Chronic Ventilator-Dependent Units in Hospitals: Attacking the Front End of a Long-Term Problem

Autor: Walter J. O'Donohue
Rok vydání: 1992
Předmět:
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
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