LTAC Overview

Kindred Healthcare is a leading provider of long-term acute care hospital services. LTAC hospitals provide an acute hospital level of care and services to patients requiring a long hospitalization.

What Is an LTAC Hospital?

Regulatory

• LTACs must maintain at least a 25-day ALOS
• LTACs are licensed as acute care or specialty hospitals
• LTACs are certified by Medicare as long-term care hospitals
• LTACs are accredited by JCAHO

Patient Services (Interdisciplinary)

• Daily physician visits
• Nursing
• Respiratory therapy
• Physical, occupational and speech-language therapy
• Nutritional therapy
• Case management and social services
• Laboratory, radiology and pharmacy
• Telemetry
• Dialysis
• Pain management
• Family interventions
• End of life care

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Types of Patients

Technology-Dependent

• Currently ventilator-dependent and difficult to wean
• Special monitoring
• IV therapy
• Dialysis
• Nutritional support

Medically Complex – Multi-System Failure

• Pulmonary disease
• Cardiac disease
• Pressure wounds
• Neuromuscular diseases
• Gastrointestinal diseases (difficulty eating/swallowing)
• Post-op complications (infection, stroke, bleeding)
• Renal disease including dialysis

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LTAC Overview

• LTAC is not chronic care
• LTACs are not skilled nursing facilities
• LTACs are not acute rehab facilities
• LTACs are not short-term acute hospitals

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What Are LTAC Hospitals within Hospitals (HIH)?

An HIH Meets the Following Requirements:

• ALOS greater than 25 days
• Focus on patients with specialized long-term needs in hospital setting
• Utilizes interdisciplinary teams
• Six month qualification period
• No more than 25% of patients can come from host hospital

In Addition, an HIH:

• Leases space from the host hospital
• Purchases ancillary services from the host hospital
• Separate acute care license
• Separate Medicare certification
• Separate JCAHO accreditation
• Separate governing body and administrator
• Separate medical director and medical staff

Key Benefits

• Place patients in more appropriate care setting
• Helps host hospital manage length of stay
• Opens ICU and telemetry beds sooner
• Provides lease revenue from unused beds
• Provides revenue from purchased ancillary services
• Offers physicians expanded daily practice area
• Attracts new physicians to the host hospital
• Creates additional jobs in the community

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Rehabilitative Care Is Different in LTAC Hospitals

Rehab Hospitals

• 3+ hours per day in 2 rehab disciplines
• Few concurrent illnesses
• Typically after knee, hip, or back surgery
• Care directed by Physical Medicine physician
• ALOS < 14 days
• Not licensed as acute care hospitals

LTAC Hospitals

• Not yet able to tolerate 3 hours of rehab per day
• Many concurrent illnesses
• Typically after illness from respiratory disease, stroke or infection
• Care directed by multiple medical subspecialists
• ALOS = 30 days
• Licensed acute care hospitals

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SNF Care Is Different From LTAC Hospital Care

SNFs

• Vent management uncommon
• Typically after a fall, broken hip, or minor stroke
• Few if any SNFs staff deal with ventilator care
• Patients frequently ambulatory
• Medicare coverage up to 100 days per spell of illness
• Patients meet criteria for chronic care
• Weekly/monthly physician assessments

LTAC Hospitals

• 24/7 respiratory therapists for weaning
• For complex respiratory disease, complicated wound care, and multi-system organ failure
• Many patients with respiratory-relevant diagnoses are ventilator dependent
• Patients are typically bed-bound on admission
• ALOS > 25 days
• Patients must meet acute care admission and continued stay criteria
• Daily physician assessments
  

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