In April, the Michigan Office of Regulatory Reinvention (ORR) recommended the deregulation of 18 occupations—among them, respiratory care. It also recommended eliminating the Michigan Board of Respiratory Care. The ORR claims to have “carefully considered the public health and safety benefits” of these occupations and determined that they did not require regulation. Really? The Michigan Society for Respiratory Care begs to differ, claiming that there is risk of harm to patients if the person providing respiratory care does not have the specialized skills that RTs have acquired through years of education and training. Without a licensing requirement, there would be no body to ensure that respiratory care providers are competent. Although RTs provide services under the direction of a physician, often this is not direct supervision; and RTs often make independent and unsupervised treatment decisions based on protocols that have been well-studied and have been found to reduce health care costs and result in better patient outcomes.
I asked several members of RT ’s editorial advisory board—all of them respiratory therapists involved in patient care—whether they thought this proposed deregulation was a big deal. They all thought it was huge. The deregulation would result in no requirements for practicing respiratory care in Michigan, and just about anyone could deliver it. Of course, the facilities could establish their own standards, but given the choice of a $7.50/hour patient care tech versus a $25/hour+ licensed RT in these days of dwindling reimbursement for underinsured or uninsured patients, who knows how stringent the standards would be? And what would be the consequences?
More than 10 years ago, by passing the Medicare Balanced Budget Refinement Act, Congress recognized that respiratory care provided by other than respiratory therapists could result in harm to the patient (and increased costs due to rehospitalization). In a letter in support of the bill to then-House Ways and Means Chairman William M. Thomas, James Maloney (D-Conn) wrote, “In the absence of competency standards, patients requiring therapy services are being put at risk … respiratory therapy is a life-sustaining treatment. If this therapy is improperly performed, the patients could be seriously harmed or killed.” Although this legislation related to skilled nursing facilities, these same risks transfer to all health care facilities.
As the National Alliance of Respiratory Care Professionals states, “There are certain aspects of respiratory care that should only be performed by a licensed Respiratory Care Professional who has completed the educational requirements and passed the national board exams.”
Respiratory therapists are working hard to elevate their profession and are advocating for increased roles as educators, case managers, and senior leadership positions and for recognition of the profession’s importance by the public. Deregulation would be a huge backward step.
Consider the domino effect. If Michigan is considering these measures, can other states be far behind? Support your colleagues in Michigan by signing the petition at: www.change.org/petitions/state-of-michigan-do-not-deregulate-the-respiratory-care-profession. Who knows? You might be helping to save the profession in your own state.
— Marian Benjamin