If CMS doesn't value respiratory therapists, can HMEs continue to employ them?

Here's a $64,000 question: If Medicare continues to cut reimbursement for home respiratory services, what will providers do to offset those cuts? This came up the other day during a conversation I had with Lou Kaufman, the vice president of patient/clinical services for Roberts Home Medical, a mid-Atlantic powerhouse that employs roughly 40 home respiratory therapists.

Here's what Lou had to say:

"If reimbursement continues to decrease, what will be the next things that homecare companies need to cut? They have already cut delivery to the bare bones with high-tech portable systems, computer routing and trying to get patients to pick stuff up.  You have to have someone answer the phone and take the order. You have to have someone send the bill to the insurance company and collect the money. You have to have somebody to deliver it. What do you not need?

"The RT. That's a value added, and homecare companies decrease profitability to maintain it—what we believe to be a higher quality product, taking better care and safer care of our patients. But a number of companies have either gotten rid of all of their therapists, or significantly decreased their rank.

The question is, for a company who has been using therapists, if that comes about, do you stop using conserving devices? Or do you continue to provide them and not titrate the patient?

"If you continue to use them without titrating, then the patients will be hypoxemic. If you stop using them, the patients are going to have less ability to be out of the home for longer periods of time. Or they are going to have to carry larger or more cylinders with them. None of that is a good situation, and there are studies out there that show that patients who are active, and continue to be active outside the home and use their oxygen all the time, have the best quality of life and the longest lives.

"The one thing we can be absolutely be sure of is that things are going to change, but I don't know how."

Mike Moran