1. So you want to start a ventilator program? What you should know!
Todd Tyson, BS, RRT
GAMES Annual Meeting
Jekyll Island

2. Questions regarding vent ???
1. Are you currently accredited to provide ventilators?
2. Are you Medicare Certified? Does your 855S application include provision for ventilators?
3. Are you thinking about invasive ventilation or limit to non-invasive?
4. Do you have a policy and procedure for ventilators?
5. Do you current employ respiratory therapist?
6. Have you selected partners, IE: vendors, financing, rental partners, PA consultants, reimbursement, etc?

3. Mechanical Ventilation
Mechanical Ventilation, in the healthcare setting or in the home, helps patients breathe by assisting the inhalation of air/oxygen into the lungs and the exhalation of carbon dioxide.
Depending on patient’s condition, mechanical ventilation can help support or completely control breathing.
Invasive requires an artificial airway IE: tracheostomy tube or endotracheal tube.
Non-Invasive requires an non-invasive interface, IE: nasal interface, full-face interface, nasal cannula interface

4. Ventilator Codes E0450/E0460/Eo461 (prior January 2016)$
E0463/E0464 (prior to January 2016) $
E0465/E0466 (Effective January 1, 2016)
$ GA/ $ AL

5. Ventilator Policy and Procedure
Patient Selection Criteria
Staff Training and Competency Check Off
Patient Education
Forms and Documentation
Follow-up, Compliance Downloads, MD Reporting
Physician documentation ongoing need and benefit of therapy
Aggregate data management, readmission reduction, exacerbations, infections, etc

6. Non-Invasive Ventilator Criteria ???
Neuromuscular Disorders
Restrictive Thoracic Disorders
Chronic Respiratory Failure associated with COPD or consequent to COPD
Patient requires ventilator, mechanical ventilator or non-invasive ventilator (BiLevel or BiLevel w/rate has been considered, tried or ruled out)
Additional documentation IE: decline in health status, worsening of condition, increase risk CO2 retention, readmission, exacerbations

7. NIV Coverage Continued
Remember- Medicare, least costly alternative, Bi-Level considered, or tried and ruled out.
Documentation needs to be clear and specific why patient needs ventilator versus a Respiratory Assist Device
Additional justification: alternative is tracheostomy which would increase risk of infection, increased trauma and stress to patient and family
Suggest retain consultant for Pre-cert/ Pre-Auth

8. Business 101 Non-capped, Non-Bid High Margin, low cost
COPD 3rd leading cause of death
Hospital COPD readmission penalty: 26% COPD readmit within 30 days of discharge
Know your market, competition, referral sources
Ventilator manufacturer partner
Finance/Rental partners
Questionable Audit RISK!!!

9. How to grow a vent business!
Focused marketing and sales promotion
Screen current O2 patients with primary COPD dx
CRF secondary COPD
CO2 retainers
Multiple Readmissions/Exacerbations
PFT/Spirometry FEV1<50% predicted
MMRC Dyspnea Scale
CAT –COPD Assessment Test
COPD GOLD Classification and Therapeutic Options

10. Does it make sense or cents?
Assumption: 300 oxygen patient, if only 15% identify at risk, then 45 NIV at $950/m0 (90% of $1055 allowable) for 12 months equals $11,500/patient or $513,000 annual revenue.
Equipment Cost: $6,000- $8500 but lease or rent for $275-$350/mo equals $13,500/mo or $162,000 annual
Respiratory Practitioner at $50,000 annual plus benefits plus marketing est $100,000 annual
$513K - $162K - $100K = $251K Profit (approx 50% margin

11. THANK YOU!!! Any Questions???
Contact Info
Todd Tyson, BS, RRT
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