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.


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How do RT departments make money?

How do RT departments make money? To answer this question, I think I'll take a backward step and ask a slightly different question: How do hospitals make money?

Unless the patient is paying out of pocket, the admitting diagnosis is what determines how much money the hospital makes on a particular patient visit. According to "Egan's Fundamentals of Respiratory Care," each patient is designated a specific Diagnosis Related Group (DRG) based on the diagnosis.

The Healthcare Financing Administration assigns a set reimbursement for each DRG. Thus, according to Egans, "Because the amount remains fixed for each admitting diagnosis, hospitals know in advance exactly how much reimbursement they will receive... Hospitals that can provide care for less than the fixed rate can keep the difference, thereby realizing a 'profit.'

"On the other hand, hospitals whose cost of care exceeds the fixed rate must absorb the cost and thus take a financial loss. By placing hospitals at risk financially, this system provides a powerful incentive for cost efficiency."

The best way to cut cost is to use the fewest procedures needed to make the stay as short as possible.

This in mind, the RT department really doesn't make any money off the therapies it does, unless those therapies get the patient better and fast.

Now, considering I believe that about 80% of the bronchodilator breathing treatments we do are not indicated, it's amazing to me that no one ever cracks down on this. I imagine what keeps this RT Cave intact is the RT Cave bosses not allowing admins to catch on to this in order to keep the procedure count up in order to keep your humble RT on the job.

Ideally, according to Egan, the goals of therapy should be clearly written in the patient's chart, and once they are met the therapy should be stopped. Egan notes that "To be cost effective, all therapy must be justified adn discontinued when no longer needed."

Yet this isn't usually the case. Rarely if ever have I seen an RT treatment discharged. Egan mentions that RT Driven Protocols are great here. I know many hospitals have them. Still, many hospitals that have protocols don't use them properly to discontinue therapies.

One reason is because RT departments need procedures to keep RTs on the job. A second reason is the hospital needs to meet intensity of service in order to get reimbursed. In this regard, often treatments are given even when not needed. A good examle of this are order sets wehre treatments are ordered automatically just so the hospital covers it's intensity of service bases.

So we can see how a hospital might make money. The greater question is: So, how do RT departments make money? I don't have an answer to that. Do you?