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Supporting LTACHS in the Post-COVID Era

By , SVP Post-Acute Operations April 9, 2024 LTACH

During the pandemic, Long-Term Acute Care Hospitals (LTACHs) filled a critical role relieving short term acute care hospitals to treat fragile critically ill and medically complex patients. As a result, LTACHs were repositioned as an essential part of the healthcare continuum.

LTACHs role in the COVID-19 pandemic

Federal waivers enabled LTACHs, which traditionally care for medically complex and fragile patients, to admit seriously ill COVID patients without the required inpatient stay of three ICU midnights in short-term acute care hospitals. Prior to the waived rules, LTACHs had to have an average length of stay for discharged Medicare patients over their cost report year.  The federal government removed the waivers for LTACH admission and length of stay and reinstated requirements in May 2023, declaring COVID was no longer a public health threat. 

Removal of COVID-era waivers putting LTACHs at risk

Removal of the waivers caused patients to stay longer at short-term acute care hospitals if they don’t meet Medicare requirements for LTACH admissions. This has created capacity issues at some short-term acute hospitals, causing delays in admitting patients and straining emergency room staff and resources. 

LTACHs’ challenges largely stem from low Medicare reimbursement rates that have stymied this healthcare sector’s growth. According to NALTH data, the number of LTACHs and LTACH beds plunged by 22% and 24%, respectively – most of which occurred since 2016 – while Medicare-age recipients grew by 28% during this same period. 

But this issue extends beyond payment levels. It’s also focused on providing greater access to care for patients who deserve to receive LTACH care when required. 

LTACHs are typically located within the walls of acute-care hospitals but function independently. They offer specialized care to patients who are too medically complex for other post-acute care settings. LTACHs specialize in services such as ventilator weaning, dialysis, cardiac monitoring, wound management and intravenous medicine management, provided by a multidisciplinary care team.

LTACHs also excel in other areas distinct from other post-acute facilities. For instance, LTACHs demonstrated during the pandemic that they have the ability to treat and control infectious diseases.   

Legislation seeks to support LTACHs

Lawmakers are trying to support LTACHs. In 2021, the LTCH Access and Stability Act sought to waive Medicare payment rates for LTACH inpatient services for an additional 12 months after the end of the COVID public health emergency. Unfortunately, the bill didn’t go beyond review in the House Ways and Means Committee.

More recently, a bill has been drafted called the Patient Access to LTACH Care Act. The bill aims to bring financial stability to LTACHs “through multiple-targeted reforms” which would provide adequate reimbursement to these hospitals for the highest-acuity patients.

LTACH resiliency
Several LTACHs owned or  managed by CHC have achieved financial resiliency through CHC’s operational support and by adopting best practices.

An example is Tyler CHC ContinueCare-Tyler, a 51-bed LTACH in Tyler, Texas, which will celebrate its 20th anniversary this year. Since its inception, the hospital has served more than 11,000 patients, earned high patient satisfaction scores, and received multiple industry awards.

“CHC’s experienced leadership in hospital management services has put Tyler ContinueCARE on the right path in ensuring its ability to succeed in a challenging environment,” Tyler ContinueCARE CEO Stephanie Hyde said. “CHC’s role has been vital to the hospital achieving financial and operational resiliency that is needed to provide the best possible patient care and experience.” 

The hospital’s successful track record can be partly attributed to implementing strategies designed to meet the healthcare needs of residents of Tyler and surrounding communities. That includes providing much-needed care to critically ill COVID patients during the pandemic saving many patients’ lives during the health crisis as a result of the waived admission restrictions.       

Support expanded role for LTACHs 

The pandemic enabled LTACHs to demonstrate their ability to go beyond their traditional role in the healthcare continuum. More communication and education are needed to generate awareness of the changing and expanding role of LTACHs to care for a medically complex and aging population in the years ahead.

By , SVP Post-Acute Operations April 9, 2024 LTACH
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