WEST HARTFORD, Conn., July 13, 2015 /PRNewswire/ -- In most cases, medically complex and critically ill patients achieve better outcomes at a similar or lower cost to Medicare when receiving care at a long-term acute care hospital (LTCH), according to a new study published in the July issue of the journal Medical Care.
The study finds most non-ventilator patients with multiple organ failure, and those who had spent three or more days in an acute-care hospital's intensive care unit (ICU) prior to transfer to the LTCH, had lower mortality rates and similar or lower Medicare costs in LTCHs compared with similar patients in other care settings, such as skilled nursing facilities and inpatient rehabilitation facilities. The study was commissioned by the National Association of Long Term Hospitals (NALTH) and is the first peer-reviewed, published study to evaluate costs and outcomes of non-ventilator patients receiving care at an LTCH.
LTCHs are specialty hospitals that care for patients with serious medical conditions who need hospital-level treatment for an extended period. These facilities offer specialized programs and individualized, sustained care for patients who often have multiple co-morbidities. Types of conditions typically treated at an LTCH include: severe wounds; respiratory, cardiac, and renal failure; severe surgical complications; and major, multiple trauma. LTCHs also specialize in caring for patients needing management of multiple intravenous medications and those on or being weaned from prolonged ventilator use.
"As our population ages and the incidence of chronic disease increases, critically ill and medically complex patients will represent a growing segment of the Medicare population," said Lane Koenig, PhD, director of Policy and Research for NALTH, and the study's lead author. "Because care for these patients requires a significant amount of healthcare resources, it's important to identify cost-effective treatment approaches."
Using 2009-2011 Medicare data, researchers identified the five most common major diagnostic categories for non-ventilator patients treated in LTCHs: respiratory, circulatory, digestive, musculoskeletal and connective tissue, and infectious and parasitic diseases and disorders. Within these five categories, researchers further reviewed those cases in which patients had spent three or more days in a standard hospital ICU and those with multiple organ failure.
The study found lower mortality rates at an LTCH for patients with multiple organ failure who had musculoskeletal and connective tissue, circulatory, and respiratory conditions. Mortality rate gaps were statistically insignificant for patients with digestive issues and infections and parasitic diseases and disorders who had multiple organ failure. Patients who spent at least three days in the ICU had lower mortality rates at an LTCH in four of the categories, while no statistically significant difference in mortality was found in the digestive category.
Further, among patients with multiple organ failure, those treated at an LTCH with circulatory, digestive and musculoskeletal and connective tissue conditions had lower costs, with Medicare cost differences ranging from $13,806 to $20,809 over an episode of care. Cost differences were statistically insignificant for patients with respiratory and infectious and parasitic conditions who had multiple organ failure.
Likewise, among patients who had spent at least three days in an ICU, LTCH care was associated with lower costs for those with circulatory, digestive, and musculoskeletal and connective tissue conditions. Those with three or more days in an ICU and with respiratory and infectious and parasitic conditions had higher costs at an LTCH.
"Our study supports the value of LTCHs in caring for the most severely ill patients," said Koenig. "Specifically, we find that LTCHs provide better care at similar or lower cost to Medicare for most medically complex patients with multiple organ failure or three or more days in intensive care."
Overall, researchers concluded that LTCH care is the superior treatment option for seven out of 10 high-severity, non-ventilator patient groups reviewed. For two of the patient groups reviewed, LTCHs reduce mortality, but at higher cost. For one group, LTCH care is associated with similar mortality and cost relative to care at other settings.
"LTCHs are an important treatment option for medically complex and critically ill patients," said Cheryl Burzynski, NALTH President. "LTCHs must be part of the conversation as payers seek ways to improve outcomes and reduce treatment costs for patients with significant illnesses."
The full study is published in the July issue of Medical Care online at journals.lww.com/lww-medicalcare.
About the National Association of Long Term Hospitals
The National Association of Long Term Hospitals (NALTH) is a not-for-profit association of long-term acute care hospitals (LTCHs) that care for patients who are medically complex, requiring prolonged hospitalization and rehabilitation. Through education, research and advocacy, NALTH supports its members in their mission to provide the highest-quality care for long-term patients. For more information, visit www.nalth.org.
Sarah Stakston, 952-346-6303
SOURCE National Association of Long Term Hospitals