Financial implications of prolonged ventilator care of Medicare patients under the prospective payment system. A multicenter study

Prospective payment based on diagnosis-related groups (DRGs) makes inadequate financial allowances for those Medicare patients who require expensive services such as prolonged mechanical ventilation. Prolonged mechanical ventilation is usually needed in the sickest patients who frequently require other modalities of life support, such as hemodynamic monitoring, dialysis, etc. The assumptions of relative fiscal homogeneity, upon which mechanisms of DRG reimbursement are based, are questionable for critically ill patients. This is particularly true, as this study purports to demonstrate, in situations where prolonged ventilator care becomes a life-saving necessity in critically ill patients. It has been shown that care of Medicare patients in the intensive care unit, in an by itself, is a financial problem. Since centers providing specialized medical care are more likely than others to receive such patients for complex management, the net negative consequences of insufficient payment are greatly magnified. We describe the inequities in reimbursement in a group of hospitals representing a spectrum of referral practices for Medicare patients who were mechanically ventilated.