lacking and as a result compromise health outcomes and lead to increased
costs.
Respiratory therapists add value
to the goals of improving quality while reducing costs; which are central
principles of the Affordable Care Act. Eliminating the role of
respiratory therapists in the emergency rooms may result in short-term savings
for the health system, however the long-term repercussions on People, Quality,
and Growth could be greater. Patients have choices about where they receive their
care and they are more informed now, more than ever before, thus the changes
will potentially impact the volumes of the health care system in outpatient
settings, which is an area for Strategic Growth of CHI and their MBOs. Maybe
there needs to be reconsideration of the changes and rather than eliminate the
role of respiratory therapists; expand the role in non-traditional areas such
as Accountable Care Organizations (ACOs) and Patient Centered Medical Homes
(PCMHs) and take advantage of the expertise respiratory therapists provide and
create solutions to improve quality while reducing costs.
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Vernon Pertelle
