title: Long-term ventilator care. A Chicago problem and a national problem.
abstract: Patients who require long-term ventilator care in an acute care setting may have a problem because diagnosis-related group (DRG) payments are less than the cost of their medical care. An alternative for quality medical care at lower cost includes admission to a long-term ventilator facility. In Chicago, only two dedicated long-term ventilator programs exist, with only 33 beds. Within 50 to 150 miles of the immediate Chicago area are three more units, with only 42 operational beds. All of the long-term care beds are full, and over 50 patients await transfer. Since acute care is reimbursed on a DRG designation and long-term ventilator care has no DRG category, there is a bias in acute care settings against these patients. Medicare patients are reimbursed up to 100 days, after which patients become eligible for public aid. Unfortunately, long-term ventilator patients often wait in acute care settings for this 100 days to elapse, even though medical care may be superior in a long-term ventilator unit. In addition to not providing the best care, this situation is economically wasteful. Solutions to these problems will require a coordinated national, state, and local plan. National medical societies should be consulted regarding solutions to health care problems that provide the best medical care at a reasonable cost for patients on long-term ventilation.
mesh_terms: D002641:Chicago; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D008134:Long-Term Care / Q000191:economics*; D008484:Medicaid; D006278:Medicare; D012040:Regional Health Planning; D012051:Reimbursement Mechanisms; D012121:Respiration, Artificial / Q000191:economics*; D012124:Respiratory Care Units / Q000191:economics*