Healthcare Headlines Blog

A Critical Level of Care

By Dr. Dean French

Kindred Hospitals, a national network of long-term acute care hospitals (LTACHs), provide specialized treatment and rehabilitation for medically complex patients.

LTACHs are equipped to treat many of the same conditions that are treated in traditional ICUs at short-term acute care hospitals (STACHs), but are designed to do so for a longer period of time. A look at the top diagnosis-related groups treated at STACH and LTACH ICUs reveals overlap between six of the top 10 conditions treated at each setting.1

Pulmonary Edema & Resp Failure Pulmonary Edema & Resp Failure
Resp Infections & Inflammations w MCC Resp Infections & Inflammations w MCC
Resp Sys Diagnosis w Ventilator Support <=96 Hours Resp Sys Diagnosis w Ventilator Support <=96 Hours
Resp Sys Diagnosis w Ventilator Support >96 Hours Resp Sys Diagnosis w Ventilator Support >96 Hours
Septicemia or Severe Sepsis w MV >96 Hours Septicemia or Severe Sepsis w MV >96 Hours
Septicemia or Severe Sepsis w/o MV >96 Hours w MCC Septicemia or Severe Sepsis w/o MV >96 Hours w MCC
Acute Myocardial Infarction, Discharged Alive w MCC Trach w MV >96 Hours or PDX Exc Face, Mouth & Neck w/o Major O.R. Procs
Heart Failure & Shock w MCC ECMO or Trach w MV >96 Hours or PDX Exc Face, Mouth & Neck w Major O.R. Procs
Infectious & Parasitic Diseases w O.R. Procs w MCC Extensive O.R. Procs Unrelated to PDX w MCC
Intracranial Hemorrhage or Cerebral Infarction w MCC Other Resp Sys O.R. Procs w MCC


The Benefit of Timely Transfer

It is not only possible for LTACHs to treat patients requiring ICU-level care, but it is also beneficial.

When medically complex patients transfer to LTACHs, they receive specialized acute care and rehabilitation that can reduce their risk of readmission. This can be seen clearly when looking at readmission rates by Hierarchical Condition Category (HCC) tier at each setting.

HCC coding is a risk-adjustment model that helps communicate patient complexity, with higher scores reflecting greater complexity.2

The Advisory Board categorizes Medicare patients into Low, Mid, High, and Very High HCC tiers.  According to this data, the average readmission rates for patients in the High or Very High HCC tiers are about 50% lower for patients transferred to an LTACH.3

LTACHs also specialize in treating patients with serious respiratory conditions, especially those on mechanical ventilation. In fact, one study found that a one-day delay in discharging to an LTACH after intubation is associated with an 11.6% reduction in the odds of weaning.4

Because LTACHs provide ICU-level treatment for complex conditions, it is beneficial for stable patients with multiple serious diagnoses to be transferred to our hospitals even while they are still in critical condition.

Elements of Kindred Hospitals’ ICUs

At Kindred, our physician-led interdisciplinary care teams with critical care expertise are fundamental to the level of care we provide.


  • All treatment plans are led by physicians who visit patients daily
  • Attending physicians have expertise in treating critically complex patients
  • Physicians with specialties such as pulmonology, infectious disease, and general surgery participate in treatment plans as needed


  • All nurses in our ICUs are certified in Advanced Cardiovascular Life Support
  • Nurse-to-patient ratios in our ICUs resemble those in STACH ICUs

Respiratory Therapy:

  • Respiratory therapists are available 24/7
  • RTs specialize in treating pulmonary patients with multiple concurrent diagnoses

Additional members of the interdisciplinary care teams may include

  • Physical and occupational therapists
  • speech-language pathologists
  • wound care nurses
  • dieticians
  • pharmacists

With our highly-skilled care teams, we are able to provide hospital services such as:

  • Management and liberation from mechanical ventilation
  • Placement, management, and removal of IV lines, catheters, and nasogastric tubes
  • Radiology, telemetry, and dialysis

At Kindred, we take our care to the next level by achieving nationally recognized hospital certifications. All of our hospitals have disease-specific care certifications from The Joint Commission in at least one of the following categories: Respiratory Failure, Sepsis, Pulmonary Rehabilitation, and Wound Care.

With our expert care teams and high-quality treatment and rehabilitation, Kindred Hospitals can help improve outcomes and reduce readmissions for medically complex patients.

Learn more about our critical level of care here.


1. MedPAR, 2022 Traditional Medicare FFS and Medicare Advantage ICU and CCU Discharges, DRGs within the top 10 rearranged to show comparison.


3. The Advisory Board. The Post Acute Care Pathways Explorer. State Average Outcomes by HCC Score Tier. HCC tiers include Medicare FFS patients with a total HCC score in the following ranges: ‘Low’ between 0 and 2, ‘Mid’ greater than 2 and less than or equal to 4, ‘High’ greater than 4 and less than or equal to 6, and Very High’ greater than 6. Accessed June 2023.

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By Dr. Dean French