Overview
CADENCE™

What is Prolonged Mechanical Ventilation (PMV)?

The following information is from the report “Management of Patients Requiring Prolonged Mechanical Ventilation”, NAMDRC Consensus Conference Statement dated 04/21/05 [NAMDRC, formerly known as the National Association for Medical Direction in Respiratory Care]. 

The definition of PMV depends on what body defines it:  regulatory bodies, caregivers, or investigators publishing in this field.  Defining what constitutes PMV is of considerable relevance.  Analogous to staging a disease process, a uniform definition is essential for interpreting the literature, analyzing outcomes data, guiding management decisions and influencing reimbursement schemes. 

In surveying existing literature, PMV has been variously defined as >24 hours, > 2 days, > 14 days, or > 29 days of mechanical ventilation.  The most widely accepted PMV definition comes from the Center for Medicare and Medicaid Services (CMS).  It includes patients who fall under several Diagnosis Related Groups (DRGs) that focus on mechanical ventilatory support.   Specifically these are DRGs 475, 483, 541, and 542.  In addition, these patients required at least 6 hours of mechanical ventilation for more than 21 consecutive days.  This 21-day stipulation is consistent with the observation that the majority of patients who are transferred to a long-term acute care (LTAC) hospital on mechanical ventilation were mechanically ventilated for at least 21 days.


What is the incidence of PMV?
  • Studies have demonstrated that 5 – 20% of the patients supported with mechanical ventilation in the ICU will not wean in two to four days. 
  • One international prospective group identified mechanically ventilated patients from 361 ICU’s in 1998 and observed that 25% of patients received mechanical ventilation for more than seven days. 
  • An analysis of data from a statewide database in New York between 1992 and 1996 noted an increased number of adult discharges with DRG 483 from 5619 in 1992 to 9351 in 1996.
  • An analysis of data from a statewide database in North Carolina revealed a 78% increase in the number of patients receiving mechanical ventilation who were discharged with DRG 483. 
  • An analysis revealed that the median age for PMV patients has decreased.  65 years old in 1993 and 62 years old in 2002
  • Hospital survival for adult PMV patients in short-term acute care hospital setting ranges from 39% to 75%, depending on patient population and definition of PMV. 

DRG Reimbursement for Short-Term and Long-Term Acute Care Hospitals. 
DRG Diagnostic Related Group Description Shortterm Acute Care Facility   Longterm Acute Care Facility  
    Payments Geometric Mean Length of Stay Payment Geometric Mean Length of Stay
475 Respiratory system diagnosis with ventilatory support $17,981 8.0 $77,405 34.2
541 Tracheostomy with mechanical ventilation 96+ hours or principal diagnosis except face, mouth and neck diagnosis WITH major operating room procedure

$99,646 38.7 $129,593 38.7
542

Tracheostomy with mechanical ventilation 96+ hours or principal diagnosis except face, mouth and neck diagnosis WITHOUT major operating room procedure

$59,806 27.5 $108,057 45.9

Note:  DRG 483 has been replaced with DRG 541 and DRG 542 as of October 200

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Note:  DRG payments are determined by multiplying the BASE RATE X DRG WEIGHTS.  See table with base rate and DRG weight and example below. 

Facility Type Base Rate DRG Weights    
    475

 541

 542
Short Term Acute Care

 $4,972

 3.6166

 20.0414

12.0286
Long Term Acute Care

 $36,833

 2.1015

 3.5184

2.9337

Example:
Facility

Long Term Acute Care
DRG

541
Base Rate

$36,833
DRG Weight

3.5184
Payment=(Base Rate x DRG Weight)

 $129,593.23

 

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