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An Overview of Long Term Acute Care Hospitals (LTACH)

LTACHs provide intensive inpatient hospital care to medically complex patients with multiple acute or chronic conditions.  LTACHs have been around for decades.  The oldest facilities evolved from tuberculosis and chronic disease hospitals.  Today, LTACHs provide a wide variety of inpatient services, including respiratory care, inpatient rehabilitation services, cancer treatment, pain management and psychiatric care.  The amounts and types of care provided is often different from (and supplements) medical care provided in acute care hospitals, skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), psychiatric facilities and palliative care facilities.  Collectively, however, these different types of facilities form a continuum of care that is the backbone of post-acute inpatient care in the United States. 

The distribution of LTACHs varies widely, with the greatest concentration of LTACHs occurring in the south and northeast.  The distribution of LTACHs is unrelated to the geographic distribution of medically complex patients.  Instead, states with strict certificate of need processes or prohibitions against proprietary hospital ownership have a lower number of LTACHs.  LTACHs vary in size from small Hospital-within-Hospital facilities to large hospitals with over 300 inpatient beds.  LTACHs may be for-profit, not-for-profit or government-owned facilities. 

LTACHs are certified by Medicare as “long-term care hospitals” and are licensed by state regulators either as acute care or specialty hospitals.   Unlike short term acute care hospitals, LTACHs have a patient length of stay requirement.  LTACHs, on average, have a patient average length of stay of greater than 25 days.  LTACHs are reimbursed by Medicare under the LTACH Prospective Payment System (LTCH-PPS). 

An Overview of Patients Admitted to LTACHs and Commonly Provided Services

Almost 80% of patients are admitted to an LTACH from an acute care hospital.  Potential LTACH patients are stable yet severely ill patients—often having six or more comorbidities/conditions.  Acute care hospital patients are generally admitted to an LTACH when they are in stable condition and have a chance of improving after an extended period of intensive care.  Therefore, even though many LTACH patients may be ventilator dependant when admitted, most patients will be weaned off of a ventilator by the time they are discharged. 

LTACHs often admit patients requiring the following types of medically complex treatments or procedures: (i) gastrostomy tubes; (ii) chest tubes; (iii) PIC/PICC lines; (iv) central lines; (v) tracheostomies; (vi) ventilation services; and (vii) dialysis services.  LTACHs may provide various other types of specialized services.  Patients are treated by an interdisciplinary team of health care professionals, including physicians, who develop an individualized treatment plan for each patient. 

The Legislative Battle Continues: Patient Admission and Facility Certification Standards

You are not alone if you are wondering how to determine when a patient should seek treatment in, or be admitted to, an LTACH (as opposed to a SNF, IRF, psychiatric facility or palliative care facility).  For the past decade, the Centers for Medicare and Medicaid Services (CMS), members of Congress, industry groups and other stakeholders have attempted to craft legislation, tools and guidelines aimed at differentiating patient populations and facility characteristics.  Most recently, the Medicare, Medicaid, and SCHIP Extension Act of 2007 (SCHIP) required the Secretary of U.S. Department of Health and Human Services to conduct a study for the purposes of establishing Federal LTACH patient admission and facility certification criteria, and to submit a report containing the Department’s recommendations to Congress by June, 2009. 

In light of remaining questions regarding patient admission and facility certification standards, the recent and rapid proliferation of LTACHs and the relatively generous Medicare reimbursement rate, SCHIP mandated a three-year moratorium (effective December 29, 2007) on the establishment and classification of new LTACHs, LTACH satellite facilities and LTACH beds in existing LTACHs or satellite facilities. 

One thing is for certain…modern medicine has allowed us to live longer and has given health care providers tools to offer increasingly acute patients a greater number and variety of treatments, medications and technologies.  As the population ages and as the nation’s traditional health care system becomes increasingly taxed by a larger number of patients requiring more intensive care, LTACHs will (and must) continue to play an increasingly critical role in the patient continuum of care. 

About the Author

Jason S. Greis, Esq.

Jason S. Greis, Esq.

Jason Greis is a health care attorney with the Chicago office of McGuireWoods.  Jason focuses his practice on providing solutions to complex business and legal issues for LTACHs and other post-acute care organizations.  He also regularly structures corporate transactions for health care and life sciences companies, while addressing various regulatory compliance issues commonly associated with such transactions. 

Jason counsels health care clients on physician self-referral prohibitions and anti-kickback issues, ancillary provider staffing issues, corporate practice of medicine, fee splitting, false claims, provider licensing, change of control issues, acquiring certificates of need, physician employment and recruitment issues, compliance with The Joint Commission standards, hospital and medical staff bylaw and practice-related matters, and other regulatory compliance issues. 

Jason’s goal is to keep readers of this Weblog apprised of the latest LTACH-related business and legal developments as this critical sector of the health care system continues to develop and mature.

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