Long-term acute care hospitals are perhaps the single-most unknown specialty in healthcare. Even if you are familiar with an LTAC, or utilize the level of care that is provided, they are very much unknown from the perspective of what they can provide to the healthcare community. In a time where costs and length of stay are extra-scrutinized, every level of care should be utilized for their expertise. To fully appreciate this area of expertise, a case manager needs to understand the full capability and innovation the continuum provides.
There are several defining principles of LTACs:
1. They differ by the organization that administers them and within each market in which they reside.
2. They have different levels of care within them, which may include a medical-surgical unit, telemetry monitoring, intermediate care units, licensed intensive care units, and transitional care units.
3. Along with inpatient units, an LTAC may have procedure rooms, an operating room or suites, outpatient services and an emergency room.
4. A long-term acute care hospital may be a freestanding hospital or a hospital in a hospital (HIH). A freestanding hospital has complete hospital services for treatment of a complex patient, including an in-house pharmacy, rehabilitation department (physical, occupational and speech therapy), and dietary, radiology and laboratory services. An HIH usually contracts the above services from the host hospitals in which they lease their space.
Peering Into a Specialty
A look into the world of long-term acute care entails looking into an undeclared specialty. The patients that require the LTAC level of care have usually been through an extensive hospitalization and need to continue aggressive care, directed by a physician, for hope of recovery. The transition is a hard one, and usually very stressful for the patient and family. In many cases, the patient and family have experienced setbacks, are disappointed, and are usually stressed. They are disenchanted because they are not discharged home or transitioned to a lower level of care. Often, the patients have complications and are looking at an extensive recovery.
The LTAC specializes in these patients, when the diagnosis and treatments are too complex for a lower level of care, such as a skilled nursing facility. An aggressive treatment plan is continued until the patient can move to the next level of care, which may be a rehabilitation facility, skilled nursing facility, home, hospice, or return to a short-term acute care hospital.
LTACs are licensed by the Centers for Medicare and Medicaid Services (CMS), the same as traditional short-term hospitals. But they have a different length-of-stay requirement for the Medicare population. Medicare requires an LTAC to have an average of a 25-day length of stay for this level of care. What most case managers and medical directors do not realize is that, outside of the Medicare patient population, the length of stay requirement is nonexistent. Private pay, commercial insurance and Medicaid plans do not have a required length of stay.
The length of stay is determinate upon the patient’s condition and treatment needs. Patients referred to the long-term acute care hospital go through a preadmission screening process. The Medicare patients must meet InterQual criteria justifying admission to the LTACH. However, generally all patients are screened prior to admission to the LTACH, regardless of payer source, in order to properly assess and determine their care needs.