Patients, families and even healthcare professionals often have questions about long-term acute care (LTAC) hospitals, their role in supporting recovery and who can MOST benefit from this specialized care setting.
“The truth is that even among professional caregivers, the precise role that long-term acute care hospitals play in the overall healthcare landscape has been a cause of considerable confusion,” says Charles Duncan, MD, Medical Director of Kindred Hospital San Antonio.
Dr. Duncan has been in practice for more than 38 years, serving as a consultant in various forms of health care. He is board-certified in internal medicine and pulmonary disease, specializing in pulmonology and critical care medicine. He graduated from the Medical College of Georgia and completed his residency at Keesler Medical Center and his fellowship at Wilford Hall Ambulatory Surgical Center. He has served as an assistant professor at Baylor College of Medicine in Houston, chief of internal medicine and medical director at Ben Taub Hospital in Houston, and senior vice president of clinical effectiveness, vice president of medical affairs and chief medical officer with Baptist Health System in San Antonio. He has served as the director of the Internal Medicine Residency Program at the University of Texas Health Science Center in San Antonio as well as various other clinical and training positions at UTHSCSA. His compassion and focus on patient dignity and autonomy have enabled him to envision how all the facets of health care can and should work together for the benefit of both the patient and the physician.
In December 2013, Congress passed legislation that established criteria and payment reform for long-term acute care hospital stays. This provided clarity and affirmation of the valuable role of LTAC hospitals. Because these hospitals are recognized as being valuable, the criteria also provide an opportunity for other medically complex patients to benefit from, and have full access to, the specialized LTAC hospital level of care. This presents new options and solutions for healthcare and managed care partners to discharge the sickest patients to this level of care without being constrained by a length-of-stay limitation. For these patients, there will be no change in care, and the LTAC hospital will receive a lower Medicare reimbursement — also known as the “site-neutral” rate.
Under the new criteria, Medicare established an LTAC hospital rate for patients who most recently spent three or more days in an ICU or experienced prolonged dependence on a ventilator. By establishing specific thresholds, short-term hospitals have the option to discharge ICU and ventilator patients to LTAC hospitals at a time when they can best benefit from this level of care.
The new criteria went into effect in October 2015, with all LTAC hospitals entering the new payment system during 2016 based upon each provider’s cost-reporting period. The two-year phase in to the full criteria will serve to assure that critically, chronically ill patients continue to have access to the interdisciplinary care that will facilitate their recovery, while also providing the sector with a measure of reimbursement predictability and stability.
“Kindred’s LTAC hospitals provide an advanced level of care for select patients, particularly those with prolonged critical illness,” Dr. Duncan says. “As our nation’s healthcare system moves to one that rewards value over volume for patient care, the change highlights the distinctive role of transitional care hospitals (or long-term acute care hospitals) in delivering improved clinical outcomes for the most difficult-to-treat patients, and in partnering with short-term acute hospitals to drive down costs and create efficiency.”
There has been a tremendous amount of discussion and confusion concerning the new LTAC hospital criteria, with the mindset that these hospitals will only admit patients from an ICU or patients on ventilators. The new criteria established the payment methodology for patients covered by Medicare and has no impact to other payers.
“Some LTAC hospitals may decide to limit their scope, but Kindred San Antonio believes that LTAC criteria expand the types of patients who can receive care in the LTAC hospital, creating new opportunities and solutions for the healthcare provider and managed care payers,” says Sherry Anderson, Director of Professional Relations and Marketing of Kindred San Antonio. “We can continue to take all the patients we take today, and we are very excited about the new opportunities to help the short-term acute care hospitals with discharge options.”
Kindred San Antonio offers care for patients who are seriously ill with multiple medical problems. Many require ventilator management and weaning, pulmonary care, extensive wound care, and dialysis, among other clinical services. Compared with other post-acute providers, Kindred Healthcare reduces the cost, trauma and risk of short-term hospital readmission by being staffed and equipped to rapidly respond to changes in medical conditions.
“The earlier appropriate patients are transferred to an LTAC hospital, the faster they improve,” Dr. Duncan says. “Prolonged short-term acute care hospital stays often require longer periods of rehabilitation.”
Charles Duncan, MD, Medical Director of Kindred Hospital San Antonio, and Sherry Anderson, Director of Professional Relations and Marketing
Kindred Healthcare, the largest diversified provider of post-acute care services in the United States and named a Fortune magazine Most Admired Healthcare Company for six years, has a mission to promote healing, provide hope, preserve dignity and produce value for each patient, resident, family member, customer, employee and shareholder we serve. As a part of Kindred Healthcare, Kindred San Antonio — now in its 27th year — can credit its longevity to a continuous focus on leading-edge care, including integration of services in the post-acute continuum, that enhances every aspect of patient treatment and care.
The Value of Post-acute Care
The most common hospital setting in America is one that provides short-term acute care for patients with pressing health issues — emergencies or surgeries brought on by illness or an accident. The immediate objective is to stabilize the patient and begin the recovery process. For many of these patients, however, a quick recovery is unrealistic. They need continued care — post-acute care. “At Kindred San Antonio, we continue the care for our patients or residents in sites of service across the post-acute spectrum,” Anderson says. “Our expertise allows us to achieve our goal of helping patients recover to the fullest by providing care in the proper care setting.”
Providers unfamiliar with LTAC facilities may hear long-term acute care but only think about the long-term care aspect and miss the acute component. Providers often don’t think of an LTAC facility as a discharge option because it is not well understood that a patient doesn’t have to stay in a short-term acute setting until they can be transferred to a rehabilitation center or skilled nursing facility. Generally speaking, LTAC patients are not healthy enough for skilled nursing facility care, acute rehabilitation hospital care or a return home. It is a common misconception that LTAC patients will remain under Kindred San Antonio’s care for a few days and then be discharged to a skilled nursing facility — this isn’t the case, however.
An LTAC facility is different from a rehabilitation hospital, which attempts to move patients as quickly as possible through the rehabilitative process. Instead, LTAC facilities focus on gradually building up a patient’s strength and abilities. At Kindred San Antonio, a wide variety of clinical services and specialties such as respiratory, physical, occupational and speech therapies are available to help patients achieve this gradual success.
A Physician-directed Interdisciplinary Approach
Fundamentally, patients in need of an LTAC hospital’s services need their care to be directed by a physician. Most are referred from short-term acute care hospitals, and they often have a myriad of complex medical conditions, with chronic conditions that may complicate recovery. However, patients can also be referred to Kindred from skilled nursing facilities, acute rehabilitation hospitals, wound-care clinics, dialysis clinics, physician’s offices and directly from emergency departments.
To serve these patients, Kindred Hospital employs an interdisciplinary team approach designed to identify medical conditions, devise treatment plans and set achievable goals that will result in positive, long-term outcomes for the patient. These patients have acute, active, ongoing medical issues. Many of them are extremely complex. As for the long-term component, the average length of stay is 25 days and daily physician oversight is provided seven days a week.
“The greatest benefit to patients admitted to an LTAC hospital is an interdisciplinary team approach that treats all aspects of a patient’s illness and allows him or her an extended period to recover,” Dr. Duncan says. “Our clinical team takes a true interdisciplinary approach to patient care because of physician daily rounding and presence, which allows Kindred San Antonio to treat sicker patients with more positive outcomes.”
Kindred’s comprehensive, physician-led interdisciplinary team approach, with recognized clinical programs, assures appropriate lengths of stay and facilitates improved outcomes and a greater chance of recovery. As a result, Kindred transitional care hospitals:
- Treated the most seriously ill and medically complex patients, discharging more than 69 percent of patients home or to a lower setting of care after an average length of stay of 27.1 days in 2014
- Outperformed national benchmarks in key quality measures including catheter-associated urinary tract infections and central-line bloodstream infections in 2014
- Reduced rehospitalizations from our LTAC hospitals by 4.1 percent — to less than 8.4 percent — from 2010 to 2014
- Reduced the average length of stay by 8.4 percent over the same period
Services include pulmonary care, complex wound care, rehabilitation, dialysis, IV antibiotic therapy, and diabetes and nutrition management. Caregiver teams are led by attending physicians who are supported by nurses, pharmacists, nutritionists, respiratory therapists, occupational therapists, speech and language pathologists, and physical therapists. This interdisciplinary approach allows caregivers to work together to take care of more than just the medical aspect. Weekly team meetings involve case management, respiratory, nursing, wound care, pharmacy, infection control, rehabilitation services and physicians to discuss issues and define goals for the upcoming week.
LTAC hospitals are often a better option for patients who are coming out of critical care but who are not yet ready for rehabilitation therapies. That is because LTAC hospitals have the ability to provide a high level of care for a longer period of time than is possible in a short-term acute care facility.
“Two-thirds of the patients who enter an LTAC hospital on a ventilator are successfully weaned off of it because they are given the time and service needed to recuperate,” Dr. Duncan says. “The importance of results like these cannot be overstated because they mean patients are far less likely to be readmitted.”
An Expanding Role for LTAC
LTACs are licensed as acute care or specialty hospitals and certified by Medicare as long-term care hospitals. They are reimbursed by Medicare under a prospective payment system/diagnosis-related groups system and have The Joint Commission as their accrediting agency. LTAC hospitals specialize in providing treatment and rehabilitation for medically complex patients in need of an extended stay and recovery time in a hospital setting.
“Kindred Hospital is proactively conveying the message of how much value we can bring to a healthcare environment in the continuum of care,” Anderson says. “Our mission is to provide the appropriate level of care, at the appropriate time, at the appropriate cost and solidify the role of LTAC hospitals.”
Kindred is building awareness among physicians in San Antonio and surrounding communities that there are places where long-term, critically ill patients can be well served in terms of outcomes and cost and serve as an invaluable discharge option. As the largest post-acute care provider, Kindred is in an enviable position to be a part of the solution to cost, quality and access and rally around our focus on quality of care and integrity, which puts Kindred at the forefront of the healthcare landscape.
There is an increasing movement toward local integration of healthcare services with providers and payers. Kindred is seeing more interest at a local level about post-acute care and how post-acute care is going to have to be better integrated with other acute care services. Kindred has been working for years on a integrated market strategy in which it develops a range of post-acute healthcare services in a local market, including LTAC hospitals, health and rehabilitation centers, rehabilitation services, and hospice services.
Charles Duncan, MD
“One of the most impactful changes occurring in health care is greater integration of the continuum of patient care in all treatment environments,” Dr. Duncan says.
The American Hospital Association developed a report that discusses the value of post-acute care in the healthcare continuum and explores how post-acute care providers can serve as important partners — both for acute care hospitals and for one another — in improving quality and reducing costs over an episode of care. According to the report, partnerships across settings not only benefit patients transitioning to a post-acute site, but can also benefit general acute care hospitals referring to and receiving referrals from post-acute care. As a provider of post-acute care services, Kindred Healthcare is piloting such partnerships and is well-positioned to work with other healthcare services providers.
With a patient-centric approach, integrated care, reduced rehospitalizations and sustained quality outcomes, Kindred San Antonio is poised to continue well into the future.
For more information about Kindred Hospital San Antonio, please contact Sherry Anderson, Director of Professional Relations and Marketing, at Kindred San Antonio, 3636 Medical Drive, San Antonio, Texas 78229, or by calling 210-616-0616.