The Centers for Medicare and Medicaid Services revised its Hospital Conditions of Participation this past summer to permit a qualified and licensed practitioner who is responsible for the care of the patient to order respiratory care, provided the practitioner is acting within his/her scope of practice under state law.  See 42 CFR 482.57(3).  The hospital’s medical staff must also authorize the practitioner to order respiratory care services.  See id.  Because of this revision, Medicare now allows nurse practitioners, physician assistants and others to order respiratory care without a physician’s countersignature if state law permits such practitioners to issue respiratory care orders.

Until January 28, 2011, however, Wisconsin law still required that a physician order all respiratory care services.  See Wis. Admin. Code DHS §124.22(4).  The physician may then delegate the task of ordering respiratory services to mid-levels, who then write the orders for the respiratory care, as long as a physician counter-signs the order.  See http://www.dhs.wisconsin.gov/rl_DSL/Hospital/frequentAskQs.pdf (question 30).

The DQA changed this discrepancy through the issuance of DQA Memo 11-004/Respiratory Therapy Orders in Hospitals, a statewide variance for DHS 124.22(4) to allow licensed practitioners, who are authorized via their practice act and are granted privileges by the medical staff of the hospital, to order respiratory care services. Effective immediately, this variance provides more flexibility for providers when it comes to respiratory care and can be found at http://www.dhs.wisconsin.gov/rl_dsl/Publications/11-004.htm.