Mechanical ventilation in the treatment of patients with both acute and long-term respiratory failure has become a commonly available and utilized treatment. Its use in the immediate postoperative state in patients with primary or secondary respiratory failure is now considered to be standard care in any acute care hospital. Not all patients who require mechanical ventilation can be weaned rapidly. These patients continue to have active medical problems. In some cases, the weaning process may take weeks or months, yet the clinical expectation is that they can eventually be weaned from ventilator support. These patients can become long-term, labor intensive, and expensive.
It is estimated that there are 60,000 intensive care beds in the United States, which account for approximately 5 percent of acute care hospital beds.1 The costs of caring for critically ill patients in intensive care units is a major medical and economic issue in the United States. Approximately 15 percent ($15 billion) of the expenditures for hospital care are for services directed at the critically ill patient (1981), and these costs continue to grow,1,2 Endotracheal intubation and ventilator management is most commonly administered in intensive care units, and thus the economic costs for the care of ventilator-dependent patients is great.
The costs of caring for long-term ventilator-dependent patients have been shown to exceed the cost of long-term ventilator care in the acute hospital setting.3,4 A study we recently completed at Rush-Presbyterian-St. Luke’s Medical Center revealed that 95 Medicare patients seen over a one-year period who required prolonged ventilator care accrued costs of $3,656,137, or $38,486 per patient. Medicare payments for patients in similar diagnosis related groups (DRG) were $8,421 per patient.5 A similar study looked at a group of Medicare patients admitted to both tertiary care and community based hospitals and found that the mean costs for the 150 patients studied over a three-month period were $31,896 (charges, $47,391) compared with Medicare payments for similar types of patients being $10,981.6
Most patients treated with ventilators in the United States receive care in intensive care units. We have shown that intensive care unit therapy is expensive in itself. We reviewed the annual costs of 446 Medicare patients who received care in a medical intensive care unit at Rush-Presbyterian-St. Luke’s Medical Center and determined they exceeded by over $4.7 million the actual reimbursements for similar patients under the Medicare Prospective Payment System.7 The costs of respiratory-related services associated with ventilator management are a significant component of these costs. Our study of long-term ventilator-dependent patients found that each day on a ventilator added $439 for respiratory-related services to the total hospital costs.5 No figure for the total number of patients requiring prolonged mechanical ventilation is available. However, the number of hospitals that has intensive care units makes the potential economic impact of these patients great. One alternative is home ventilator care. This is an important alternative but is not applicable for large segments of long-term ventilator patients because of the need for a dedicated home support group.
The general purpose of this study was to explore another alternative possibility for long-term ventilator care, the long-term ventilator facility. Specifically, this study was designed to determine the number and utilization of long-term ventilator beds in our metropolitan area and to define characteristics of a medically and economically sound long-term ventilator unit.
METHODS
To provide better ventilator care, Rush-Presbyterian St. Luke’s Medical Center and McNeil Health Service Corporation conducted a study to assess the need for chronic ventilator facilities in the Chicago metropolitan area. These interviews were done under the direction of Terry Kline, President of the Rush/McNeil Joint Venture. Sources for this study included:
•Site visits to two nationally acclaimed long-term ventilator units: (1) Plaza Medical, Camden, NJ, Chronic Ventilator Facility, and (2) Children’s Hospital of Philadelphia Unit, Chronic Ventilator Unit, to assess the facilities of long-term ventilator units deemed to be superb in medical care
•Interviews with key medical directors of long-term ventilator programs in the Chicago metropolitan area
•Interviews with local and statewide agencies, including the Illinois Department of Public Aid (IDEA); Illinois Department of Public Health, Division of Rehabilitation; Illinois Health Service Agency; and the Illinois Department of Aging.
•Interviews with selected Illinois Nursing Homes
RESULTS
Long-term ventilator care for adult and geriatric patients is not adequately provided in the Chicago metropolitan area, resulting in a significant drain on the finances of the Illinois Health Care System and the medical system.
Few dedicated long-term ventilator programs exist anywhere in the Chicago metropolitan area, as evidenced by the lack of long-term ventilation (LTV) beds in both the immediate Chicago area or the region outside the immediate Chicago area (Table 1). The following are the findings at the time of our survey:
•Only two dedicated LTV programs exist in the immediate Chicago area, accounting for only 33 beds (Table 1)
—Oak Forest Hospital, which has 28 acute care beds
—Colonial Manor Nursing Home, which has five skilled nursing beds
•Only three dedicated LTV programs exist outside the immediate Chicago area, accounting for only 42 operational beds (Table 2)
—Sycamore Hospital (VenCare), which has four LTV beds
—Sandwich Hospital (VenCare), which has 28 LTV beds
—Pekin Nursing Home, which has ten skilled nursing beds
Here is the full article found on Chest Journal: https://journal.chestnet.org/article/S0012-3692%2815%2943558-5/fulltext