The Diverse Role of the Respiratory Care Practitioner in Home Care

Practitioners might be involved in many different duties and responsibilities, and play a vital role in the home care DME business.

Leroy Perez, CRT, RCP

Over the years, we have seen an increase in respiratory patients in the home care durable medical equipment (DME) arena. The number of patients with obstructive sleep apnea, chronic obstructive pulmonary disorder (COPD), or neuromuscular disorders, and newborns requiring apnea monitoring has been on the rise. As RCPs investigate opportunities and evolve into the home care DME business, they are finding an ever-changing work environment. The days have changed from when they just set up concentrators and nebulizers; today there are new avenues in RCPs’ roles. As with any specialty, the more knowledgeable a person is in the DME area, the more marketable they become. There is more to home care DME than in previous years. RCPs play a more involved role, such as marketing DME to case managers, social workers, and physicians. RCPs are now involved in marketing and maintaining relationships with managed care networks. They are also involved in obtaining prior authorizations for high-end respiratory DME (ventilators, continuous positive airway pressure, and bilevel positive airway pressure). Knowledge of Medicare guidelines and requirements plays an enormous role in DME, which requires RCPs to be well versed in this area. This helps in preventing and lowering denial rates, which directly affect profit margins and the bottom line. In the traditional hospital setting, these issues are nonexistent outside of diagnosis related groups (DRGs).

The DME market is a very dynamic environment especially toward the end of the week and on Fridays. For this reason, RCPs need to be proactive and anticipate equipment and supply needs. Communication with physicians and case managers often gives RCPs the needed advance notice of pending discharges. This is key in being prepared for the end of the week.

Teaching and Training
Teaching and training is still at the core of home care DME. RCPs play an instrumental role in this area. The more time they spend with patients and the more detailed the teaching and training, the less likely there will be after-hours calls. The initial time investment with the patient is very crucial. This is the time when RCPs begin to form a positive relationship with patients and start to build trust. Getting called out after hours incurs additional hourly pay, which adds up the overtime for the pay period. There are two ways to address this issue: arrange for compensation time off or accept the overtime. While home visits by RCPs are still not covered by Medicare and most managed care networks, this is still a very crucial service. RCPs can perform diagnostic tests/procedures in the home setting with a valid prescription from a physician. These services can help them to intervene prior to an acute onset. Some procedures that can be performed include oximetry, peak flows, and bedside pulmonary function tests. Most, but not all, are covered under Medicare or managed care networks. These are the opportunities for RCPs to contact the managed care case managers and discuss patients’ current conditions and desired goals, which can prevent an emergency department visit or early hospital admission. This can actually prevent added cost to the managed care company. Situations like these are invaluable marketing strategies.

Home care patients have an enormous information resource in RCPs. They can discuss and educate patients about COPD and asthma, and explain the disease process. RCPs can also inform patients on how their illness may affect them, what they can expect, and what measures they can take to help limit their acute onsets. Early intervention still remains key. Once again, teaching and training is vital and RCPs can cover a wide range of topics. Activities of daily living and current respiratory status are some examples. RCPs can also teach patients how to monitor their own respiratory status and how to be aware of any significant or acute changes.

Patients
RCPs deal with a wide range of patients/clients. This is why interpersonal skills are very important. They have to be very patient-oriented and have patience when dealing with home care patients. Patients often are very unsure of what is going on with their health and sometimes their new diagnosis. RCPs need to take the time and try to make patients feel comfortable and safe with their newly prescribed equipment.

Problem solving is a vital skill that RCPs must possess. Often, in the home setting, RCPs have to quickly modify or troubleshoot equipment while keeping the patient calm and safe. This is especially true when dealing with home ventilators. There are many topics that RCPs need to cover when educating family members and caregivers, along with in-servicing the Home Health Nursing Agency. Addressing the needs of the nursing agency is vital not only for the patient and the current case, but for future marketing and networking. This can pay off in the long run by producing new referrals.

Apnea Monitoring
The number of infants with apnea of prematurity has also been on the rise. Throughout the country, there are similar trends. For RCPs, this area can be very demanding and tedious as they are responsible for apnea monitor programs. The most important responsibility is education and training. Parents need to become very comfortable with the apnea monitor so they can properly set up the monitor for the infant. The majority of after-hour calls come from caregivers who are having problems with the monitor. Usually, troubleshooting via phone can solve the problem. In these situations, RCPs have to keep clients calm and under control until the problem is resolved. Downloading monitors is another skill that RCPs should master. There are several different factors that come into play, such as coordinating the dates and times with caregivers, which can be challenging, not to mention finding locations in which the monitors can be downloaded. At that time, RCPs should reinforce prior education that has been shared with the caregiver, such as the three primary times that infants need to be monitored including when infants are napping/sleeping, when they are not in view, and when they are in a car seat.

Management
Management is another position where RCPs can become key members of DME organizations. There are several companies that employ RCPs as branch managers. The knowledge that RCPs possess plays an enormous part in the success of the branch. They can educate customer service representatives, marketers, and delivery personnel on respiratory equipment. They can also help support the marketers on calls that concentrate on respiratory equipment.

Sales and marketing positions are other avenues that RCPs can take. Once again, the RCPs’ knowledge is an added plus. They are able to discuss respiratory equipment in great detail with case managers, social workers, and physicians, which is a great marketing strategy.

Documentation is also a skill that RCPs must master in the DME home care setting. There are usually teaching and training materials that are covered with the patient. Other than that, the only other documentation that will become a part of the patient’s medical records is that of the RCP. Going back to basics, if it is not written, it was never done. Often the RCP’s documentation can help overturn denials or be instrumental in any type of liability or legal proceedings. The documentation can assist companies in investigations. As you can see, there are many different duties and responsibilities in which RCPs may be involved. Overall, they play a vital role in the home care DME business. RCPs can find a very challenging and satisfying position in this area.

Leroy Perez, CRT, RCP, is the clinic manager of Specially for Children at Children’s Hospital of Austin, Austin, Tex.