The Confusion Around AVAPs: BiPAP Machines in Disguise?

In the world of respiratory therapy and home healthcare, the distinction between BiPAP machines and ventilators has significant implications for patient care and logistics. One particular type of BiPAP machine, known as AVAPs, has sparked controversy due to how it's classified and billed.

AVAPs, a variation of BiPAP, stands out because it guarantees a specific tidal volume for patients. This feature sets it apart from traditional BiPAP machines, which provide varying levels of pressure support but do not guarantee tidal volume. Despite this distinction, home healthcare companies often refer to AVAPs as ventilators. Why? Because this classification allows them to bill Medicare and other insurers at higher rates, similar to how ventilators are reimbursed.

This billing strategy, while financially advantageous for providers, creates challenges during patient discharge. Nursing homes, crucial destinations for post-acute care, frequently refuse patients using AVAPs. They argue that they lack the training and equipment necessary to manage "ventilator" patients, even though AVAPs function similarly to BiPAP machines with added features.

As a result, discharge planners often face the daunting task of finding suitable nursing homes located hours away. This situation not only complicates patient transitions but also places undue burden on caregivers. Consider the story of one elderly wife who visits her husband daily, driving four hours round-trip. Such journeys are physically and emotionally taxing, particularly for someone in their eighties.

In essence, AVAPs and traditional BiPAP machines serve the same primary purpose: providing respiratory support. Both are typically positioned at the edge of a patient's bed, and in most cases, patients can independently manage their machines. Nurses generally only need to assist occasionally, such as with putting on or removing the mask, which is no different from BiPAP machines.

It seems that nursing homes use the term 'ventilator' as a reason to reject patients, despite AVAPs functioning similarly to BiPAP machines. This trend poses challenges for the community at large and particularly for individuals like the 80-year-old wife who visits her husband daily regardless of how far away the nursing home is that he is stationed in.