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In My Opinion

Medicare Respiratory Therapist Access Act

Published January 13, 2014 11:58 AM by Jimmy Thacker

This year, the AARC will start lobbying in earnest for House Resolution 2619; the Medicare Respiratory Therapist Access Act, known as HR 2619. It is a part of a long-term strategy to improve the presence of respiratory therapists on Capitol Hill and in a hospital, DME, or doctor's office near you. 

I spoke with Sheryl West of the AARC about some issues; some on the record and some off. She is highly intelligent, well-read, open to discussion, and extremely articulate in her support not only of this bill, but of our profession. I thank her for the hour I took up on what I am sure was a busy Monday morning. 

One of the misperceptions that I had, and I think many CRTs have, is that the AARC is working overtime to push us out of the field of respiratory therapy. Not true. The AARC has gone to extremes not only to protect the CRTs, but to allow them to continue working. What, then, is the bill about? It's about projecting respiratory therapy in the same light other disciplines in the hospital are projected, such as radiology, physical therapy, occupational therapy, and others. 

So here's a wake-up call for every CRT working; the AARC is not the end of your career. Sadly, only a little over a third of us working in respiratory therapy are members of the only professional group that is lobbying for us, and may perceive HR 2619 as a threat to their jobs. Again, not true. HR 2619 seeks to get recognition for the unique and specialized work respiratory therapists do, both in and out of the hospital. That is it in a nutshell, as I understand it. I have heard from so many who hold the CRT credential (like me) that this is the equivalent of the apocolypse for CRTs, and another slap in the face for the CRT, and it really is not. It is true that unless you hold the RRT credential and a bachelor's degree in a medical discipline that there could be some tasks that you cannot perform, particularly outside of the hospital walls, and receive payment for. You can still do the task, you and your employer just may not be reimbursed all you could be with the CRT credential as opposed to the RRT. 

You have to understand a little about politics. Any MBA will tell you that politicians and businesses in general care about three things: how to save money, how to maximize profits, and how to pay for your new idea. Studies are underway to determine a cost benefit for having those with advanced credentials and advanced degrees provide some, and the key word is"some," medical care. This in no way has an effect on the CRT doing his or her work in the hospital, rehab facility, DME, or other areas. Even those hired by physicians in the office will not be put out of a job based on this legislation, though the physician may decide to find an RRT to maximize their ability to get paid by Medicare. That is an employer decision, and not a ramification of HR 2619. Other insurance companies, such as Blue Cross Blue Shield, Aetna, etc, will likely follow the tracks of Medicare, as they always have.

One of the misperceptions I held until talking with Ms. West is that the AARC wants to divide up the CRTs and the RRTs. I wrongly perceived this bill as yet another attempt at doing just that. I was wrong. hat is done enough at the respiratory care manager level, who seek to hire only RRT's, or at the state level, as in the case of California where CRTs are unwelcome.

Even though I do not like this, I do understand that it is an organizational responsibility to look out for the welfare of the people, the patients, and the organization at whatever level you find yourself prominent in. Though I may not agree with you, if you are a respiratory manager who feels that hiring only RRTs or those
who will get their RRT in the next six months raises your level of care, you owe it to yourself and your organization to use that as a basis for hiring only RRTs.

CRTs, myself included, have had opportunities to go on with schooling and get the RRT credential. Whatever reason a CRT uses to avoid doing that (mine was serving in the military; no opportunity for school) is the bed you have made. Now you must lie in it. This is not a new trend; the push for elevating the profile of respitarory therapists has been around for a while, so if you ignored it or just chose to live in denial, then shame on you.

What HR 2619 does is specify that work done by a "qualified respiratory therapist" can be reimbursed at a higher rate than than it is when performed by someone that is not "qualified" according to Medicare standards. Some RRTs will be affected, too; not all RRTs have a bachelors degree in a health related field that Medicare will decide is acceptable under the term "qualified." The point is this is not a bill that excludes the CRT; it does not address the work of the CRT at all.

In the past, I have been critical of the AARC for dividing up the profession, waging an "us and them" war behind the scenes. I was wrong. The AARC,
as our only professional representative on Capitol Hill, is trying to use the playing field they have in front of them, Washington D. C., in the best manner
to advance all of respiratory care. 

In my opinion, all respiratory therapists need to show their support for HR 2619 by writing their politicians. The AARC has graciously offered an FAQ page on their website (http://www.aarc.org/, look under governmental affairs) which addresses not only concerns from CRTs, but also provides a good case for why this is a good bill for all of us. Even if, for whatever reason, you are not a member of the AARC, you can log on and read the FAQ's. Even if you are not a member, you can have your say about your profession with your politicians; the AARC even has a template you can use and a list of politicians representing you on their website. Politicians are supposed to represent us. If you decide to have no voice, you cannot complain when your voice is not heard.

Use your voice, support HR 2619, join the AARC, and do some homework on issues that present you challenges both on the AARC website, and on your own through congressional and senatorial websites, watchdogs, and by keeping up with professional news. It is through excellence and continued education that we get respiratory therapy the respect it deserves and secure our futures.  

That's just my opinion,

Jim Thacker, MBA, MHA, CRT, AE-C

Windsor, MO



My Michael could you have been more wrong about the ACA ?

Obamacare has been an outstanding success. The cost savings are running greater than predictions. The private healthcare industry did an about face and has not imbraced it. More companies are entering the states that setup exchange. You were flately wrong. Or I point out the Republican Kaiser was wrong.

As to RT in general. for that matter professions as a whole.  You are lobbying in public forum for a lesser certification. To be equal to those who went further and achieved higher. In the coming days a CRT will take and pass to become and RRT.  Why should you be rewarded for sitting on you CRT.

As in all professions, the higher you reach, the higher you achiever typically the greater the degree or certification. And thus higher pay and job security

RT is still growing at one of the fastest rates according to the Bureau of Labor.

As for an internship, outstanding idea. As for more job opportunities I would say what part don't you understand. Most RT's grads sit at home and blindly submit resumes online. Then complain there are no jobs. Guess What ? there was a job posting and someone who set far beyond blind resumes and CRT got it.

Tom March 1, 2015 2:55 PM

Michael, I completely agree with you!  

Though I am an RRT and have been for many years and have been in this profession since the early 1970's (back to 'Inhalation Therapy'), I have seen the AARC do very little to protect our profession.  I see this piece of legislation yet another opportunity to further divide our profession and become the death of it.

We have many hurdles in front of us...among them the new 'health care act', the ongoing battle between CRT's and RRT's and RRT's vs BSRT's, combining of hospital departments essentially eradicating RT, and fewer and fewer jobs in all areas of our profession.  It seems the AARC and NBRC have done little, if anything, to actually promote us and the future of RT, but seem rather good at extracting money from us.  

Back in the early 1980's I contacted the AARC liaison in Washington (it may have been the same person to whom this author spoke) and even then we were 'on the verge' of being able to hang our own shingle as other professionals, PT, OT., etc.  And here we are 30 years later and the best we can do is for minimum BSRT's to work in a doctor's office?  

To be honest, I have seen many BSRT's get out of school and have such little clinical experience it would be frightening to think they were taking care of patients.  I have also seen some whose expertise was high.  There is no consistency in quality of care based on degrees.  The same is true of CRT's vs RRT's.  I have worked with RRT's that I wouldn't let touch me and CRT's that provide the highest quality of care.  All of this leads to our profession looking at hard questions of our very survival.  

I would like to see the AARC get it's head out of the clouds and start working with those of us in the trenches to protect our profession, improve the consistency in quality of care, and find ways for us to be reimbursed so that our expertise can flourish in all areas of patient contact.  Barring quality professionals from being part of our growth will only stunt it, not promote it.  A good start would be an internship.  

Gene January 26, 2014 4:26 PM

Well, Jimmy, I think you've been bamboozled by AARC. First, you are writing in the ADVANCE, not AARC website. Your opinion is as a holder of baccalaureate and advanced business/administrative degrees. Gee, do they count towards the bill's academic science requirement? I don't think they should, but they likely will. (Unless your undergraduate degree is in biology, chemistry, physics, etc.)

And what's to become of all the public community college programs that grant Associates in Science half-degrees?

Do you really think that military-experienced respiratory care practitioners are any less competent than therapists from the civilian sector? I hardly think so.

And as far as I can tell, the State of California's Respiratory Care Board is still granting Respiratory Care Practitioner licenses to AS graduates who pass the CRT exam administered by the NBRC.

I do not support the AARC's lobbying effort to pass HR 2619. What's needed most are job opportunities for graduating therapists. There is no internship process, and these days hospitals tend to abuse employees as per diem chattel.

Things don't look too good for health care plans, either. Robert Wood Johnson and Kaiser News Service has said that the PPACA (974 pages, aka: Obamacare) is the likely last gasp of the private health insurance system.

The health insurance system has run amok for over 40 years, by cherry-picking profits and running up costs at double-digit annual inflationary rates.

My worry isn't HR 2619 and whether it passes or not.

My chief concern is whether this system, as we know it, will survive its own greed.

And whether the nation wakes up and embraces HR 676 (30 pages, Rep. John Conyers, Detroit) which will open a new era of rational costs and access to health care resources: single payor health in the USA.

Michael January 22, 2014 1:01 AM

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