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The Role of Long-term Acute Care Hospitals in Treating the Critically Ill and Medically Complex: An Analysis of Nonventilator Patients.

Koenig L, Demiralp B, Saavoss J, Zhang Q - Med Care (2015)

Bottom Line: LTCH care is associated with increases in Medicare payments ranging from $3146 to $17,589 (P<0.01) with no mortality benefit for 3 categories and payment reductions of $5419 and $5962 (P<0.01) at lower or similar mortality for 2 categories.LTCH patients with multiple organ failure experience lower mortality at similar or lower payments (3 categories) or similar mortality at lower payments (1 category) compared with patients in other settings, with mortality benefits between 5.4 and 9.7 percentage points (P<0.05) and payment reductions between $13,806 and $20,809 (P<0.01).For patients with ≥3 days in intensive care, LTCH care is associated with improved mortality and lower payments in 4 and 3 categories, respectively.

View Article: PubMed Central - PubMed

Affiliation: *KNG Health Consulting, LLC, Rockville, MD †Formerly KNG Health Consulting, LLC, Baltimore, MD.

ABSTRACT

Background: Little evidence exists on the effects of receiving care in a long-term acute care hospital (LTCH).

Objective: To examine LTCH effects on mortality and Medicare payments overall and among high-acuity patients.

Research design: A retrospective cohort study of Medicare beneficiaries using probit and generalized linear models. An instrumental variable technique was used to adjust for selection bias.

Subjects: Medicare beneficiaries within 5 major diagnostic categories and not on prolonged mechanical ventilation.

Measures: Mortality (365 d) and Medicare payments (180 d) during an episode of care.

Results: LTCH care is associated with increases in Medicare payments ranging from $3146 to $17,589 (P<0.01) with no mortality benefit for 3 categories and payment reductions of $5419 and $5962 (P<0.01) at lower or similar mortality for 2 categories. LTCH patients with multiple organ failure experience lower mortality at similar or lower payments (3 categories) or similar mortality at lower payments (1 category) compared with patients in other settings, with mortality benefits between 5.4 and 9.7 percentage points (P<0.05) and payment reductions between $13,806 and $20,809 (P<0.01). For 1 category, we found no difference in mortality or payments between LTCH and non-LTCH patients with multiple organ failure. For patients with ≥3 days in intensive care, LTCH care is associated with improved mortality and lower payments in 4 and 3 categories, respectively.

Conclusions: Receiving care in an LTCH may improve outcomes for some patients. Further research is needed to better define patients for whom care in these hospitals is beneficial.

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Related in: MedlinePlus

Marginal LTCH effects on 365-day mortality and 180-day Medicare payments. The figure illustrates the baseline marginal effect estimates presented in Tables 4 and 5. Error bars show the 95% confidence intervals. LTCH indicates long-term acute care hospital.
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Figure 1: Marginal LTCH effects on 365-day mortality and 180-day Medicare payments. The figure illustrates the baseline marginal effect estimates presented in Tables 4 and 5. Error bars show the 95% confidence intervals. LTCH indicates long-term acute care hospital.

Mentions: The marginal effect of LTCH care on Medicare payments is positive but smaller in magnitude for patients with ≥3 days in an ICU/CCU compared with other patients in the respiratory and infectious and parasitic DDs categories. In the digestive category, LTCH patients with ≥3 days in an ICU/CCU experience similar reductions as other LTCH patients. In the remaining 2 categories (circulatory and musculoskeletal and connective tissue), LTCH care is associated with lower Medicare payments for patients with ≥3 days in an ICU/CCU, whereas it is related to similar or higher Medicare payments for patients with <3 days in an ICU/CCU. The payment model results were robust to excluding from the study sample those with very low predicted probability to transfer to an LTCH (Appendix C, Supplemental Digital Content 3, http://links.lww.com/MLR/A955). A comparative graphical presentation of mortality and payment results is included in Figures 1–3.


The Role of Long-term Acute Care Hospitals in Treating the Critically Ill and Medically Complex: An Analysis of Nonventilator Patients.

Koenig L, Demiralp B, Saavoss J, Zhang Q - Med Care (2015)

Marginal LTCH effects on 365-day mortality and 180-day Medicare payments. The figure illustrates the baseline marginal effect estimates presented in Tables 4 and 5. Error bars show the 95% confidence intervals. LTCH indicates long-term acute care hospital.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4470738&req=5

Figure 1: Marginal LTCH effects on 365-day mortality and 180-day Medicare payments. The figure illustrates the baseline marginal effect estimates presented in Tables 4 and 5. Error bars show the 95% confidence intervals. LTCH indicates long-term acute care hospital.
Mentions: The marginal effect of LTCH care on Medicare payments is positive but smaller in magnitude for patients with ≥3 days in an ICU/CCU compared with other patients in the respiratory and infectious and parasitic DDs categories. In the digestive category, LTCH patients with ≥3 days in an ICU/CCU experience similar reductions as other LTCH patients. In the remaining 2 categories (circulatory and musculoskeletal and connective tissue), LTCH care is associated with lower Medicare payments for patients with ≥3 days in an ICU/CCU, whereas it is related to similar or higher Medicare payments for patients with <3 days in an ICU/CCU. The payment model results were robust to excluding from the study sample those with very low predicted probability to transfer to an LTCH (Appendix C, Supplemental Digital Content 3, http://links.lww.com/MLR/A955). A comparative graphical presentation of mortality and payment results is included in Figures 1–3.

Bottom Line: LTCH care is associated with increases in Medicare payments ranging from $3146 to $17,589 (P<0.01) with no mortality benefit for 3 categories and payment reductions of $5419 and $5962 (P<0.01) at lower or similar mortality for 2 categories.LTCH patients with multiple organ failure experience lower mortality at similar or lower payments (3 categories) or similar mortality at lower payments (1 category) compared with patients in other settings, with mortality benefits between 5.4 and 9.7 percentage points (P<0.05) and payment reductions between $13,806 and $20,809 (P<0.01).For patients with ≥3 days in intensive care, LTCH care is associated with improved mortality and lower payments in 4 and 3 categories, respectively.

View Article: PubMed Central - PubMed

Affiliation: *KNG Health Consulting, LLC, Rockville, MD †Formerly KNG Health Consulting, LLC, Baltimore, MD.

ABSTRACT

Background: Little evidence exists on the effects of receiving care in a long-term acute care hospital (LTCH).

Objective: To examine LTCH effects on mortality and Medicare payments overall and among high-acuity patients.

Research design: A retrospective cohort study of Medicare beneficiaries using probit and generalized linear models. An instrumental variable technique was used to adjust for selection bias.

Subjects: Medicare beneficiaries within 5 major diagnostic categories and not on prolonged mechanical ventilation.

Measures: Mortality (365 d) and Medicare payments (180 d) during an episode of care.

Results: LTCH care is associated with increases in Medicare payments ranging from $3146 to $17,589 (P<0.01) with no mortality benefit for 3 categories and payment reductions of $5419 and $5962 (P<0.01) at lower or similar mortality for 2 categories. LTCH patients with multiple organ failure experience lower mortality at similar or lower payments (3 categories) or similar mortality at lower payments (1 category) compared with patients in other settings, with mortality benefits between 5.4 and 9.7 percentage points (P<0.05) and payment reductions between $13,806 and $20,809 (P<0.01). For 1 category, we found no difference in mortality or payments between LTCH and non-LTCH patients with multiple organ failure. For patients with ≥3 days in intensive care, LTCH care is associated with improved mortality and lower payments in 4 and 3 categories, respectively.

Conclusions: Receiving care in an LTCH may improve outcomes for some patients. Further research is needed to better define patients for whom care in these hospitals is beneficial.

Show MeSH
Related in: MedlinePlus