Bone R C
Chest. 1987 Sep;92(3):536-9. doi: 10.1378/chest.92.3.536.
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.
在急性护理环境中需要长期呼吸机护理的患者可能会面临一个问题，即诊断相关分组（DRG）支付低于其医疗护理成本。以较低成本获得优质医疗护理的一个替代方案是入住长期呼吸机护理机构。在芝加哥，仅有两个专门的长期呼吸机护理项目，床位仅33张。在紧邻芝加哥地区50至150英里范围内还有另外三个机构，仅有42张可用床位。所有长期护理床位已满，超过50名患者等待转院。由于急性护理是根据DRG指定进行报销，而长期呼吸机护理没有DRG类别，急性护理环境中存在对这些患者的偏见。医疗保险患者可报销长达100天，之后患者有资格获得公共援助。不幸的是，长期使用呼吸机的患者常常在急性护理环境中等待这100天过去，尽管在长期呼吸机护理机构医疗护理可能更优质。除了无法提供最佳护理外，这种情况在经济上也是浪费。解决这些问题需要国家、州和地方的协调计划。应就如何以合理成本为长期使用呼吸机的患者提供最佳医疗护理的医疗保健问题解决方案咨询全国性医学协会。
