The impact of long-term acute-care facilities on the outcome and cost of care for patients undergoing prolonged mechanical ventilation.
OBJECTIVE
To compare the 6-month mortality rate of chronically ventilated patients treated either exclusively in a traditional acute-care hospital or transferred during hospitalization to a long-term acute-care facility. To analyze the hospital cost of care and estimate the amount of uncompensated care incurred by acute-care hospitals under the Medicare prospective payment diagnostic related groups system.


METHODS
Retrospective chart review and questionnaire.


METHODS
Fifty-four acute-care referral hospitals and 26 longterm acute-care institutions.


METHODS
A total of 432 ventilated patients selected from 3,266 patients referred but not transferred to a study long-term acute-care facility and 1,702 ventilated patients from 4,174 patients referred and then subsequently transferred to the long-term acute-care facility. Six-month outcomes were determined for the subgroup of patients > or =65 yrs old (279 and 1,340 patients, respectively). Hospital charges were available for 192 of the 279 nontransferred patients who were > or =65 yrs old and 1,332 of the 1,340 transferred patients.


METHODS
None.


RESULTS
The 6-month mortality rate was 67.4% for the 279 nontransferred patients and 67.2% for the 1,340 transferred patients. On multiple regression analysis, variables associated with the 6-month mortality rate included initial admitting diagnosis, age, the acute physiology score, and presence of decubitus ulcer. After controlling for these variables, there was no significant difference in 6-month mortality rate, but admission to the long-term acute-care facility was associated with a longer mean survival time. Average total hospital costs for the 192 nontransferred patients was $78,474, and estimated Medicare reimbursement was $62,472, resulting in an average of $16,002 of uncompensated care per patient. Estimated costs for the long-term acute-care facility admissions were $56,825.


CONCLUSIONS
Patients undergoing prolonged ventilation have high hospital and 6-month mortality rates, and 6-month outcomes are not significantly different for those transferred to long-term acute-care facilities. These patients generate high costs, and acute-care hospitals are significantly underreimbursed by Medicare for these costs. Acute-care hospitals can reduce the amount of uncompensated care by earlier transfer of appropriate patients to a long-term acute-care facility.
Seneff
M G
MG
Department of Anesthesiology and Critical Care Medicine, The George Washington University Medical Center, DC 20037, USA.
Wagner
D
D
Thompson
D
D
Honeycutt
C
C
Silver
M R
MR
D000368:Aged; D003363:Cost Control; D003953:Diagnosis-Related Groups / Q000191:economics; D005260:Female; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008134:Long-Term Care / Q000191:economics*; D008297:Male; D006278:Medicare / Q000191:economics; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000191:economics; D012044:Regression Analysis; D012121:Respiration, Artificial / Q000191:economics* / Q000401:mortality*; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000191:economics*; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013997:Time Factors; D017664:Uncompensated Care / Q000191:economics*; D014481:United States