HomeVA ProstheticsVA Handbook 1173.13 - Home Respiratory Care ProgramResponsibilities

13.6. Responsibilities

a. The Chief of Staff at the local VA Medical Center. The Chief of Staff at the local VA medical center is responsible for:

(1) Coordinating the efforts of all medical disciplines required for treatment of patients who require home respiratory care.

(2) Selecting a home respiratory care team (HRCT) comprised of the involved medical disciplines and designating the chairman of the team. The team will normally consist of a physician responsible for respiratory care as the Chairman, a prosthetic representative as the coordinator and a VHA Respiratory Care Practitioner. The team may also include representatives of Pharmacy Service, Nursing Service, Health Administration Service, Quality Management, and the contractor's respiratory care practitioner as dictated by local needs.

(3) Reviewing the program on a quarterly basis and advising the HRCT as to any necessary adjustment of team composition or quality assurance initiative changes that may be necessary from time to time.

b. Prescribing Clinician. The Prescribing Clinician will be responsible for:

(1) Determining the need for home respiratory care based on the patient's prognosis, medical history, results of 1) arterial blood gases (ABG's) or pulse oximetry, according to the Guidelines for home oxygen in the Department of Defense/VHA Clinical Practice Guidelines for Asthma/COPD,** 2) sleep study, 3) effective ventilator settings, or 4) effectiveness of other interventions.

(2) Assure the prescription/consult includes the following general information: a) home oxygen: method of delivery, liter flow FiO2 (continuously, on exertion, at night), method of delivery, and duration. b) Airway pressure: mask type, settings, spacers, other associated devices.?ác) Ventilator: settings, FiO2, mode. **While the guidelines only address the use of oxygen for COPD, exceptions to the criteria may be clinical conditions where it has become practice to try oxygen therapy, i.e., cluster headaches, end stage CHF or other terminal illness. In general, if the patient does not desaturate to the level of 55 PaO2, even in light dyspnea, supplemental oxygen is not indicated. Physician discretion should be employed.

(3) Re-evaluating the patient to ensure the continued need for intervention. The initial re- evaluation may be accomplished from 4 weeks to 3 months, depending upon the reason for the intervention. A re-evaluation for veterans requiring long-term oxygen and mechanical ventilation will occur at least annually. The clinician.will notify Prosthetics of the continued need or the need to discontinue intervention.

(4) Authorizing fee-basis evaluations, if so indicated in accordance with VA Acquisition Regulation 801.670-3, Medical, Dental, and ancillary services, for eligible patients who are unable to report to the VA medical center for evaluation of continued need or initial determination of need for home respiratory care.

c. Prosthetic Service. The Prosthetic Service, or other responsible entity, is responsible for administering the program. This includes the following functions:

(1) Determining the eligibility of the veteran for home respiratory care.

(2) Working with the responsible home oxygen therapy physician to identify contracted home oxygen therapy requirements for equipment management such as concentrators, tanks, regulators, canulas, masks, tubing, Continuous Positive Air Pressure (CPAP) devices, ventilators, and other respiratory care equipment. This responsibility also includes submission of the home respiratory care requirements to A&MMS for development of a solicitation for bids or offers and inspection of bidders' or offerors' facilities prior to award of the contract to provide home oxygen therapy to eligible VA beneficiaries or identifying vendors already under contract.

(3) When designated by the contracting officer, appropriate personnel will serve as the Contracting Officer's Technical Representative (COTR) for the home respiratory care contract. The designee will ensure the contractor's compliance with technical requirements of the contract, including all JCAHO requirements as specified in the contract.

(4) Monitoring contractual compliance and JCAHO standards on a quarterly basis. For example, this will be accomplished through site visits, receipt and review of all required documentation and performance improvement activities, customer satisfaction surveys and patient interactions. The results will be documented and maintained according to established local policy.

(5) Scheduling home visits at a minimum of 10 percent (10%) of the patients on home respiratory care on a yearly basis. These random home visits are necessary to provide quality assurance of this treatment modality. Individual home visits may be conducted by multi- disciplinary teams consisting of clinicians and prosthetic representatives.

(6) In concert with clinical respiratory representative, formulation and distribution of the medical center's policy relating to the home respiratory care program including eligibility criteria and clinical and administrative responsibilities.

(7) Recording all transactions/expenditures for this program by utilizing the appropriate prosthetic software module, i.e., Home Oxygen Program. Recording home oxygen use as follows: Budget Object Code (BOC) 2574, Cost Center 8272, for rental item, repair, preventative maintenance, cylinder contents or liquid oxygen contents or other service contract cost; and BOC 2674, Cost Center 8272, for purchasing new equipment and/or supplies for home oxygen use

(8) Budget management and control of all Fund Control Points relating to home respiratory care.

(9) Purchase of equipment such as Continuous Positive Airway Pressure (CPAP devices), Bi- level Positive Airway Pressure (BiPAP devices), concentrators, ventilators, nebulizers, etc.

(10) Rental of equipment as concentrators, cylinder tanks, liquid reservoirs, ventilators, etc.

(11) Payment for liquid oxygen and cylinder tank fills and refills, and all invoices reflecting charges associated with the home respiratory care program.

(12) Purchase of consumable supplies such as masks, tubing, disposable nebulizer kits, nasal cannulars, humidification bottles, nasal pillows, etc.

(13) Performance Maintenance Inspections (PMIs) on VA owned equipment.

d. Home Respiratory Care Team. The Home Respiratory Care Team is responsible for:

(1) Reviewing all aspects of the home oxygen program in relation to local needs and resources to ensure that patients receive appropriate care, home oxygen equipment, and other aspects of the program are available.

(2) Recommending changes in the medical center policy on home respiratory care.

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