How LTACHs Can Prepare for an Uncertain Future

The pandemic brought an unprecedented opportunity for LTACHs to demonstrate their vital role in the healthcare continuum and their value as partners to traditional hospitals. Uniquely equipped to treat critically ill, complex and medically fragile patients, LTACHs serve as a patient overflow option when hospital ICU beds reach capacity, as was the case during the height of the pandemic and during subsequent surges of COVID cases. Since the public health crisis, the role of LTACHs is, by and large, better understood and more widely appreciated by regulators, providers and patients. Wise LTACH leaders are leveraging this advantage to bolster their value proposition and enhance their performance. 

Future Outlook

Overall, LTACH leaders are cautiously optimistic about the future, and industry analysts see significant sector growth potential, based on the number of patients per year who qualify for LTACH services. LTACHs received more referrals and expanded their referral sources during the COVID crisis, solidifying partnerships that outlasted the pandemic because of LTACHs’ proven ability to provide the appropriate level of care for steady-state acute patients in a way that decompresses overburdened or at-capacity ICU units at any given time. 

However, government and managed-care payers are as focused as ever on treating patients at the lowest-cost, clinically appropriate setting. LTACHs remain under watch and are subject to continual efforts to lower their reimbursement rates and limit the sector’s growth. 

The Case for LTACHs

In communicating their value proposition, LTACHs must differentiate themselves from other types of post-acute care facilities. Although all post-acute settings provide value to appropriate sets of patients, only LTACHs offer the optimal next level of care in certain cases. When a patient’s acuity might otherwise delay discharge from the ICU, thereby limiting capacity for new patients, they can safely be transferred to an LTACH for intensive care treatment. At an LTACH, patients who are still too medically complex for other, lower level post-acute providers, continue to receive intensive interventions, such as ventilator weaning, dialysis, cardiac monitoring, aggressive wound management and intravenous infusions, while being managed by a multidisciplinary care team dedicated to improving the patient’s health status, function and psychosocial wellbeing.

In addition to providing specialized care, LTACHs excel in certain areas distinct from other post-acute facilities. LTACHs stood out during the pandemic for their ability to treat and control infectious diseases, for example. They are able to do so because of diagnostic capabilities, dialysis and negative pressure isolation rooms that minimize the need for outpatient services and, therefore, reduce the risk of disease spread. Additionally, they have infectious disease specialists on staff, and their infection control standards comply with CMS requirements for general acute care hospital licensing. 

Communication is Key

None of these benefits necessarily matter unless stakeholders—acute healthcare providers, patients, regulators, payers—are aware of them. The distinct capabilities LTACHs possess will be necessary for an aging and increasingly medically complex population, and LTACHs will need to communicate their role and relevance clearly and compellingly. Effective communication channels include:

• Care coordination: The pandemic improved communication between short-term acute care hospitals and LTACHs, as providers had to exchange more care-coordination information. Leaders must strive to maintain this level of proactive, trust-building communication.
• Continued education. It’s essential to educate referring physicians and ICU clinicians about the extent of LTACH-level care. The case management team at referral facilities should be educated, as well, about an LTACH’s target patient populations and the types of conditions for which an LTACH setting is most appropriate.  
• Influence. The future and growth potential of the LTACH sector depends largely on federal policies; therefore, the industry must join together and continually demonstrate the crucial need that LTACHs fill in the healthcare system.

Demonstrating Value

Going forward, LTACHs can leverage the heightened awareness and appreciation they earned during the COVID-19 to amplify their value proposition, provided they can’t only state but also demonstrate their effectiveness by measuring outcomes and comparing those metrics with national benchmarks. 

In defining their role, LTACHs might strategically narrow their focus from chronically, critically ill patients in general to a short list of specific clinical diagnoses, co-morbidities or functional impairments at which they demonstrably excel and for which there is market demand. For example, as demand increases for pulmonary care, traditional hospitals are turning to LTACHs to assist in treating these patients. An Advisory Board Daily Briefing from August 30, 2018, offered advice for LTACHs that seems prescient now that the pandemic has subsided: “Clinical specialization is often the key to getting referrals, making the case for appropriate utilization of higher-cost settings, and tapping into new patient populations.”

Partnership is another factor in long-term LTACH success. LTACHs that have access to national benchmarking data, centralized services and economies of scale will fare better going forward. These benefits as well as operational assessments and market analyses are all provided by CHC ContinueCARE to best position LTACHs for long-term success. 

By April Myers, SVP Post-Acute Operations October 11, 2022 LTACH