RTs Can be Key Players in Discharge Planning and Preventing Readmissions

June 27, 2013

Respiratory therapists can be key players in Medicare plans to improve discharge planning and prevent hospital readmissions, and the AARC is making sure the Centers for Medicare and Medicaid Services (CMS) gets that word.

Two recent developments with CMS are important to the respiratory therapy community. The first is that revisions to discharge planning guidelines now recognize respiratory therapists as integral to a well-designed discharge evaluation process. The second is comments that AARC has submitted to CMS in relation to its proposal that COPD would be part of the Hospital Readmissions Reduction program beginning in 2015.

Discharge Planning

On May 17, 2013 CMS issued a memo to all State Survey Agency Directors regarding substantive revisions to the Interpretive Guidelines on Discharge Planning. With the many innovative Medicare payment models underway that emphasize care coordination, transition planning, community care transitions and hospital readmissions, CMS believes that it is necessary to strengthen the discharge planning process so patients can be more involved in their health care and improve their recovery.

The good news for respiratory therapists (RTs) and their patients is that CMS recognizes RTs as integral to a well-designed discharge evaluation process that uses a multidisciplinary team. More important, specific requirements as part of the evaluation process include an assessment of whether the patient is capable of taking care of his or her needs through self-care and the extent to which they may need post-hospital services such as respiratory therapy.

One of the recommendations of the Medicare Payment Advisory Committee back in its 2007 report on preventing hospital readmissions was that patients should receive self-management education pre- and post-hospital discharge. So, the new guidelines also help support our Part B initiative to provide self-management for pulmonary patients in the physician practice setting once they have been discharged.

A unique feature of the new guidelines is what CMS refers to as the “blue boxes.” These are advisory practices designed to promote better patient outcomes and are not to be cited by surveyors with respect to hospital compliance with the Conditions of Participation. The information in the blue boxes is meant to display care transition practices that have proven to be successful throughout the industry. This “official” CMS document helps make the case for the respiratory therapist to assume a greater role in his or her facility’s discharge planning process.

Readmissions Reduction Proposal

The revised discharge planning process comes on the heels of CMS’s proposal to include Chronic Obstructive Pulmonary Disease (COPD) as part of the Hospital Readmissions Reduction program beginning in fiscal year 2015. The AARC submitted comments to CMS on June 24 that highlighted the skills of RTs and why they can play an important role in preventing hospital readmissions. Emphasis was placed on AARC’s proactive approach to collecting “best practices” from our members that show financial savings and reduced readmissions for COPD and asthma that have been integrated into their hospital department’s policies. We also offered to share the data with CMS once it has been vetted and the clearinghouse has been established.

While the reality of Medicare coverage policy provides very limited coverage of RT services outside of the hospital setting, any time CMS recognizes RTs in a positive way makes that document a good document indeed.