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Hospitals are feeling the pinch, and it's much bigger than a needlestick.
As U.S. unemployment vaulted to a 25-year high of 8.5 percent, more patients newly without health insurance and already short on cash are eschewing elective procedures, inpatient surgeries, and emergency room visits. Those in desperate need are relying on charity care.
 Nearly half of 736 hospitals surveyed by the American Hospital Association saw a moderate or significant increase in non-paying patients since July 2008.1 Hospitals already enduring decreased Medicaid and Medicare reimbursements footed the $923.6 million bill.2
"It is important for us and other hospitals to take care of individuals who have serious illnesses who may be losing their health care," said Michael Cornelius, RRT, Esq., manager of noninvasive services at Merrimack Valley Hospital in Haverhill, Mass. But that begs the question: "How are we going to take care of those individuals?"
For many respiratory department managers, the answer has been to offset these costs by increasing reimbursable services, using staff more efficiently, and making strategic purchasing decisions. They are working hard at working smarter.
Adding value
Respiratory therapists at St. Luke's Northland Hospital in Kansas City, Mo., are no stranger to performing work outside the typical RT job description. For nearly a decade, they have performed 63 percent of in-patient phlebotomy. More recently they have joined the hyperbaric lab and performed electrocephalograms, electrocardiograms, and pulmonary function testing along with their normal respiratory workload.
"Not everyone loves doing the cross-trained stuff, but it is really for us, being a small institution, one of the best ways to take care of things," said MaryLou Guy, MBA, RRT, CHT, the manager of cardiopulmonary and neurodiagnostic services.
Guy has been looking to expand respiratory's scope even further by establishing an outpatient pulmonary rehabilitation lab. She plans to work with partner physicians' practices to provide annual spirometry screening and early intervention for patients with chronic obstructive pulmonary disease.
Even if respiratory departments cannot expand services, opportunities exist to improve RTs' value within the hospital. Studies already have shown that RT-directed protocols can improve the timeliness of care and patient outcomes, but managers now are finding they offer significant cost savings.3
It is more important now, more than ever, that we position ourselves such that we are accepted and have proven that we belong in a more forward-thinking, more advanced practice environment," said Michael J Hewitt, RRT-NPS, RCP, FAARC, FCCM. "If we don't, we will not survive as a discipline."
At Peninsula Regional Medical Center in Salisbury, Md., Hewitt is implementing proactive protocols. For example, therapists begin treating postoperative and traumatic injury patients who by criteria are at risk for potential pulmonary compromise and complications even if they have a clear chest X-ray and no signs or symptoms.
"(We) try to keep the patients from getting to the point where they develop lung processes that increase their length of stay and put them more at risk," said Hewitt, director of the Respiratory Care, Pulmonary Diagnostics, Sleep & Neurology Department.
In his previous employment, proactive protocols significantly reduced postoperative and post-traumatic patient population length of stay, mortality, and admission to the intensive care unit. "All of (these) have a significant impact on a patient's outcome, but also - as we have to be very aware of as directors now - an impact on our financials."
Relying on ingenuity
Even reactive protocols have value. While 95 percent of patients receive levalbuterol at Rockingham Memorial Hospital in Harrisonburg, Va., a protocol allows therapists to administer treatments every eight hours instead of four or six hour intervals.
"That has saved a ton of time," said Stan Holland, MS, RRT, director of Pulmonary and Sleep Services. Regaining the equivalent of two full-time employees means therapists who used to be tied up administering basic treatments now have been redeployed to work more hours in the critical care unit, staff a new open heart program, and attend more than 500 emergency Cesarean sections each year.
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