Respiratory Health Services: Dan Hirschfeld, President

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Respiratory Health Services (RHS) is a national leader in clinical outcomes for respiratory therapy services provided to pulmonary patients in skilled nursing facilities. Founded in 1991, RHS was a co-creator of the original model of respiratory care in the long-term care industry. The company now employs more than 400 respiratory therapists and services more than 600 locations across the United States.

RHS is committed to improving outcomes for patients who need more complex care in nursing home environments. Through technology, staff and training, the company works hard to help nursing homes provide an optimal level of care to patients.

“We are a partner with skilled nursing facilities,” said Dan Hirschfeld, president of RHS. “We help nursing homes care for medically complex patients, we give them the reimbursement necessary for those patients, and we provide good clinical outcomes.”

Assisting nursing home staff with quality outcomes

“The greatest evolution I have seen in this industry relates to the acuity of patients,” Hirschfeld said. “Patients are getting sicker and sicker. In addition, reimbursement is, in part, driving the displacement of these patients from hospitals, long-term care and acute care facilities, relocating them into nursing homes. This is good in some ways, because they are in a lower cost environment, which benefits healthcare overall. But we want to make sure that the staff is comfortable in caring for these patients.”

In skilled nursing facilities, nurses are not always prepared to handle complex patients, and that’s where RHS comes in.

“The vast majority of patients coming in for rehabilitation and then going home have some pulmonary distress,” he said. “Nurses need support from respiratory therapists.” With RHS’s expertise and trained staff, “patients get the treatment they need and experience the best outcomes possible.”

Hirschfeld said the higher acuity of patients can be an opportunity for nursing homes when handled well. RHS offers two products to nursing homes: respiratory therapy for pulmonary patients, and ventilator programs. The ventilator programs are a growing area for the company, which has been making significant investments in technology.

“We are investing in the ventilator units, using the latest technology to make sure that they’re smaller, quieter and better for patients,” Hirschfeld said. “Through the ventilator programs, we are able to increase census for nursing homes by offering a specialty program that allows them to attract more patients and establish themselves as a clinical leader in the marketplace.”

Part of helping these facilities gain a positive reputation comes from RHS’s detailed tracking of quality measures.

“We track all outcomes of patients, whether in our respiratory or our ventilator programs,” said Hirschfeld. “We are an industry leader on outcomes, and we receive strong recommendations from hospitals because they consider us a preferred place for discharge based on our clinical outcomes.”

Helping nursing homes face reimbursement challenges

In today’s market, reimbursement is always a challenge for healthcare organizations, and RHS addresses those needs with customers.

“Long-term care is under pressure overall at both the federal and the state level,” Hirschfeld said. “We want to work with customers by partnering with them to try to survive during this period of low reimbursement pressure.”

Nursing homes that provide services through RHS are able to receive a higher reimbursement per patient, anywhere from $11 per day to $300 per day, according to Hirschfeld. In addition, current legislation, RUGs IV, will change the way nursing homes receive reimbursement, and may possibly create higher reimbursement for complex pulmonary patients.

By tracking clinical outcomes, RHS is also prepared to help nursing homes face a pay-for-performance environment. “We are in a position to help nursing homes understand their costs and survive in that environment as well.”

Staying strong through staff development

Attracting and developing staff is one key to remaining a leader in clinical outcomes. Investments in staff and training have helped RHS recruit and retain qualified therapists. “Trying to find enough staff is a challenge. There is always a shortage of clinicians.”

RHS addresses this challenge by partnering with schools to help provide clinical affiliations in nursing homes for respiratory therapy students. Hirschfeld hopes that through positive clinical affiliation experiences, these students will consider a career in long-term care.

“After we hire staff, the next component is making sure that we have the most highly trained team available, and we do this by investing in our people,” Hirschfeld said. RHS has made significant investments in technology and other resources, including laptops, handheld devices, clinical programming and continuing education. “We teach staff and managers how to use these resources to interact with customers to get the outcomes we’re looking for,” he said. “We have received a lot of great recognition for our training and education videos, and we’ve been recognized as a best place to work in key markets.”

“Although we’re a large organization with numerous locations, we work to create a family environment. We provide ‘large company’ resources to therapists and patients, but have an intimate, ‘small company’ atmosphere because our staff feel connected to the company and to each other. This leads to our ability to attract and retain therapists.”

With the company’s stellar reputation combined with reimbursement changes that make it easier for nursing homes to offer respiratory programs, Hirschfeld anticipates continued growth for RHS in the coming years.

-by Patricia Chaney

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