1. THE ROLE OF THE RESPIRATORY THERAPIST IN A HOSPITAL BASED HME COMPANY DIANNE L. LEWIS, MS,RRT,FAARC HOSPITAL LIAISON NCH HOME MEDICAL

2. JOB DESCRIPTION …the Hospital Liaison will independently assess, coordinate and facilitate the discharge planning needs of all home medical equipment,respiratory therapy, enteral therapy, and infusion therapy IV orders per physician orders and the needs of the patient, using standards of care, policies and procedures outlined by HME industry, clinical, regulatory and reimbursement guidelines and in accordance to governing hospital policies …the Hospital Liaison will independently assess, coordinate and facilitate the discharge planning needs of all home medical equipment,respiratory therapy, enteral therapy, and infusion therapy IV orders per physician orders and the needs of the patient, using standards of care, policies and procedures outlined by HME industry, clinical, regulatory and reimbursement guidelines and in accordance to governing hospital policies

3. NCH HOME MEDICAL PRODUCTS AND SERVICES Oxygen Oxygen Respiratory – CPAP, Bi-level, Nebulizers, Suction machines Respiratory – CPAP, Bi-level, Nebulizers, Suction machines Home Medical Equipment – walkers, wheelchairs, canes, commodes, beds,low air loss mattresses, alternating pressure pad w/pump Home Medical Equipment – walkers, wheelchairs, canes, commodes, beds,low air loss mattresses, alternating pressure pad w/pump Enteral formulas Enteral formulas Lifeline Response services Lifeline Response services

4. GOALS Discharge planning performed in a timely and appropriate manner. Discharge planning performed in a timely and appropriate manner. Improve patient education Improve patient education Ensure patient meets criteria for equipment/ services prior to discharge Ensure patient meets criteria for equipment/ services prior to discharge Provide seamless care Provide seamless care Provide marketing services Provide marketing services

5. DISCHARGE PLANNING Powerchart ordering Powerchart ordering Order placed in computer Order placed in computer Patient information available Patient information available No phone calls or faxes No phone calls or faxes Order received in HL office, warehouse and Central distribution. Order received in HL office, warehouse and Central distribution.

6. DISCHARGE PLANNING Central Distribution Central Distribution Equipment storage walkers, cane, commodes, etc Equipment storage walkers, cane, commodes, etc Portable O2 Portable O2 Discharge patient with equipment in 30 minutes Discharge patient with equipment in 30 minutes One company can meet most patient needs One company can meet most patient needs Over 100 types of equipment available Over 100 types of equipment available

7. IMPROVE PATIENT EDUCATION OXYGEN OXYGEN NEBULIZER NEBULIZER CPAP CPAP Hospital Liaison delivers portable O2 Hospital Liaison delivers portable O2 Show and demonstrate Show and demonstrate Discuss home equipment to be delivered Discuss home equipment to be delivered Respiratory therapist visit in home Respiratory therapist visit in home

8. ENSURE PATIENT MEETS CRITERIA FOR EQUIPMENT/SERVICES Diagnosis Diagnosis Height and weight Height and weight Qualifying Spo2 Qualifying Spo2 Eliminate duplication of equipment Eliminate duplication of equipment Obtain necessary paperwork, ABN, Financial Assistance, Financial Responsibility Obtain necessary paperwork, ABN, Financial Assistance, Financial Responsibility Communicate with CM/SS if not the preferred provider Communicate with CM/SS if not the preferred provider

9. SEAMLESS CARE NCH Healthcare System to NCH Affiliate NCH Healthcare System to NCH Affiliate Services / Equipment provided to all Medicare, Medicaid, insurance, self pay and indigent. Services / Equipment provided to all Medicare, Medicaid, insurance, self pay and indigent.

10. CHALLENGES INDIGENT CARE INDIGENT CARE National average for HMEs – 2.9 to 4% National average for HMEs – 2.9 to 4% NCH Healthcare System – 7% NCH Healthcare System – 7% NCH Home Medical – 16% NCH Home Medical – 16%

11. INDIGENT CARE NCH Hospital patients discharged – 5000 to 6000 NCH Hospital patients discharged – 5000 to 6000 North Collier (NCOL) Hospital patients discharged – 900 to 1000 North Collier (NCOL) Hospital patients discharged – 900 to 1000 NCH Referrals – @1100 NCH Referrals – @1100 NCOL referrals - 186 NCOL referrals - 186 NCH Hospital Indigent – 5% NCH Hospital Indigent – 5% North Collier Hospital Indigent – 33% North Collier Hospital Indigent – 33%

13. INDIGENT CARE Physician preference not patient preference Physician preference not patient preference CM/SS discharge process different CM/SS discharge process different HL not always available for discharges HL not always available for discharges

14. CHALLENGES Billing Billing Billing performed by hospital billing department Billing performed by hospital billing department Write offs Write offs Lack of knowledge Lack of knowledge Contract with equipment provider to do billing Contract with equipment provider to do billing

15. MARKETING Sales Calls Sales Calls Health Fairs Health Fairs Educate office staff on paperwork Educate office staff on paperwork Educate hospital staff on NCH Home Medical Educate hospital staff on NCH Home Medical Maintain marketing supplies and materials Maintain marketing supplies and materials

16. Other Duties Maintain inventory of equipment at both hospitals Maintain inventory of equipment at both hospitals Enter patient information/orders into MedAct Enter patient information/orders into MedAct Weekend On-Call Weekend On-Call