The Science Journal of the American Association for Respiratory Care

2003 OPEN FORUM Abstracts


THE RATIONALE FOR THERAPIST INVOLVEMENT IN THE DELIVERY AND UTILIZATION REVIEW OF NEBULIZED MEDICATION AND CHEST PHYSIOTHERAPY IN ACUTE AND GENERAL CARE SETTINGS.

Randy Scott, BS, RCP, RRT; Grey Benton, MA, RCP, RRT; Leo Langga, BS, RCP, RRT; Philip Gold, MD, MACP; Katy Terry, RC Billing Coordinator. Loma Linda University Medical Center and Children's Hospital, Loma Linda, California.

Background:
Some facilities have and some intend to, shift intermittent respiratory care duties to Nursing services in acute and general care units. We hypothesize that it is more fiscally responsible to provide the care by Respiratory Therapists (RT).

Method: We examined costs associated with revenue, equipment, drugs, personnel, utilization review (UR) and education to assess the potential impact of shifting acute and general respiratory care to registered nurses (RN). Critical care areas were excluded. Data from 2001 and 2002 were used and extrapolated to present day dollars. Medicated nebulizer (MN), metered-dose-inhaler (MDI), chest physiotherapy (CPT) and incentive spirometry (IS) were included, accounting for 89% of the work in these areas. A range of training times for RNs providing care was determined by surveying instructors from two-year programs for RTs and RNs.


Table 1: Fiscal Impact RT RN (minimum) RN (maximum)
Net cost of UR program $25,499 $20,038 $20,038
Cost of providing care -$1,120,467 -$1,436,798 -$1,436,798
Cost of training $0 -$3,442,382 -$968,803
Billed & Collected revenue $4,334,550 $0 $4,334,550
Column totals (yearly) $3,239,583 -$4,859,142 $1,948,987



RESULTS:
(1) The UR program uses roughly one full time equivalent (FTE) between adult and children's areas and has a net positive balance due to reductions in unnecessary care. Nursing service's impact would be about 21% less due to their higher salary. (2) Using RNs would increase the cost of providing care by about 28%. (3) The initial training cost for 2,800 RNs would be between 8.6 and 31.1 million dollars (depending on the education standard used for training) and would take at least 61 days (two training sessions/day, seven days/week). (4) Using survey data from 10 RT and 15 Associate Degree RN programs in California, we established that the amount of training time for RNs to match the RT education standard was 172.7 hours. This is the sum of the differences in hours of education (Ed-Hrs), for the procedures surveyed, between RT and RN programs (see table 2 below). (5) Ongoing RN training costs due to attrition would be between 0.97 and 3.4 million dollars per year (depending on the training standard used) and would take between 43.0 and 172.7 hours for each RN.

Table 2: Ed-Hrs Patient Assessment RT Medications MN/MDI CPT/IS Totals
RT Programs 103.4 38.2 38.2 35.8 215.7
RN Programs 20.3 6.0 7.8 9.0 43.0


(6) With RNs performing RT procedures, there would be a net revenue loss of 4.3 million dollars, unless RNs are able to bill over and above the room rate. Even if nursing services billed and used the minimum standard for training (specified by the RN programs themselves), there would still be a net loss of 1.29 million dollars per year when compared to RTs providing care.

CONCLUSION:
Currently, the net effect of shifting 20.5 FTEs of respiratory care to nursing services would be a loss of between 1.29 and 8.1 million dollars per year after the initial training investment of between 8.6 and 31.1 million dollars. The actual loss would depend on nursing services ability to bill for care and upon the education standard used. Our data indicate that it is fiscally prudent for RTs to provide intermittent care in acute and general care units.

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THE RATIONALE FOR THERAPIST INVOLVEMENT IN THE DELIVERY AND UTILIZATION REVIEW OF NEBULIZED MEDICATION AND CHEST PHYSIOTHERAPY IN ACUTE AND GENERAL CARE SETTINGS.