There are many unknowns under the new Patient-Driven Payment Model (PDPM). Among them include how the model will impact the various residents coming into skilled nursing facilities and other long-term care centers, specifically as it concerns respiratory care and ventilator services.

Under the new Medicare model, respiratory therapy and ventilator care provide skilled nursing facilities with considerable financial benefits. Residents who demand this level of care are automatically placed into the highest payment group under PDPM. Those with COPD with shortness of breath while lying flat and those who need respiratory treatment seven days a week with a minimum of fifteen minutes a day with a respiratory therapist would qualify for the second-highest payment group. 

Long-term care centers looking to add ventilator services to their current structure must look beyond the Medicare reimbursement they will receive, however. While they would capture the 100 days of Medicare eligibility for these patients, it’s likely these individuals could become long-term residents that would then exceed their 100 days and be long-term residents under Medicaid. Not all organizations in a given market could accept these patients, but it’s important for SNFs to weigh a short-term spike in reimbursement with what long-term care would entail.

Additionally, other respiratory methods could also increase a resident’s payment score in the non-therapy ancillaries (NTA) category, which would include other services beyond equipment, supplies, and drugs. Some of the respiratory conditions and services that could increase an individual’s NTA points include ventilator post-admit care, cystic fibrosis, asthma, chronic lung disease, pulmonary fibrosis, and COPD.

If ventilators are being used on-site, a respiratory therapist must be accessible at all times. But it’s also important that a facility’s nursing team is educated on and properly prepared to handle all the necessary treatments if a therapist was unavailable or offsite. 

These reimbursement benefits are one of the reasons why more facilities are showing interest in respiratory therapy under the PDPM, but they aren’t the only benefits. Respiratory care services will also improve the quality of care provided to residents, promote greater outcomes, and will also work to reduce risk through more accurate documentation completed by experts in the field. 

Above all else, quality will continue to be at the forefront of every successful healthcare organization. Every employee who works at a skilled nursing facility or another long-term care center must be able to efficiently treat patients who are experiencing a range of health conditions, and that includes respiratory complications as well. As someone who oversees a facility that is one of the only ventilator-certified organizations in our area, effective treatment, and trained staff is how the center is able to offer the best respiratory care to its residents.