Case Study

LTACH Model of Success: Trinity Mother Frances Hospitals and Clinics – Tyler TX

The Situation

As the U.S. population has aged, many hospitals have struggled with capacity issues. Such institutions often find themselves with many patients who have received appropriate treatment, but are still too fragile to be discharged to a rehabilitation hospital, nursing home or similar step-down facility. Several years ago, Trinity Mother Frances Hospitals and Clinics faced exactly this challenge. Community Hospital Corporation (CHC) stepped in with a solution.


Trinity Mother Frances Hospitals and Clinics (TMF) is a highly regarded, faith-based, not-for-profit health system located in Tyler, Texas. The system includes a tertiary hospital, two critical access hospitals, an inpatient rehab hospital, and Trinity Clinic, a multispecialty physician group.

Several years ago, TMF was struggling with capacity issues. Its 350-bed hospital was at full capacity, with a large number of patients who were simply not ready to be discharged to a step-down facility. TMF needed a solution—and fast. Then, in 2003, TMF tapped CHC to conduct a feasibility study for a proposed LTACH on TMF’s campus.

Long-term acute care hospitals, or LTACHs, provide highly specialized, acute care for critically ill patients who suffer from multisystem complications and thus require long hospitalizations. LTACH patients average a length of stay of 25 days or more, along with specialized, 24/7 clinical treatment and/or therapeutic intervention.

“It’s been a team effort between Trinity Mother Frances, CHC and ContinueCARE. We all have a common goal to create the right patient care environment to help patients get well.”

Stephanie Hyde, CEO, Tyler ContinueCARE Hospital

The Plan

CHC’s detailed analysis of patient discharge data, DRG counts, TMF’s case mix index and other key indicators confirmed the need for a highly efficient, expertly managed LTACH.

Implementing CHC’s strategy for success, CHC and TMF created a joint venture – Tyler ContinueCARE Hospital – which initially consisted of designated beds within the existing TMF hospital. A TMF/CHC team developed processes and procedures to allow Tyler ContinueCARE Hospital to purchase TMF services such as dietary, radiology, housekeeping and IT. Tyler ContinueCARE Hospital was successfully launched in 2004.

Tyler ContinueCARE Hospital continued to operate successfully for the next 18 months. The facility faced a challenge when the Center for Medicare and Medicaid Services (CMS) unexpectedly revised its method used for calculating Medicare reimbursement basing its fees on patient length of stay. Tyler ContinueCARE Hospital leadership saw the facility’s financial performance begin to deteriorate, despite the fact that there had been no change to its average length of stay (ALOS). Recognizing the impact of the regulation change, the CHC/Trinity Mother Frances/Tyler ContinueCARE team implemented a roadmap for success to bring quick corrective action.

The Results

By appropriately managing patient mix and constantly monitoring other key variables, the TMF/CHC partnership has succeeded in achieving many improvements, including:

  • Revised the patient admissions criteria to include only those who are most likely to benefit from the LTACH environment—thus ensuring improved outcomes for patients and financial viability for the facility
  • Moved patient satisfaction from 82% to 90%
  • Attained physician satisfaction scores of 3.67 on a scale of 4.0
  • In both 2014 and 2015, received the HealthStream award for satisfaction from the physicians’ point of view
  • Purchased more than $8 million in services from Trinity Mother Frances, the host hospital, in FY 2015
  • Generated $5.9 million in distributions for the TMF health system in FY 2015

About Community Hospital Corporation

Community Hospital Corporation owns, manages and consults with hospitals through three distinct organizations – CHC Hospitals, CHC Consulting and CHC ContinueCARE, which share a common purpose to guide, support and enhance the mission of community hospitals and healthcare providers. Based in Plano, Texas, CHC provides the resources and experience community hospitals need to improve quality outcomes, patient satisfaction and financial performance. For more information about CHC, please visit

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