Across the US, the dramatic rise in ICU bed utilization might be considered good economic news: filling hospital beds is generally good business for a hospital. But not in the case of long-term ICU beds. That’s because most patients on ventilators are covered by Medicare, and hospitals receive the same flat DRG payment for these patients, whether they stay one day or six months. With many patients staying months at a time, hospitals are facing significant cost overruns.

Those trends became apparent at the Luther Midelfort — Mayo Health System, in Minnesota, where Mark Lindsay, MD, is chair of the department of pulmonary and critical care medicine. In 1997, Lindsay decided it would be a good idea to move many of these long-term ventilator patients from the hospital ICU to the ventilator unit at the Lakeside Nursing Home, which had vacancies. He calls it an example of “shared opportunities” for both facilities. Seven years later, the project is doing remarkably well. It has led not only to cost savings, but also to better care. “We’re talking about millions of dollars,” says Lindsay. “More importantly, we can dramatically improve the care of these patients.”

The results are striking. From 1987 to 1997, the nursing home had 11 patients on ventilators. Only one patient was weaned successfully, and the majority died. Compare that with the results from 1997 to 2002, while the project was in place: the nursing home had more than 100 ventilator patients, and 67 percent of them came off their ventilators.

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