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Extended Acute Care: Community Need For Long-Term Care Hospital/s In The Finger Lakes Region . Kathryn Votava, PhD, RN GoodCare.com ™ Washington, DC. PREPARED FOR: THE FINGER LAKES HEALTH SYSTEMS AGENCY ROCHESTER, NY October 1, 2007.

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extended acute care community need for long term care hospital s in the finger lakes region

Extended Acute Care:Community Need For Long-Term Care Hospital/sIn The Finger Lakes Region

Kathryn Votava, PhD, RN

GoodCare.com™

Washington, DC

PREPARED FOR:

THE FINGER LAKES HEALTH SYSTEMS AGENCY

ROCHESTER, NY

October 1, 2007

finger lakes health systems goal
Finger Lakes Health Systems Goal
  • “to provide all people the right care, at the right time, in the right place for the right price.”
according to medicare what is a ltch
According to Medicare: What is a LTCH?
  • Acute hospital with ALOS ≥ 25 days
    • It’s not a “unit”
    • Has its own staff, administration & board of directors
    • Can co-locate within another hospital or on a campus with other Medicare providers
      • Hospital-within-hospital (HWH)
      • Satellite HWH
  • If owned by another acute hospital:
    • Restricted to 25% admissions from acute hospital owner
what is extended acute care eac does a ltch fit in the acute care puzzle
What is Extended Acute Care (EAC)? Does a LTCH fit in the acute care puzzle?
  • Acute Hospital Stay beyond the “average” DRG.
  • Aggregate of Need –
    • Multiple diagnoses
    • Complex acute care
  • Higher level of care than ALC or complex SNF
do long term care hospitals fit in the extended acute care picture in the finger lakes region
Do Long Term Care Hospitals fit in the Extended Acute Care picture in the Finger Lakes region?
  • What is the clinical profile of EAC patients?
  • What are their acute hospital service use patterns?
  • Is their a community need for Long-Term Care Hospitals (LTCH/s)?
  • What might the LTCH CON recommendations be?
eac community needs assessment inclusion criteria
EAC Community Needs Assessment Inclusion Criteria:
  • Finger Lakes region SPARCS acute hospital episode 2003 – 2006:
    • Discharged from region acute hospital
    • Region resident with acute hospital outside the Finger Lakes region
  • > 17 years of age
  • Top 50 LTCH DRGs
  • Acute hospital LOC ≥ 75th percentile
eac demographics 2003 2006
EAC Demographics 2003-2006

Ethnicity

Sex

Age Groups

%

eac clinical groups
EAC Clinical Groups
  • Medical EAC Groups:
    • Complex:
      • Wounds
      • Infectious Disease
      • Heart Failure
    • Respiratory or Ventilator
  • Psycho-Behavioral
ltch candidates inclusion criteria
LTCH Candidates Inclusion Criteria
  • LTCH Clinical Admission Criteria Per Medicare:
      • Clinical stability
      • Need 24 hr. skilled care
      • Need 24 hr. laboratory service
    • 80% of acute hospital episodes meet criteria at some point during acute hospital stay.
acute hospital days saved estimate assumptions
Acute Hospital Days Saved Estimate Assumptions
  • Acute hospitals will discharge clinically ready patients to LTCH to optimize acute DRG payment.
  • LTCH occupancy will be 90%.
acute hospital days saved estimate

N

K = 1

[Acute Hospital LOS – (2007 Medicare GLOS – 1day)] Acute Hospital Discharge Clinical Readiness

Acute Hospital Days

Saved

Acute Hospital Days Saved Estimate
  • Acute Hospital Discharge Clinical Readinessestimated on a range of additional LOS above the “average” acute DRG:
    • 5% = Prompt Clinical Readiness
    • 15 % = Mid-range Clinical Readiness
    • 25 % = Late Clinical Readiness
ltch bed need in finger lakes sub areas
LTCH Bed Need in Finger Lakes Sub-areas
  • Monroe/Livingston Monroe and Livingston
  • Southern Tier Chemung, Schuyler & Steuben
  • Central Region Ontario, Seneca, Wayne & Yates
  • Western Region Genesee, Orleans & Wyoming
ltch business case
LTCH Business Case
  • Geographic Distribution of LTCHs
    • Concentrated in Monroe/Livingston and Southern Tier
    • Facilitated discharge planning and enhanced clinical outcomes when families have easier access to patient while in hospital
  • Financial Viability of LTCH
    • LTCH Reimbursement
      • Bundled Reimbursement
      • Payors other than Medicare
      • Potential LTCH back-up
    • 25% referral restriction
ltch business case continued
LTCH Business Case continued
  • Capital, Construction and Renovation Costs
    • Converting existing space vs. new construction
  • Acute Hospital Opportunity Cost
    • EAC patients as outliers in the acute hospital
    • Blocking beds for new acute admissions
  • Potential Impact of LTCH in acute hospital market
    • Better clinical outcomes for LTCH patients
    • Opportunity cost to acute hospital market
how does a ltch fit in the acute hospital care puzzle
How does a LTCH fit in the acute hospital care puzzle?
  • “to provide all people the right care, at the right time, in the right place for the right price.”