Hartman gives standing orders

MONTROSE, Colo.--Hartman Brothers Medical believes it has a rare relationship with physicians that allows both parties to spend less time doing paperwork and more time taking care of home oxygen patients. About two years ago, Hartman created a form that spells out the routine services that its respiratory therapists (RTs) are allowed to provide without having to go back to physicians for approval-things like adjusting liter flows and performing titrations. It then asked physicians to sign the form, called a standing order. Ninety-five percent of them did. “We let physicians know if something big changes, of course,” said Cathy Rauen, Hartman's director of respiratory. “But if it's something like changing the oxygen flow from 2 liters to 2.5 liters, we don't need a new order. We just fax them the adjustment.” Hartman's transition to standing orders has everything to do with Rauen. Before joining Hartman 13 years ago, she worked for Montrose Memorial Hospital, where standing orders between physicians and hospital-based RTs are common practice. Standing orders have been a hit with not only Hartman and physicians but also patients, Rauen said. “I think they really appreciate that there's somebody paying attention to them after their visits with doctors,” she said. “They know they have someone to call, if they need to. If we can't solve the problem, we call their doctors, often directly from their homes.” For the few physicians who didn't sign standing orders, Hartman notifies them prior to or at the time of changes. It also offers customized standing orders for physicians with specific interests, such as those with pediatric patients. With continuing pressure on reimbursement for home oxygen therapy, it behooves providers to jump on standing orders, said industry consultant Patrick Dunne. “We haven't been able to see the forest for the trees, because we're traditionally pushed into this clinical, non-clinical divide and, technically, Medicare doesn't pay for respiratory services,” he said. “But it's the only way to go. It saves time and money in the long run, and it means better care for patients.”