Marginal cost of liberating ventilator-dependent patients after cardiac surgery in a stepdown unit

Background. With the recent changes in Medicare reimbursement for ventilator-dependent patients at skilled nursing facilities, hospitals may, by necessity, be required to liberate these patients from mechanical ventilation before discharge. This study sought to determine the marginal cost of liberating ventilator-dependent patients in a cardiac stepdown unit. Methods. By retrospective analysis, the complete billing records of all 15 ventilator-dependent patients were obtained and abstracted for each item used. The drug or supply acquisition cost and direct variable cost of other items and labor were used to compute the daily and total marginal cost for each patient. Results. Of 15 patients, 13 were discharged alive and liberated from mechanical ventilation. Length of stay was 28 ± 23 days. Average per diem cost was $438.77 ± 152.34. Costs were significantly higher in patients who required hemodialysis: $555.31 ± 491.04 versus $380.54 ± 272.25 (p< 0.01). Conclusions. Ventilator-dependent patients can be inexpensively liberated from mechanical ventilation in a stepdown unit.