Healthcare Headlines Blog

ATI Advisory Study Reaffirms Value of LTACHs for Critically Complex Patients

By Sean R. Muldoon, MD, MPH, FCCP, Chief Medical Officer, Kindred Hospitals

Executive Summary

  • Research shows long-term acute care hospitals (LTACHs) can play an important role in “appropriately managing clinically complex patients”
  • LTACH expertise in pulmonary care contributes to expedited recovery for patients requiring mechanical ventilation
  • Discharging medically complex patients to Kindred Hospitals can help reduce readmissions

Caring for Medically Complex Patients

Medically complex patients, who comprise a small but growing percentage of the patient population, often require one or more post-acute care (PAC) providers along a recovery journey that can span a number of weeks.  Ensuring patients are receiving the most appropriate level of care can help improve and expedite recovery.

The long-term acute care hospital (LTACH) is one PAC setting that is often inaccurately perceived as cost-prohibitive and indistinguishable from a skilled nursing facility (SNF) in terms of care. However, as acute care hospitals, LTACHs provide specialized physician-led treatment and rehabilitation that is unique and key to the recovery of medically complex patients, especially those on prolonged mechanical ventilation.

These ideas are supported by a number of studies, including a recently published report by ATI Advisory.

The recent ATI Advisory (ATI) study reaffirmed that LTACHs can play an important role in “appropriately managing clinically complex patients” by providing specialized care.

Expediting Recovery for Pulmonary Patients

Patients with severe pulmonary conditions often require long-term respiratory support and mechanical ventilation.

The ATI study revealed that a specialized focus on complex pulmonary patients can advance breathing independence and recovery. To demonstrate this, ATI examined data on patients that discharged from a short-term acute care hospital (STACH) with DRGs 003 or 004, two respiratory conditions requiring mechanical ventilation. They compared those discharged to a Kindred LTACH in Las Vegas to those discharged to SNFs nationwide and found that those who transitioned from the STACH to an LTACH discharged to home 20 days sooner than those who transitioned to a SNF.

These findings led ATI to conclude that “certain ventilator associated STACH DRGs, such as 003 and 004, are particularly well-suited for the highly specialized respiratory care provided at LTAC hospitals.”

Unique Capabilities of LTACHs That Aid In Complex Care and Recovery

At an LTACH, patients benefit from daily physician oversight and interdisciplinary care from ICU/CCU-level clinicians. Patients with severe lung conditions, including those on mechanical ventilation, receive care from pulmonologists and respiratory therapists who follow established protocols for ventilator liberation.

As part of the recovery process, LTACHs ensure that patients begin mobilizing as soon as possible. Comprehensive therapy provided by PTs, RTs, OTs, and SLPs is integrated with specialized acute care to promote full recovery.

These capabilities allow LTACHs to play a key role in “providing cost-effective care to and appropriately managing clinically complex patients”.

Decreased Spending at Kindred Hospitals

Kindred Hospitals are experts in providing continued acute care to medically complex patients, as reaffirmed by the results of the ATI study. When looking at all conditions, ATI found that Medicare FFS spending for readmissions was 17% less for patients at Kindred than for those in other LTACHs across the country. 

These findings led ATI to conclude that “Kindred LTAC hospitals effectively managed patient needs during the initial LTAC hospital stay, likely reducing disruption to patients and improving patients’ overall care experience during their post-LTAC hospital period.”

Kindred Hospitals has provided quality care for 30 years, and continues to introduce initiatives that improve care, such as:

  • Pursuit of disease-specific certifications from The Joint Commission in Sepsis and Respiratory Failure in all hospitals.
  • Move Early Program incorporates mobilization as early as is safe, even for patients on ventilators, allowing for a quicker, more complete recovery.
  • AfterCare Program, in which specialty trained RNs follow up once patients have discharged to home to discuss durable medical equipment and medication needs and education, primary care provider appointments, and any additional post-discharge services needed.

If you have a medically complex patient in need of continued acute care, call a Kindred Clinical Liaison for a patient assessment. Our Clinical Liaison team will help you determine whether an LTACH stay is appropriate for your patient. If you are unsure of who your Kindred representative is, please feel free to contact us via to speak with a Registered Nurse who can assist.

By Sean R. Muldoon, MD, MPH, FCCP, Chief Medical Officer, Kindred Hospitals