Long-term acute care (LTAC) is the type of care provided in Kindred Transitional Care Facilities. More than 20 years ago, Kindred helped to pioneer the long-term acute model of care. Today, Kindred has a nationwide network of transitional care facilities unique in their ability to care for medically complex patients who benefit from extended recovery time.
LTAC differs from the care provided at acute care general facilities in that it is for patients who stay, on average, about 25 days. Care levels extend from ICU beds (at most of our facilities) to monitored beds to general medical care. Most of our facilities have ORs or treatment rooms for invasive and minor surgical procedures such as G-tube placement and wound debridement.
Transitional care facilities are unique in their ability to care for difficult to treat, chronically critically ill patients who require specialized and aggressive goal-directed care over an extended recovery period. Typical patients have multiple co-morbidities, multi organ system failure, and significant loss of independence, most following a traditional hospital stay.
We are unique in our ability to care for critically ill patients who require specialized, aggressive, goal-directed care over an extended recovery period. Transitional care facilities provide care to complex medically complex patients who require an extended stay in a highly focused setting.
LTAC is unique for many reasons, including:
The typical LTAC patient is older with three to six concurrent active diagnoses, or someone who has suffered an acute episode on top of several chronic illnesses. Over 95% of our patients are admitted from a STAC (short-term acute care) hospital. Approximately 25% of our patients are on mechanical ventilation, 25% have at least one wound, and almost 50% have a central line. Approximately 40% of our patients are, on admission, colonized with MRSA, VRE, resistant gram-negative organisms or C. difficile.
Most of our patients have already undergone extensive work-ups at the STAC and have developed and initiated a treatment plan with the referring physician team. Common conditions include but are not limited to ventilator weaning, severe infection, complex wound care, CHF, COPD and renal insufficiency. As many as 10% of our patients may require acute hemodialysis at some time during their stay.
Patients receive long-term acute care through treatment delivered according to their individual needs. Our board-certified physicians see patients daily to assure the best outcomes possible. The majority of our patients are admitted after a stay in a short-term hospital, often from intensive care and step-down units. Kindred facilities specialize in caring for patients with:
Unlike STACs, transitional care facilities providing long-term acute care are designed instead for the development, administration and adjustments of prolonged medical treatment plans carried out by a multidisciplinary team including nurses, respiratory therapists, pharmacists, rehabilitation therapists and specialty physicians such as cardiologists, neurologists, gastroenterologists and ENT physicians. The main attending physician is generally a hospitalist, internist or pulmonologist.
In addition, due to the size of our facilities, the Chief Executive Officer, Chief Clinical Officers and Quality Managers are actively involved in the daily care of patients.
Medicare patients are paid under a modified DRG system. About 50% of the patients receive a DRG payment. Non-Medicare patients are paid by a contracted or negotiated rate between the transitional care hospital and the insurer.
As with traditional inpatient care, prudent use of tests, prevention of complications, and attention to patient safety are essential. We encourage and promote the Medical Staff involvement in the hospital care teams such as Quality Committee, Medical Executive Committee, Infection Control and Utilization Review.
LTAC reimbursement for Medicare patients (70%) follows the usual Medicare in-patient Evaluation and Management (E&M) fee schedule. Therefore, reimbursement for a given E&M code is the same as if that care was provided in a short-term acute care hospital. For managed care patients (15-25%), fees are set by each insurance company, and vary between the in- network and out-of-network fee schedule. Therefore, it is not necessary to be on a panel to receive reimbursement. A few states have Medicaid rates for transitional care facilities providing long-term acute care, and those transitional care facilities accept Medicaid patients. Physicians are paid according to that state’s fee schedule.
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