AHA Urges Congress to Remove Legal Barriers to Value-Based Payment Arrangements

Congress should adopt a single broad exception to federal fraud and abuse laws for financial relationships designed to foster collaboration, efficiencies and improvements in health care, AHA told leaders of the Senate Finance and House Ways and Means committees today. Read More   

How a New Payment Stream Could Come to Senior Care

As baby boomers age over the next several decades, the demand for senior care options will increase-and there currently are limited ways for middle-income earners to pay for these services. Read More  

What is an Accountable Care Organization (ACO)?

The Centers for Medicare and Medicaid Services (CMS) broadly defines ACOs as “groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.” The ultimate goal of this care coordination is to streamline services and ensure that patients get the right care at the right time with better clinical outcomes. A secondary goal is to create savings to the Medicare program by eliminating duplicate services, medical errors and preventable rehospitalizations.

Just as there are different kinds of patients, there are different kinds of hospitals. Kindred Transitional Care Hospitals provide a wide range of services to help patients with complex medical issues who need additional recovery time after a stay at a traditional hospital. While every patient receives individualized care from a team of healthcare professionals, our goal is for each person to reach the highest level of recovery before discharge.

With our Direct Admit Program, physicians can admit medically complex patients from short-term acute care hospitals, skilled nursing facilities, home health and other service providers directly to a Kindred Hospital. We work directly with physicians to make sure their patients have a smooth transition into our hospitals and the highest level of care continuity to prevent future readmissions.

What are care management’s best practices at this early stage in its existence? This question was answered by William Mills, MD, Chief Medical Officer for Kindred at Home and Vice President of Medical Affairs for Kindred’s new Division of Care Management, during a break-out session at Kindred’s Fifth Annual Clinical Impact Symposium.

There’s no doubt that readmissions to acute care hospitals are costing the healthcare system a lot of money, and the patients who cost the system the most might fit a profile like this:

Patients like this typically see anywhere from two to ten doctors regularly. They have no home support, so when a crisis arises, 911 is called and the patient is taken to the emergency room, which leads to a hospital stay eight out of ten times, Dr. Mills said. Rehabilitation and a long-term care stay follow, then home care and then the cycle recurs.

For patients like this, wouldn’t it make more sense to deliver care in the home setting?

Kindred’s Transitional Care Hospitals play a vital role in the recovery process for the sickest and most medically complex patients who require aggressive medical care and rehabilitation over a longer period of time. For patients who have complex ventilator needs, multi-organ system failure or complicated medical problems that are very difficult to treat, transitional care hospitals may represent the first important step necessary to make recovery and return home possible.

These hospitals are licensed as general acute hospitals, often featuring such familiar elements as Intensive Care Units (ICUs), operating rooms and on-site laboratory and radiology services, but they also are distinguished by an additional Medicare certification that recognizes the need for extended recovery periods.

and keeping patients on the road to recovery at the highest level of function possible. As such, Kindred works with chronic-acute patients before they’re discharged to anticipate concerns they might have after they leave and to educate them about medicine management, wound care, follow-up care, caregiver issues and other aspects of their disease process.

“If patients don’t understand what’s happening to them, they panic and bounce back to the hospital,” says Beth Hock, Chief Clinical Officer, Kindred Hospital Dayton and 2013 President’s Award Winner. “Kindred nurses constantly talk about what they’re doing as another way of training patients about their condition.”

Kindred Hospital Dayton also recently took patient education to a whole new level with a 48-year-old woman who suffered a spinal injury that left her a ventilator-dependent quadriplegic.

Transitional Care Hospitals (TCHs) offer aggressive, medically complex care, intensive care and short-term rehabilitation.

Certified as long-term acute care hospitals and licensed as acute care hospitals, Transitional Care Hospitals are unique in their ability to care for critically ill patients who require specialized and goal-directed care over an extended recovery time. They have an additional Medicare certification that supports a length of stay measured in weeks as compared to the typical five-day stay for patients in traditional hospitals. At Kindred, about two-thirds of our TCH patients have Medicare.

TCH patients require an average length of stay of 25-30 days, and have many co-existing medical conditions, some acute and some chronic. Examples of some of the services TCH patients require are:

Some of the conditions commonly seen in a TCH are:

An intervention known as noninvasive ventilation is being increasingly studied and used in patients with chronic respiratory failure. An article in a recent issue of the journal Respiratory Care, which followed a national symposium dedicated to the care of the chronically critically ill patient, examined its use in several patient populations. Noninvasive ventilation, or NIV, does not require an artificial airway, in contrast to tracheostomy (surgical creation of an airway through the neck) or the placement of a breathing tube through the nose or mouth. NIV is achieved most often through the delivery of pressure and flow to the normal airway through the nose and/or mouth.

The benefits of NIV therapy include reduced re-hospitalizations of out-patients and a reduction in potential complications such as infection that can occur with invasive ventilation techniques.

October 21-27 is Respiratory Care Week, a week set aside to recognize respiratory therapists for their hard work and dedication. “The respiratory therapists at Kindred provide a wide range of respiratory care to patients with complex respiratory disorders and other extensive medical complexities,” says Kelly Bailey, Area Director of Respiratory Care, Kindred Healthcare. “Our respiratory therapists add value and expertise to the interdisciplinary team through the development, utilization, and implementation of best clinical practices and standardization.”

Sean R. Muldoon, M.D., M.P.H., F.C.C.P.
Senior Vice President and Chief Medical Officer
Kindred Healthcare Hospital Division

Many important questions were raised by information published in the June 2012 issue of the journal Respiratory Care. This issue followed a national symposium dedicated to the “chronically critically ill patient,” the patient with ongoing costly medical interventions, risk for medical complications and death, and the need for extensive post-acute care services.