Making a Difference

BenjaminMarian Benjamin

The Centers for Disease Control and Prevention estimates that 6.2% of children in the United States have asthma. It is more prevalent in poorer communities, although experts can find no specific reason why that is so. Happily, several ambitious programs have been developed to treat childhood asthma in areas where the populace has a limited social/economical background, and these programs have met with some success.

Respiratory Consulting Services Inc (RCS), a school/home-based program, was launched by Harold Finn, CRT, RCP. In 1989, Finn was (and still is) the director of cardiopulmonary services in a small rural hospital in Williamston, NC. Through his position there, he was acutely aware that local children with chronic respiratory disorders were in what he calls a revolving door situation. “The children would present to the ER, be admitted to the hospital, and then be discharged after 2 to 3 days of bronchial hygiene and respiratory management. On an average of every 3 weeks, the cycle would repeat itself,” says Finn. The expense of these hospitalizations placed a great economic burden on families, many of whom were uninsured.

In collaboration with a group of pediatricians, Finn’s concept for his company developed as a solution to this dilemma. Although Finn knew that RTs could provide the same respiratory services in home and school settings that were being provided in the hospital setting, funding for outpatient respiratory services for children was not provided through North Carolina Medicaid. When Finn contacted Medicaid to see if funding could be made available, his concept was met with skepticism even though funding was available for other outpatient services such as physical, occupational, and speech therapies. He persevered and finally found someone willing to talk to him about a plan for outpatient respiratory care. Initially, reimbursement included only services for children with chronic respiratory disorders such as cystic fibrosis, bronchopulmonary dysplasia, and cerebral palsy, and children with tracheostomies and those on ventilators, but not asthma.

In 1999, RCS was approached to provide asthma care management as it had been providing chronic respiratory care. Again, reimbursement was an issue. Finn went back to Medicaid—this time with documentation of cost savings through his chronic respiratory program. Faced with this evidence, Medicaid established reimbursement for RTs to provide asthma management in much the same way as for chronic care—taking the services to the child.

Finn’s program is unique. Unlike 99% of programs that are funded by soft money, such as grants and through foundations, RCS is now a preferred provider for many major insurance companies. Even if uninsured, however—10% to 12% of children served by RCS have no insurance—all children who need services will receive them from RCS. “Children don’t deserve to be sick,” Finn says. “We work with every child.”

Consistently, children served by RCS have experienced not only decreased ER visits and hospitalizations, but decreased absences from school as well. Other outcomes include an increased ability to participate in physical activity, increased academic performance, and an increased level of asthma knowledge and self-management skill.

Clearly, Finn’s experience demonstrates the difference one RT can make in the quality of life of poor children with asthma and the financial burden of repeated emergency room visits and missed school days—both of which can have lifelong consequences.

—Marian Benjamin