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Executive Summary

Cedar Gate Technologies conducted a review of claims data of ACO beneficiaries treated at LTACHs and SNFs in Las Vegas. They found that readmission rates and Medicare spending were lower for patients who discharged to LTACHs, and lowest for those discharging to Kindred LTACHs specifically. Cedar Gate concluded that LTACHs can deliver improved outcomes and cost savings for complex patients.

As America’s patient population becomes ever more complex, it is increasingly important to identify the most effective and cost-efficient care pathway for patients. In order to accurately evaluate the most appropriate settings for a patient, payers must take a long-term perspective. Medically complex patients, whose recovery journeys may be prolonged, often require treatment at more than one post-acute care (PAC) setting and are at greater risk of being readmitted to the short-term acute care hospital (STACH). Ensuring patients get the most appropriate level of care following an ICU stay can significantly reduce rate of return to acute and therefore overall episode of care cost.

Nevada Silver State ACO and the Critical Role of LTACHs

In a recent study, Cedar Gate Technologies, evaluated claims data from the only two LTACHs included in the Silver State ACO’s (SSACO) preferred provider network: Kindred Hospital Las Vegas – Flamingo and Kindred Hospital Las Vegas – Sahara¹. This ACO, part owned and managed by Kindred Hospitals, is unique in that:

1. It utilizes LTACHs at a higher rate than other ACOs in the nation, and
2. Its beneficiaries treated at the two participating Kindred LTACHs are more clinically complex than those treated at other LTACHs or SNFs in the Las Vegas market

Between 2015 and 2020, the SSACO earned shared savings annually, amounting to over $86 million.  In 2020, they earned the second highest shared savings per assigned beneficiary compared to other top performing ACOs in the country and achieved a quality score of almost 99%. 

Pressure tested by higher LTACH utilization rates and a complex patient population, the SSACO still achieved record savings and quality scores, making the SSACO an excellent model for studying efficient managed care strategies.

Cedar Gate Research Parameters and Key Findings

For the purposes of this study, Cedar Gate focused on the two conditions with the highest STACH discharge volume of SSACO beneficiaries to the SSACO LTACHs – congestive heart failure (CHF) and sepsis.  They compared spending and readmission rates of the SSACO LTACHs to other LTACHs and to SNFs within Las Vegas between 2017 and 2020.

The results of the study revealed that utilization of the SSACO LTACHs yielded cost savings, primarily through reduced readmissions². Two key findings were:

• In the 180-day episode following discharge from an LTACH or SNF, ACO beneficiaries with a discharge to Kindred LTACHs experienced a 33% and 39% reduction in the risk-adjusted Medicare spending for sepsis and CHF, respectively, compared to Medicare beneficiaries with discharges to SNFs in Las Vegas.
• Kindred LTACHs saw a lower STACH readmission rate in the 90- and 180-day periods after post-acute discharge for both chronic conditions when compared to other LTACHs and SNFs within the Las Vegas market.

Unique Clinical Capabilities of LTACHs that Support Complex Care Recovery

There are several aspects of care at an LTACH that lead to reduced readmission among medically complex patients. 

At an LTACH, physicians, many of whom are sub-specialists in areas such as pulmonology, infectious disease, and cardiology, provide patients with daily oversight.

Furthermore, these physicians, along with ICU- and CCU-level clinicians organized into customized interdisciplinary care teams, are trained to treat medically complex patients who come to an LTACH with an average of six comorbidities.

Licensed as acute care hospitals, LTACHs, unlike lower levels of care, are equipped with on-site laboratories, telemetry, radiology, pharmacies and dialysis which reduce the need for outpatient services.

How Kindred Hospitals Can Help Medically Complex Patients Recover

Kindred Hospitals have several innovations that make them an invaluable partner in treating complex patients. Throughout 30 years of providing lasting recovery, they have continued to focus on innovative care initiatives, such as their:

• Pursuit of disease-specific certifications from The Joint Commission in Sepsis and Respiratory Failure in all hospitals across the country
• Move Early program which 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 with patients post-discharge to discuss durable medical equipment and medication needs and education, primary care provider appointments, and any additional post-discharge services needed.

References

1. https://atiadvisory.com/long-term-acute-care-ltac-hospitals-as-part-of-the-value-based-solution-a-case-study-of-ltac-hospitals-in-las-vegas/
2. Findings based on claim and utilization data provided by Kindred, and results with other data may vary.