Respiratory Care Unit Opens in Botetourt

By Christina Rogers, The Roanoke Times, Va.

Jun. 21–The simple act of breathing can have a hefty price tag for patients dependent on round-the-clock ventilator care.

And with few assisted-living facilities in Virginia providing this type of long-term specialized care, some patients are forced to move far from their homes — and even out of state — in search of available beds.

It’s a problem that one Fincastle nursing home is trying to address.

On Monday, Brian Center Nursing Care opened a seven-bed respiratory care unit in its 60-bed facility off Old Fincastle Road in Botetourt County.

The new unit is the second of its kind in Southwest Virginia and will provide 24-hour, machine-assisted breathing for patients suffering from everything from spinal cord injuries to lung disease.

Of the 278 nursing facilities in Virginia, only eight offer this type of specialized care to adults.

“We’re adding a much-needed resource to the state,” said Thomas Clarke, president of Roanoke-based Kissito Healthcare, a nonprofit organization that manages Brian Center and 10 other nursing and rehabilitation centers across the country.

The cost of providing such specialized care can range from $350 to $400 per patient a day, Clarke said. Those high operating costs, combined with low reimbursements from Medicaid, have closed similar programs in the past — including one this month in Lynchburg.

Clarke admits it’s a niche market that not many assisted-living facilities are interested in serving.

But that’s a risk the Brian Center for Nursing Care is willing to take. The facility’s staff hopes the service will give Botetourt County’s oldest nursing home a competitive edge over other assisted-living facilities opening in the area.

The new unit should help the nursing facility diversify and extend its marketing reach throughout the state and into surrounding states, Brian Center administrator Ryan Koeniger said.

Though the Fincastle unit will most likely attract elderly patients, Clarke said, it is not unusual for younger victims of car accidents to seek ventilator care.

A ventilator, sometimes called a respirator, is a mechanical substitute for normal breathing that pumps air in and out of the patient’s lungs and airways.

The Brian Center has already admitted one patient. It has also fielded calls from hospitals in Georgia and Tennessee, both of which were looking to place patients in ventilator beds.

The shortage of ventilator nursing care has caused bottle-necking at some Roanoke-area hospitals, where some patients are forced to extend their stays while looking for available beds.

Patricia Rushmore, a director for Carilion Care Management, said she’s seen patients wait for weeks and even months for ventilator beds.

Recently, she said, the hospital had a patient whose daughter lived in Georgia. The hospital hoped to send the patient there. “But what we found in speaking with Georgia is that they are doing placements out of state also,” Rushmore said.

Ventilator care is a costly treatment requiring round-the-clock vigilance and a team of trained specialists. Mechanical ventilators cost from $15,000 to $20,000, although most assisted-living facilities lease them. And because most patients requiring this type of care are on Medicaid, the care is largely funded by the state.

The Brian Center expects to recover the entire cost of its ventilator care from Medicaid, in addition to making a slight profit. It applied for a reimbursement rate with Medicaid of $518 per patient a day, a higher rate than the anticipated cost of $350 to $400 a day.

“There is a financial purpose to the opening of the unit,” Koeniger said.

“We are trying to turn around some financial issues, but at the same time, we’re filling a really big need.”

The region’s other ventilator-care provider, the Avante Group, shut down a similar program at its nursing facility in Lynchburg on June 1, saying it had lost more than $10 million since 2002 on its respiratory therapy to Medicaid patients.

Avante Group vice president Michael Patterson said the state was paying only a fourth of the cost of providing ventilator services, an expense Patterson estimated at about $1,000 a day per patient.

“Basically, [the state] disagrees with the cost of the service,” Patterson said. The Florida-based company, which owns about 20 nursing homes, closed similar programs at Avante facilities in Harrisonburg and Waynesboro. It still operates 18 ventilator beds at its nursing home in Roanoke.

Craig Markva, a spokesman for the state medical assistance department, stands by the reimbursement rate, saying the agency was not familiar with Avante’s decision to close its ventilator care unit in Lynchburg. According to the medical assistance department, the state pays an average rate of $411 per ventilator patient per day.

“There are other facilities with similar rates which have not closed,” he said.

Still, the financial tug-of-war has also made respiratory care a scarce resource in other states.

West Virginia, for instance, offers no additional reimbursements for long-term ventilator care and therefore has no ventilator facilities.

And North Carolina has few facilities — making both states a market the Brian Center can potentially tap.

“It’s a pretty simple formula,” said Carilion Hospital Systems spokesman Eric Earnhart. “When there is adequate reimbursement to provide a service, the service seems to exist fairly well.”


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