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Hope for the Future: RT Role in Value Based Health Care (VBHC)

By Vernon Pertelle posted 04-06-2014 15:20

  
Health care has changed at a rapid pace over the past five years.  While we're fully aware of the changes occurring under the Affordable Care Act (Act), Respiratory Therapists (RTs) are very familiar with change.  We've seen departments in the hospitals go from centralized to decentralized just  to go back to a centralized model; coverage under the 'Medicare Part A' benefit in skilled nursing facilities (SNFs) for RT services discontinued under the Balanced Budget Act (BBA) during the Clinton administration, and now the role of the RT being eliminated altogether at certain organizations. (see The KentuckyOne Case)  We've embarked on an era that I call "The New Healthcare Normal", in which Value Based Health Care (1, 2) is central and the products and services (inputs) are measured based on the relative value of the outputs (improved health outcomes while reducing costs).  

The vast majority of organizations have always prioritized cost reduction and resource stewardship, however payors including and most importantly Centers for Medicare and Medicaid Services (CMS) will only reimburse/reward providers and organizations if they demonstrate improved quality, better outcomes while reducing costs.  The good news about VBHC is that it's designed to improve access to important health care services by removing barriers and encouraging consumers of care to become more engaged to live healthier lifestyles. VBHC is predicated on developing networks that prioritize high-quality and high-value health care to mitigate the need for high-cost medical services.  

This creates an opportunity for RTs to thrive by providing exceptional respiratory patient centered care for patients diagnosed with Chronic Obstructive Pulmonary Disease (COPD).  While there are many more conditions that are relevant under the VBHC methodology; the burning platform is in controlling and reducing costs associated with COPD.  CMS' Readmission Reduction Program will include COPD in FY 2015 and providers, organizations will be assessed penalties based on CMS' Excess Readmission Ratios.  (See CMS Readmission Reduction Program Overview).  CEOs and CFOs of organizations are aware of the penalties and charged with developing solutions to prevent them. The impact on the bottom line could be significant based on the overall revenue of the organization.  Thus the timing is ideal for RTs to demonstrate value through programs and services that can help with the challenges of managing patients with COPD.

The first step is in developing a comprehensive strategic plan that is value based; second is to identify key stakeholders to demonstrate the program's value and third is to build a network that is scalable to assure the program's effectiveness and success.  Now is certainly not the time to wait on the sidelines for the changes to occur; we now have an opportunity to be proactive and develop solutions that establish RTs as a valuable and essential component of the continuum of care.

1 Michael E. Porter and Elizabeth Olmsted Teisberg, Redefining Health Care: Creating Value-Based Competition on Results (Boston: Harvard Business School Press, 2006), 86-87.

2 Michael E. Porter, “What Is Value in Health Care?” New England Journal of Medicine (2010) 363:2477-2481.




 
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