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Wednesday, March 30, 2011

Breathing treatments make no money for hospital

When it comes to your RT department boss being happy by the breathing treatment count, he is not happy because a breathing treatment means higher profits for the RT department and the hospital. That's not the case at all.

The truth is, he's happy because of the procedure count. Procedure count is important because the more procedures a department does, the more money is allocated to your department. Likewise, the procedure count has to be high enough to justify the allocation of a staff position.

That's right. In order for you to keep your job you have to do so much work. So the next time you or your co-worker complain about needless work, just think of it from this perspective. I like protocols, yet if we discontinue all needless procedures, we RTs will be our of work.

And trust me, I too am one to complain about needless work. For one thing it makes me feel like an assembly line worker: it diminishes self esteem, dignity and mercy. However, a job is a job. It pays the bills.

As far as reimbursement is concerned for a specific patient, it is a fact that it doesn't matter if you give 1 treatment or 100 to a patient on Medicare or Medicaid, because the Centers for Medicaid and Medicare Services (CMS) reimburses a flat fee for each diagnosis related group (DRG).

This is what happens when we allow the government to make the rules. This is what happens when the government is flipping the bill. So while your department charge for a breathing treatment might be $100, the only person paying that $100 is the person who has no health insurance.

Actually, the best health care reform would be to make it so that people without health insurance paid the same as those who do. This might help lower the cost of medicine as far as the customer is concerned, and it might just allow people visiting hospitals a better opportunity to pay the bill. It might prevent some health related bankruptcies.

On a related issue, Anthony L. DeWitt (AARC Times, December 2010), Whisteblowing 101, wrote that a hospital can bill for the 10 treatments that were ordered while the patient was admitted, and this will not be considered as fraud even if the treatments were not given.

The same principle applies: CMS reimburses a flat fee for a specific DRG (diagnosis). DeWitt writes that:

"In essence, the hospital is banking on being able to treat the patient efficiently and get them out of the hospital quickly. So whether the patient gets one treatment or 10 treatments, the cost to Medicare is the same because it's calculated on the basis of the diagnosis. Internally, the hospital can bill for 40 treatments never done, and it won't have any effect on the final bill to Medicare."

Poppycock? Why sure it is. Yet such is how it is when the government is in charge of flipping the bill. However, as goofy as this sounds, useless and un-indicated breathing treatments that burn you and me out might be what's keeping us on the job.

Something to think about anyway.


1 comment:

kscottrichey said...

Yes, the good old “Kitchen Sink” therapy,

Let’s add some EZPAP, CPT, and we better get a blood gas.

Oh yeah how about consulting a priest to perform an exorcism, and maybe a witch doctor to perform an animal sacrifice or voodoo.