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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, CHRISTUS Trinity Mother Frances Health System faced exactly this challenge. Community Hospital Corporation (CHC) stepped in with a solution.


CHRISTUS Trinity Mother Frances Health System (CTMFH) 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, CTMFH 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. CTMFH needed a solution—and fast. Then, in 2003, CTMFH tapped CHC to conduct a feasibility study for a proposed long-term acute care hospital, or LTACH, on CTMFH’s campus.

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, CTMFH’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 CTMFH created a joint venture – Tyler ContinueCARE Hospital – that initially consisted of designated beds within the existing CTMFH hospital. A CTMFH/CHC team developed processes and procedures to allow Tyler ContinueCARE Hospital to purchase CTMFH 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 team collaborated on a roadmap for success to bring quick corrective action.

The Results

By appropriately managing patient mix and constantly monitoring other key variables, this partnership has succeeded in achieving many improvements over time, 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
  • Patient satisfaction increased to 90%
  • Physician Satisfaction scores at 82%
  • Obtained CIHQ Center of Excellence in 2019
  • Obtained CIHQ Center of Excellence for Respiratory Therapy in 2019
  • Purchased more than $95 million in services from CHRISTUS Trinity Mother Frances, the host hospital, as of June 2020
  • Generated $32 million in distributions to CTMFH through FY20
  • Provided $3 million in charity care to local patients in the community

“Our ability to respond to the COVID pandemic would have been seriously challenged already if it was not for you and your entire team’s support. The ability of your facility to take COVID patients appropriately during their long convalescence has provided us the opportunity to care for the most critical in our region.”

Mark Anderson, MD, Chief Medical Officer CHRISTUS Trinity Mother Frances Health System

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