Long-Term Acute Care Hospitals What are they? What services do they offer? Presented by: Maxi Adams MBA, BSN, RN
LTACH STACH LTACH = Long-Term Acute Care Hospital STACH = Short-Term Acute Care Hospital
What is the difference? Most people who need inpatient hospital services are admitted to an acute-care hospital for a relatively short stay. Long-term acute care hospitals (LATCHs) are certified as acute-care hospitals, but LTACHs focus on patients who, on average, stay more than 25 days. Medicare vs. Commercial
Many of the patients in LATCHs are transferred there from an intensive or critical care unit. LTACHs specialize in treating patients with clinically complex problems such as multiple acute or chronic conditions, but who may improve with time and care LTACHs generally provide services like respiratory therapy, antibiotic therapy, wound care and rehab services
Long-term care vs. Long-term acute care Long-term care usually refers to care that s custodial, such as assisting with feeding or dressing, even if there is some health care given Medicare does not cover custodial care in a long-term acute care hospital LTACHs are hospitals that give inpatient services to people who need a much longer stay to get well.
What is the difference? Skilled Nursing Facility (SNF) Vent liberation not planned Typically after a fall, broken hip, or minor stroke Few SNFs deal with ventilator care Patients are frequently ambulatory Full Medicare coverage up to 100 days per spell of illness Patients meet criteria for chronic care Weekly/monthly physician assessments LTACH For complex respiratory disease, complicated wound care, and multi-system organ failure Many patients with respiratory-relevant diagnoses are ventilator dependent Patients are typically bedbound ALOS = 25 days Patients must meet acute care admission and continued stay criteria Daily physician assessments
Patient Profile What does a typical LTACH patient look like?
Where do LTACH patients admit from and discharge to? Admit to LTACH From: Short-term acute care ICU Step-down Unit Med/Surg Floor Direct admit / other MD Office Home Care Agency Emergency Department Skilled Nursing Facility Discharge from LTACH to: Home with Home Services Home w/out Home Services Rehab Assisted Living/SNF
LTACHs in the continuum of care High LTACHs ACUTE CARE HOSPITALS TRANS CARE ICU Intensity of patient service OUTPATIENT REHAB HOME HEALTH CARE ASSISTED LIVING SKILLED NURSING FACILITIES TRANS CARE CHRONIC CARE SUBACUTE & INPATIENT REHAB HOSPICE Low HOME ADULT DAY CARE
One-third of Source LTACH discharges are in 5 DRGs Sixty Percent of these DRGs are respiratory related LTACHs 5 most frequent DRGs DRG Description Proportion 207 RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT 96+HRS 12.00% 189 PULMONARY EDEMA & RESPIRATORY FAILURE 11.88% 871 SEPTICEMIA W/O MECHANICAL VENTILATION 2.90% 592 SKIN ULCERS W MCC 2.80% 177 RESPIRATORY INFECTIONS & INFLAMMATION 2.10% Total 31.68% STACHs 5 most frequent DRGs DRG Description Proportion 127 HEART FAILURE & SHOCK 5.64% 89 SIMPLE PNEUMONIA & PLEURISY AGE >17 W CC 4.16% 88 CHRONIC OBSTRUCTIVE PULMONARY DISEASE 3.34% 209 MAJOR JOINT & LIMB REATTACH PROC. OF LOWER EXTREMITY 3.06% 14 SPECIFIC CEREBROVASCULAR DISORDERS EXCEPT TIA 2.67% Total 18.87% Source: 2012 MedPAR, 2013 AHCRQ
Reimbursement changes for LTACHs Inpatient Prospective Payment System (IPPS) -Will have a treatment plan like that of a STACH Prospective Payment System (PPS) -The stay in the STACH included at least 3 days in an ICU -The stay in the LTACH included ventilator services of at least 96 hours
LTACHs across the United States Medicare recognizes about 436 long-term acute care hospitals in the United States Examples: Select, Kindred Are there any LTACHs in North Dakota?
LTACHs in North Dakota There are 2 LTACHs in North Dakota -Vibra Hospital of the Central Dakotas (Mandan) -Vibra Hospital of Fargo Privately owned Founded in 2004 92 locations 20 states Employs about 10,000 employees
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