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Ventilator bill will help patients, facilities

By Karen Mansfield newsroom@heraldstandard.Com 4 min read

As skilled nursing facilities that provide care for ventilator-dependent patients across Pennsylvania closed their doors due to lack of state funding over roughly the past two years, Transitions Healthcare Washington worried about how it would continue to operate and serve its patients who can’t breathe on their own.

Transitions – and other facilities in the commonwealth – got some help in June, when a bill that provides additional Medicaid funding for facilities that serve a substantial number of patients who require ventilator or tracheotomy care was signed by Gov. Tom Wolf.

Senate Bill 108 was sponsored by Sen. Camera Bartolotta (R-46), and similar legislation was sponsored in the House of Representatives by Sen. Tim O’Neal (R-Washington).

“It’s been a long haul, but it was a huge win,” said Jennifer Watson, administrator at Transitions. “We could all see the train coming, because skilled nursing facilities were unable to counterbalance the low level of reimbursement with our costs. With this bill, we were not only able to stay open and available, but also able to expand to serve Washington County and surrounding counties.”

The bill provides for an additional $130 per day payment for ventilator or tracheotomy care provided by skilled nursing facilities that meet certain criteria based on the volume and proportion of Medicaid patients they serve.

“I’m so glad this finally happened,” said Bartolotta, who worked for about three years to increase the Medicaid funding. “It’s important for the hundreds of patients who desperately need these places. It’s incredibly expensive to care for these patients. They need places that can care for them, with highly skilled and trained staff. The additional funding will help those facilities keep their doors open.”

Even before the COVID-19 pandemic, nursing homes and other facilities in Pennsylvania that care for ventilator-dependent patients struggled with the costs of specialized equipment, supplies, and staff, while Medicaid payments for ventilator and tracheotomy care substantially declined in the past 10 years.

The result: a severe lack of funding that has strained facilities, causing some to close their doors and forcing ventilator and tracheotomy patients to move a long distance – often away from their families – to one of the remaining nursing homes that offer these services, or receive care in a hospital, where the daily cost of care is roughly four times higher.

On any given month, about 700 patients require ventilator or tracheotomy care. Of Pennsylvania’s 627 nursing homes, it’s estimated that only 24 provide those services.

At least three facilities in the region shut down their ventilator units – accounting for 75 beds – during the pandemic because they could no longer afford to operate them.

Transitions is the only post-acute ventilator facility in Washington, Greene and Fayette counties, Watson said.

She noted that even as other facilities were forced to close, Transitions added 12 ventilator beds, increasing its capacity to 22 beds, to provide care to patients who need their care.

“The cost of operating ventilator beds is significantly higher than the reimbursement,” said O’Neal.

At Transitions, it costs about $500 a day to care for a ventilator-dependent patient. The facility was getting about $200 from Medicaid a day, leaving $300 a day in uncovered costs, which added up to about $6,000 a day, or nearly $2.2 million a year.

“That’s a big disparity. As the facilities closed down, it started a domino effect, and patients were being displaced hundreds of miles away from their families,” said Watson.

O’Neal said families should not be forced to unnecessarily travel hours to visit loved ones due to a lack of nearby ventilator or tracheotomy care.

COVID, noted Watson, has amplified the importance of having facilities that provide ventilator and tracheotomy services, like Transitions.

Said Bartolotta, “Because of COVID, I think so much attention has been paid to the necessity of ventilators for people of any age for a number of reasons. People finally understood how important these facilities are to people who need these places in order to survive.”

Bartolotta noted that 1 in 10 ventilator patients is under 40 years old, and nearly half are under 65.

Dependence on a ventilator can result from a variety of reasons, Watson said: auto accident, fall, stroke, degenerative disease such as ALS, and COVID-19. While some remain on a ventilator long-term, many fully recover.

“Transitions was 1,000% committed to doing whatever it took to keep this unit open,” said Watson. “We are committed to our patients and to this community.”

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