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AARC Memo Angers Home Care RT Members
An internal memo issued by the American Association for Respiratory Care (AARC) to its members late last month has some home respiratory therapists fuming. To add fuel to the fire, many home care providers and RTs have asked the AARC for a formal response and are still waiting for it.
The e-mail warned that recent Medicare reimbursement changes had resulted in some home oxygen patients being switched to oxygen devices that may not meet their needs. The memo encouraged hospital-based RTs to watch out for their home patients to make sure their equipment and care are not comprised.
In addition, a link to an Oxygen Rights article on YourLungHealth.org, a consumer site, said that most home care companies are honest — a comment that has since been removed from the Web site.
"I took from that there are some (home care companies) that are dishonest," says Lou Kaufman, RRT-NPS, director, Patient/Client Services, Roberts Home Medical. "I don't disagree with that; there probably are. But I don't want to see that from my professional organization to the public. Would they ever say that most hospitals are pretty good but there are some that aren't so hot out there? I don't think so."
In fact, many providers took the AARC's comments as a direct insult to home care RTs because the memo seemed to imply that home care RTs were not as good as hospital RTs, according to Kaufman.
Cindy Gray, a 20-year member of AARC and director of respiratory development, Advanced Home Care, says. "I feel that my national organization let me down and I think they misinformed the public."
The memo also urged RTs to encourage physicians to write detailed prescriptions for home oxygen therapy to include:
• Liter flow and duration
• The target O2% produced at the prescribed liter flow by the device
• The need for a backup system (if patient requires oxygen 24 hours per day)
• If a portable device is indicated; the minimum capacity in hours, as well as the maximum weight of the device should be included in the revised prescription.
Some AARC members questioned these requirements, specifically what is meant by the target O2% produced at the prescribed liter flow by the device. Kaufman, who has been a member of the AARC for 35 years and an RT for many years, says that he has no idea what the target O2% means and none of his peers have been able to explain it either.
"Whoever wrote the memo clearly did not understand home care because things that they asked to happen would be great for hospitals but make no sense whatsoever for home care," Gray says. "That is what we honestly find over and over again is that the hospital respiratory therapists do not understand home care. They still believe that you go to a wall and plug in a regulator for oxygen, and not that there are machines that make the oxygen in the home."
Gray says the prescription for a back-up system is one example because the Centers for Medicare & Medicaid Services (CMS) does not pay for those systems. Though providers had offered these systems for free in the past, the transfer of ownership stipulation will mean providers would lose ownership of these systems, essentially giving away equipment for nothing in return, she says.
The home care members of the AARC have demanded an apology and correction. Home care section chair Bob McCoy said he believed that most members who had sent letters had been answered by phone or e-mail. Gray said that she still has not received a response, nor had many of her peers. Kaufman contacted AARC President Sam Giordano who responded but did not answer his direct questions. Kaufman says there has been no response to his follow-up email.
McCoy says the organization is working on a formal response and clarification of the guidelines. He will attend a board meeting scheduled this week to discuss the matter. McCoy did not give a timeline for a response.
According to McCoy, the e-mail was intended to protect patients and "was not intended to insult or to misrepresent our professional therapists in the home," he says. "There were some people that saw it that thought it might not have been worded quite correctly but weren't as upset as some. So, we've got some people who really took it personally, which I guess we're all under such attack that we're getting tired of it, especially from our own professional organization. Again, I've talked to Sam and that was not what they intended to promote or present."
McCoy says the email was "preaching to the choir," as the home care RTs who received the message were not the ones who might be suspected of fraud and abuse.
Still, the e-mail might result in a loss of support for the AARC from the home care industry. Kaufman says that though he will continue to be a member to keep up with his continuing education, his support for the organization has dwindled. "I was an AARC membership ambassador," he says. "On my nametag every day for I don't know how many years — since the buttons came out — my nametag said: I am AARC, That button is in the trash."
Gray had a similar response. She says she no longer feels compelled to support and advocate for AARC initiatives and that her relationship with AARC will be very strained.
"I do hope that the AARC makes this right simply because I believe in the premise of a national organization, but I believe that the national has to support all of its members equally," Gray says.
To view the Oxygen Rights article, visit www.yourlunghealth.org/headlines/2008/06/medicare/index.cfm.
To share your comments with Respiratory Management, send an email to the editor at ebury@1105media.com.
To report problems with competitive bidding — such as loss of service for oxygen patients — visit AAHomecare's Web site and click on the bid feedback form for providers or Medicare beneficiaries under the Homecare Updates tab.
