Over the last several years, changes to the admission criteria and reimbursement structure of long-term acute care hospitals (LTACHs) have proven highly significant. However, the original intent of the LTACH with its ability to manage a critically ill patient population hasn’t changed. More specifically, a respiratory population often requiring long-term ventilator management and weaning still needs care.
Never has the need for this unique venue of care been more obvious than during the current public health emergency. While some LTACHs chose to remain COVID free and only accept patients once negative test results were achieved, many played a critical role in the continuum of care as a frontline discharge disposition for a highly acute patient population from the early stages of COVID illness onwards. Whether LTACHs accepted these patients once COVID negative or during the acute phase of their illness, taking these complex patients allowed for bed turnover to help meet critical bed needs during the pandemic.
What this means for the healthcare industry is the reemergence of the LTACH as a crucial component of the continuum of care. As recognized at 42 CFR 412.23(e), an LTACH provides treatment to patients requiring an extended length of stay, with an average length of stay for Medicare patients of greater than 25 days. LTACHs have always been an acute care venue of care; they are not to be confused with other long-term care or skilled nursing facilities. Just like every acute care hospital, LTACH’s must meet all State and Federal hospital regulatory requirements. That said, what better way to treat patients suffering from an acute respiratory illness requiring long-term acute care stays?
LTACH’s specialize in the treatment of patients who require an extended acute care stay for complex conditions. Acute care hospital beds and intensive care unit beds do not specialize in treating long-staying patients who have acute-level care needs. LTACH’s are designed to treat those patients requiring acute level
services over a longer period of time. While there is no limit to the diagnoses that can be treated within an LTACH, the following are the most common medical
complexities are seen within this venue of care:
● Respiratory failure, including ventilator dependency;
● Ventilator Care and Weaning, including Tracheostomy;
● Respiratory infections and other disorders;
● Medically complex conditions;
● Cardiac/Cardiovascular conditions;
● Renal disease;
● Wound care (secondary to a primary diagnosis); and
● Extended post-surgical care.
The above diagnoses are acutely aligned with many of the primary and/or secondary conditions that have been associated the SARS-CoV-2 virus, the respiratory illness most closely associated with the COVID-19 pandemic. While we anxiously await the end to the current public health emergency, we have seen steadily
increasing interest in the long-term acute care venue of care. Health systems are taking a “lessons learned” approach to what may best accommodate the needs of providers.
Now, a pandemic should not be necessary to recognize the value of the long-term acute care venue of care for health systems. Understanding what an LTACH provides, the patients best served by this venue, and the ancillary benefits to associated health systems make the LTACH an increasingly important venue of care within the healthcare delivery system. With the current health crisis keeping everyone on high alert, managing a finite number of beds to meet the critical needs of a seemingly infinite number of patients, has once again brought the need for LTACHs to the fore. Beyond the ability to open critically needed beds, the benefits of an LTACH to a health system make this venue worth investigating. Ancillary LTACH benefits include:
● Extending the continuum of care;
● Preparing health systems for changes to post-acute reimbursement;
● Off-loads burden on acute care hospitals, providing an appropriate venue for long term acute patients;
● Allows for bed turnover in the acute care setting;
● Diminishes short term acute DRG revenue loss;
● Recognized by managed care payers;
● No limitations on diagnoses, age, or scope of services; and
● The ability to cross-utilize services and resources within the health system’s care continuum.
Additionally, LTACHs have long been known for their heavy respiratory patient population. LTACHs provide a framework for positive outcomes with ventilator management, respiratory illness, and the associated complications which may occur. Having a critical base as your patient population, LTACHs can safely admit
patients from the Intensive Care Unit (ICU) setting, offloading burden from their acute care partners and managing those patients requiring an extended acute care stay.
What this current health crisis has demonstrated is that the long-term acute care hospital venue can serve as an appropriate and much-needed discharge disposition for a critically ill patient population. What we are seeing is that health systems have identified the absence of this venue within their continuum and
are now seeking to evaluate whether an LTACH is a viable long-term strategy for their organizations. The pandemic has shown the industry that LTACHs have long been known for and what they were always intended to be: a much needed long term acute care partner that provides an outlet for critically ill patients who require specialized care