Chronic Ventilator-Dependent Units in Hospitals: Attacking the Front End of a Long-Term Problem
Autor: | Walter J. O'Donohue |
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Rok vydání: | 1992 |
Předmět: |
Mechanical ventilation
Rehabilitation business.industry medicine.medical_treatment media_common.quotation_subject Ventilator dependent General Medicine Payment medicine.disease medicine Major Diagnostic Category Medical emergency business health care economics and organizations Human services Reimbursement Health care financing media_common |
Zdroj: | Mayo Clinic Proceedings. 67:198-200 |
ISSN: | 0025-6196 |
DOI: | 10.1016/s0025-6196(12)61323-8 |
Popis: | The Medicare Catastrophic Coverage Act of 1988 mandated that the Secretary of Health and Human Services establish up to five chronic ventilator-dependent demonstration units in hospitals for up to 3years each. The purpose ofthis project was to assess the appropriateness of classifying chronic ven tilator-dependent units in hospitals as rehabilitation units and thus allowing reimbursement outside of the diagnosis-re lated group (DRG) system. The law was later amended by passage of the Technical and Miscellaneous Revenues Act of 1988, section 8402, to clarify that at least five ventilator dependent units would be included in the demonstration project for at least 3 years each and to ensure that the project would be implemented by the Health Care Financing Ad ministration (HCFA). Inadequate Reimbursement for Prolonged Mechanical Ventilation.-A major motivation for enactment of this leg islation came from studies that demonstrated inadequate re imbursement from the existing DRGs for Medicare patients who required prolonged mechanical ventilation in the hospi talY Two new DRGs were introduced in 1987 (DRGs 474 and 475) to increase payment for patients who required mechanical ventilation with a tracheostomy or with an en dotracheal tube. These new DRGs applied only to patients with an MDC (major diagnostic category)-4 designation, for which a primary pulmonarydiagnosis must be the reason for admission. It soon became apparent that up to 75% of patients who required prolonged mechanical ventilation in the hospital did not have a primary pulmonary diagnosis at the time of admission; hence, the problem of inadequate reimbursement persisted.v' Moreover, HCFA consistently denied requests for additional reimbursement for hospital based, long-term ventilator care units, contending that they might be eligible for further reimbursement if they were providing intensive physical medicine and rehabilitative services. HCFA determined,however, that management of ventilator-dependent patients did not qualify as a rehabilita tive service, and for reimbursement outside of the DRG system, at least 75% of the services provided must be reha |
Databáze: | OpenAIRE |
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