A Long Term Acute Care Hospital (LTACH), as recognized by 42 CFR 412.23 (e), generally provides diagnostic and medical treatment to patients with chronic diseases or complex medical conditions. The Medicare patient’s average length of stay in a LTACH exceeds 25 days. It is important to remember that a LTACH is an acute-care hospital. The only difference between a LTACH and an acute-care hospital is that the Medicare aggregate length of stay, computed at year’s end, must be greater than 25 days. Not all patients will have a length of stay of 25 days but the target range is 18-35 days.
Long-term acute care hospitals have become essential to an effective continuum of care within a health system. LTACHs are mirror images of short-term acute care hospitals, serving patients whose medical condition require a longer stay than the Centers of Medicare and Medicaid (CMS) prescribed DRG.
While LTACHs are not limited in the diagnoses that may be treated, most LTACHs specialize in one or more product lines. For example, LTACHs developed by Murer Consultants typically offer specialty programs for medically complex, cardiac, pulmonary and complex rehabilitation patients. LTACHs offer programs for, and specialize in, a patient population that other post-acute settings do not offer. It’s a venue for those patients with acute care needs requiring a long length of stay.
Acute care hospital beds and intensive care unit beds do not specialize in treating long-term patients who have acute-level care needs. Acute and ICU programs are not designed for a long-term patient population, nor for diagnoses that are commonly treated by an LTACH. For example, five to six days is a typical average length of stay in many acute care hospitals. LTACHs treat patients who have a greater severity of illness and more co-morbidities than patients in acute care hospitals.
The high acuity level demonstrated by the LTACH patient population also differentiates LTACHs from inpatient rehabilitation hospitals/units and skilled nursing facilities/units. Both LTACHs and rehabilitation facilities are equipped to treat patients who require rehabilitative treatment. However, rehabilitation facilities are required to treat patients within specific diagnostic categories and those who can tolerate three hours of therapy per day, five days per week. LTACHs are an ideal care venue for patients who fall outside these requirements.
The average LTACH patient has many co-morbidities and it is not uncommon that such patients cannot tolerate the therapy requirements of rehabilitation facilities.
Due to acuity levels, LTACH patients are also inappropriate for skilled nursing facilities. LTACH patients, like acute care hospital patients, require approximately eight hours of direct nursing per day and daily physician contact. Conversely, most skilled nursing patients receive four direct nursing hours per day and do not have contact with a physician on a daily basis.
The benefits of a Long Term Acute Care Hospital (LTACH) include:
- Extension of the Continuum of Care;
- Reduction in DRG Revenue Loss at Short-Term Acute Hospitals;
- Recognition by Managed Care Payment Structure;
- No Limitation on Type of Diagnoses;
- No Limitation on Age;
- No Limitation on Scope of Services Provided; and
- Ability to Cross-Utilize Services and Resources within the Health System Continuum.
Conditions appropriate for LTACHs include those that involve:
- Medically Complex Conditions;
- Respiratory Infections and Disorders, Including Tracheostomy;
- Cardiac/Cardiovascular Conditions;
- Renal Disease;
- Wound Care;
- Rehabilitation Related Diagnoses with Complex or Tertiary Needs; and
- Extended Post-Surgical Care.
Like a short-term acute care hospital, the long-term acute care hospital patient must have the medical necessity requiring an acute level of inpatient care. Once a patient no longer meets this criteria, discharge planning should move the patient to the next appropriate level of care including discharge to home if appropriate.
A long term acute care hospital is an ideal vehicle to stem losses due to extended lengths of stay and increased patient acuity. The LTACH should reflect the patient diagnostic population of the short-term acute in harmony with the mission and philosophy of the health system and its medical staff. Together, the LTACH and short-term acute hospital form a continuum of care with appropriate reimbursement levels reflective of anticipated lengths of stay and each venue’s purpose.