COMMENTARY:

Roberts-nel­son bill would set­tle role of LTACS within Medi­care, pre­serve ac­cess

Modern Healthcare - - NEWS - David Ch­er­now

Roberts-nel­son bill would set­tle role of LTACS in Medi­care

It’s rare these days for Democrats and Repub­li­cans to agree on any­thing. It’s even more rare to find con­sen­sus in the in­dus­try on fed­eral pol­icy. But on one is­sue—defin­ing which pa­tients would be best treated in long-term acute-care hos­pi­tals—we have now seen it on dis­play.

The na­tion’s 450 LTAC hos­pi­tals have long strug­gled un­der the uncer­tainty cre­ated by the ab­sence of clear Medi­care reg­u­la­tion. This uncer­tainty has led to the un­in­tended con­se­quence of lim­it­ing pa­tient ac­cess to the ex­tended care that LTAC hos­pi­tals pro­vide.

But that might soon change. Thanks to the lead­er­ship of Sens. Pat Roberts (R-kan.) and Bill Nel­son (D-fla.), a bi­par­ti­san bill, en­dorsed by the Amer­i­can Hos­pi­tal As­so­ci­a­tion and the vast ma­jor­ity of LTAC hos­pi­tals, has been in­tro­duced in the Se­nate and cospon­sored by six other sen­a­tors.

Based on a se­ries of pol­icy pro­pos­als first de­vel­oped by the AHA and re­fined by two well-re­spected Se­nate vet­er­ans act­ing in a bi­par­ti­san fash­ion, the Roberts-nel­son bill would make clear which fa­cil­i­ties qual­ify as LTAC hos­pi­tals. Among other things, it would en­sure that LTAC hos­pi­tals treat only high-acu­ity pa­tients. This needed pro­posal was de­vel­oped by the AHA dur­ing a year­long process in which many stake­hold­ers, in­clud­ing those be­yond the LTAC hos­pi­tal com­mu­nity, were con­sulted. As a re­sult, the pol­icy rep­re­sents a broad con­sen­sus.

The pro­posed fed­eral reg­u­la­tion, or what the Medi­care Pay­ment Ad­vi­sory Com­mis­sion calls “cer­ti­fi­ca­tion cri­te­ria,” are years over­due. Still, they come at an op­por­tune time: Washington is try­ing to find sav­ings in the fed­eral govern­ment’s en­ti­tle­ment pro­grams to re­duce bud­get deficits. The Roberts-nel­son leg­is­la­tion pro­vides ex­actly what law­mak­ers want most: the po­ten­tial for sav­ings in Medi­care re­im­burse­ments.

LTAC hos­pi­tals have been around for more than three decades and oc­cupy an in­creas­ingly vi­tal space. They spe­cial­ize in treat­ing pa­tients who need ex­tended acute hos­pi­tal stays due to the com­plex­ity and sever­ity of their con­di­tions. This can in­clude heart fail­ure or other car­diac dis­ease, in­fec­tious dis­ease, neu­ro­log­i­cal or other post-trauma con­di­tions, pul­monary/ven­ti­la­tor wean­ing, re­nal dis­ease and other med­i­cally com­plex con­di­tions.

The typ­i­cal LTAC hos­pi­tal of­fers daily

It may be tough medicine for us, but for a se­cure place in the sys­tem it is worth the com­pro­mise.

physi­cian vis­its; mul­ti­spe­cialty med­i­cal and sur­gi­cal con­sul­tants; a low pa­tient-to-nurse ra­tio; 24-hour nurs­ing and res­pi­ra­tory ser­vices; on-site phys­i­cal, speech and oc­cu­pa­tional ther­apy; an on-site phar­macy; car­diac mon­i­tor­ing; di­ag­nos­tic and lab­o­ra­tory ser­vices; case man­age­ment; dis­charge plan­ning and more.

Un­like other set­tings, LTAC hos­pi­tals pro­vide acute care for an ex­tended pe­riod of time. To qual­ify as an LTAC hos­pi­tal for Medi­care pay­ment, a hos­pi­tal must meet Medi­care’s con­di­tions of par­tic­i­pa­tion for acute-care hos­pi­tals and have an av­er­age in­pa­tient length of stay greater than 25 days. This is nearly 20 days longer than the av­er­age gen­eral hos­pi­tal stay.

LTAC hos­pi­tals are also ex­tremely di­verse. They are large and small, not-for-profit and for-profit, and serve both el­derly and young pa­tients. Many are lo­cated un­der the same roof as gen­eral hos­pi­tals, while oth­ers are free-stand­ing. Still, ac­cord­ing to the AHA, 87% of LTAC hos­pi­tals will be able to com­ply with the cri­te­ria in the Roberts-nel­son leg­is­la­tion. The new Se­nate bill also pro­vides for a grace pe­riod for LTAC hos­pi­tals to pre­pare for the stricter cri­te­ria. Although the bill would im­pose tougher stan­dards, it en­joys a broad spec­trum of sup­port from the na­tion’s LTAC hos­pi­tals. Across the broader hos­pi­tal in­dus­try, other key groups such as the Fed­er­a­tion of Amer­i­can Hos­pi­tals also have been sup­port­ive.

In a mes­sage to AHA mem­bers, AHA Pres­i­dent and CEO Richard Umb­den­stock noted the his­tor­i­cal sig­nif­i­cance of the bill: “Since 2004, Congress, the Medi­care Pay­ment Ad­vi­sory Com­mis­sion and other stake­hold­ers have called for the de­vel­op­ment of pa­tient and fa­cil­ity cri­te­ria that would de­fine LTAC hos­pi­tals and the types of pa­tients they serve. (The Roberts-nel­son) bill puts us on a path to fi­nally es­tab­lish uni­form pa­tient and fa­cil­ity cri­te­ria that will dis­tin­guish LTAC hos­pi­tals from all other provider set­tings,” Umb­den­stock said. “The new cri­te­ria will bring about a com­mon def­i­ni­tion for LTAC hos­pi­tal pa­tients and ser­vices and so­lid­ify that ac­cess to care is based on pa­tients’ med­i­cal needs. This will al­low LTAC hos­pi­tals to fo­cus on their mis­sion of car­ing for very sick pa­tients who need in­ten­sive care for a long pe­riod of time.”

The leg­is­la­tion has many ad­van­tages, chief among them that it pro­tects ac­cess to ap­pro­pri­ate care for med­i­cally com­plex pa­tients who re­quire rel­a­tively ex­tended hos­pi­tal stays. In many ways, it may be tough medicine for us. But if the cri­te­ria are ce­mented in law and the na­tion’s LTAC hos­pi­tals fi­nally are given a per­ma­nent place in the con­tin­uum of Amer­i­can med­i­cal care, it will be worth the com­pro­mise.

For all of these rea­sons, the Roberts-nel­son leg­is­la­tion is des­per­ately needed. Washington is hun­gry for some­thing that mem­bers of both par­ties can em­brace. The LongTerm Care Hos­pi­tal Im­prove­ment Act of 2011 fits that de­scrip­tion well. Even bet­ter, the hos­pi­tal in­dus­try agrees that when it is fi­nally en­acted into law, pa­tients will be the ul­ti­mate ben­e­fi­cia­ries.

David Ch­er­now is pres­i­dent and chief de­vel­op­ment and strat­egy of­fi­cer of Se­lect Med­i­cal Hold­ings Corp., Me­chan­ics­burg, Pa.

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