Becker's Hospital Review

Executive Briefing: Post-Acute Care Strategy 63 Sponsored by: 9 Considerations for Developing a Long-Term Acute-Care Hospital By Heather Punke F "Due to Medicare's 25 percent rule, not all long-term acute care or hospitals and health systems traditionally focused on patients can come from one source," says Ms. Boney. "It may acute care, considering a post-acute care and long-term be difficult for smaller communities to fill that need." In order to acute care strategy may be a somewhat new concept. It has seriously consider adding an LTACH, become newly important for acute-care hospitals should have three to four solhospitals and health systems to focus id referral sources in mind, according to on total cost of care along the continuum "It has become newly Ms. Boney. because of healthcare reform's focus on population health and more accountable important for acute-care Patient type. "From a micro perspeccare. the needs of hospital," hospitals and health systems tive, look at Bootz, senior your president says Jason vice In light of these changes, many hospitals and health systems, including Hendrick to focus on total cost of care of post-acute services for CHC. "Look at the types of patients your hospital is Health System in Abilene, Texas, are renewing their focus to provide the right along the continuum because actively treating." care in the right place at the right time. "Our goal is to take care of a patient anyof healthcare reform's focus Hendrick Health System has operated an LTACH for many years, and keeps it where along the [care continuum]," says operating because of the patient popuon population health and Brian Bessent, FACHE, assistant vice lation that it serves, according to Mr. president at Hendrick Health System. Bessent. "We're seeing sicker patients more accountable care." coming in the doors," he says. He also Long-term acute care in particular may notes the system's patient population is be an especially new concept to many aging and generally more likely to need longer to recover from illacute-care provider organizations. From 2007 through December nesses, making the need for long-term care more likely. 2012, acute-care hospitals did not have the option of considering adding a long-term acute care hospital to their campuses due to Legal limitations and partnerships a federal moratorium limiting the creation of new LTACHs and the Since 1993, by federal law, new LTACHs cannot operate as a expansion of existing LTACHs. However, since the moratorium's distinct part within a hospital; instead, they must be governed and sunset at the end of last year, acute-care hospitals and health staffed separately from the acute-care hospital, with a hospital systems can once again consider an LTACH as a viable option serving as a "host" to the LTACH. Essentially, this means acutefor their post-acute care strategy. Long-term acute care can serve care hospitals that are interested in starting a new LTACH must as a bridge for patients caught between traditional acute care and bring in an outside partner to govern and run the LTACH as a hospost-acute care. pital within a hospital. "It's one of the biggest barriers" to starting Determining market need an LTACH, says Mr. Bootz. "Hospitals have to look externally to About 2 to 3 percent of patients in an acute-care setting would other sources to provide long-term acute care." benefit from long-term acute care hospitalizations, says Leslie Acute-care hospitals have many options when it comes to choosBoney, vice president of post-acute development at Community ing an LTACH hospital provider. Many LTACH providers are forHospital Corp. There are two main things hospitals should conprofit entities, but Community Hospital Corp. offers a unique, nonsider when pondering the possibility of an LTACH. profit model for LTACH development through CHC ContinueCare, Surrounding market. First, hospitals should consider their surthe post-acute care company of CHC. CHC ContinueCare offers rounding market when considering an LTACH. Under current legisthe host hospital a chance to participate in distributions of excess lation, a limited portion of an LTACH's patient population can come cash flow resulting from the operation of the LTACH, an option from the host hospital without a financial penalty. So, acute-care for-profit partners don't have, according to Mr. Bootz. hospitals must evaluate potential referral sources for its LTACH.

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