It's rare these days for Democrats and Republicans to agree on anything. It's even more rare to find consensus in the industry on federal policy. But on one issue—defining which patients would be best treated in long-term acute-care hospitals—we have now seen it on display.
Bipartisanship does exist
Roberts-Nelson bill would settle role of LTACs within Medicare, preserve access
The nation's 450 LTAC hospitals have long struggled under the uncertainty created by the absence of clear Medicare regulation. This uncertainty has led to the unintended consequence of limiting patient access to the extended care that LTAC hospitals provide.
But that might soon change. Thanks to the leadership of Sens. Pat Roberts (R-Kan.) and Bill Nelson (D-Fla.), a bipartisan bill, endorsed by the American Hospital Association and the vast majority of LTAC hospitals, has been introduced in the Senate and co-sponsored by six other senators.
Based on a series of policy proposals first developed by the AHA and refined by two well-respected Senate veterans acting in a bipartisan fashion, the Roberts-Nelson bill would make clear which facilities qualify as LTAC hospitals. Among other things, it would ensure that LTAC hospitals treat only high-acuity patients. This needed proposal was developed by the AHA during a year-long process in which many stakeholders, including those beyond the LTAC hospital community, were consulted. As a result, the policy represents a broad consensus.
The proposed federal regulation, or what the Medicare Payment Advisory Commission calls “certification criteria,” are years overdue. Still, they come at an opportune time: Washington is trying to find savings in the federal government's entitlement programs to reduce budget deficits. The Roberts-Nelson legislation provides exactly what lawmakers want most: the potential for savings in Medicare reimbursements.
LTAC hospitals have been around for more than three decades and occupy an increasingly vital space. They specialize in treating patients who need extended acute hospital stays due to the complexity and severity of their conditions. This can include heart failure or other cardiac disease, infectious disease, neurological or other post-trauma conditions, pulmonary/ventilator weaning, renal disease and other medically complex conditions.
The typical LTAC hospital offers daily physician visits; multispecialty medical and surgical consultants; a low patient-to-nurse ratio; 24-hour nursing and respiratory services; on-site physical, speech and occupational therapy; an on-site pharmacy; cardiac monitoring; diagnostic and laboratory services; case management; discharge planning and more.
Unlike other settings, LTAC hospitals provide acute care for an extended period of time. To qualify as an LTAC hospital for Medicare payment, a hospital must meet Medicare's conditions of participation for acute-care hospitals and have an average inpatient length of stay greater than 25 days. This is nearly 20 days longer than the average general hospital stay.
LTAC hospitals are also extremely diverse. They are large and small, not-for-profit and for-profit, and serve both elderly and young patients. Many are located under the same roof as general hospitals, while others are free-standing. Still, according to the AHA, 87% of LTAC hospitals will be able to comply with the criteria in the Roberts-Nelson legislation. The new Senate bill also provides for a grace period for LTAC hospitals to prepare for the stricter criteria. Although the bill would impose tougher standards, it enjoys a broad spectrum of support from the nation's LTAC hospitals. Across the broader hospital industry, other key groups such as the Federation of American Hospitals also have been supportive.
In a message to AHA members, AHA President and CEO Richard Umbdenstock noted the historical significance of the bill: “Since 2004, Congress, the Medicare Payment Advisory Commission and other stakeholders have called for the development of patient and facility criteria that would define LTAC hospitals and the types of patients they serve. (The Roberts-Nelson) bill puts us on a path to finally establish uniform patient and facility criteria that will distinguish LTAC hospitals from all other provider settings,” Umbdenstock said. “The new criteria will bring about a common definition for LTAC hospital patients and services and solidify that access to care is based on patients' medical needs. This will allow LTAC hospitals to focus on their mission of caring for very sick patients who need intensive care for a long period of time.”
The legislation has many advantages, chief among them that it protects access to appropriate care for medically complex patients who require relatively extended hospital stays. In many ways, it may be tough medicine for us. But if the criteria are cemented in law and the nation's LTAC hospitals finally are given a permanent place in the continuum of American medical care, it will be worth the compromise.
For all of these reasons, the Roberts-Nelson legislation is desperately needed. Washington is hungry for something that members of both parties can embrace. The Long-Term Care Hospital Improvement Act of 2011 fits that description well. Even better, the hospital industry agrees that when it is finally enacted into law, patients will be the ultimate beneficiaries.
David Chernow is president and chief development and strategy officer of Select Medical Holdings Corp., Mechanicsburg, Pa.
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