Role of LTAC Hospitals in COVID-19 Pandemic
The ongoing COVID-19 pandemic has significantly disrupted all acute and post-acute care delivery in a manner that may permanently change hospital discharge patterns and provider roles moving forward. Healthcare providers have had to communicate more quickly and beyond their typical care silos, adjust staffing structures and sometimes their physical plants, ensure sufficient personal protective equipment (PPE), and develop separated care in order to minimize transmission of COVID-19 – all while delivering uninterrupted care for COVID-19 and non-COVID patients.
Although national patient admissions have decreased year-over-year in short-term acute care hospitals (STACHs) – and therefore in post-acute care settings as well – surges on a local market basis have strained intensive care units. Further exacerbating these surges has been an increasingly complex patient mix, one that reflects COVID-19 diagnoses and related ailments, fewer elective surgeries, and critical conditions that require higher levels of care and rehabilitation. This dynamic has had implications for post-acute care especially as SNFs, typically ~50% of discharges to post-acute care, have been challenged to accept patients.
The evolving post-acute care continuum has presented an opportunity to evaluate how patient pathways and provider roles are shifting under the load of the pandemic. For this work, ATI gathered perspectives from healthcare professionals and clinicians in STACHs and in post-acute care, who reported on their experience with patients in both Medicare FFS and Medicare Advantage during the public health emergency. ATI also performed preliminary Medicare FFS claims data analysis (Q2 2020 data) to identify early patient trends and support qualitative feedback.
In this environment, many LTAC hospitals have played a critical role in public health efforts, working closely with STACHs to deliver necessary hospital-level services to a more clinically complex population, including non-COVID and COVID-19 positive patients. As patient complexity has increased (national LTAC hospital Case Mix Index (CMI) was 1.119 in May 2019, and 1.242 in May 2020), healthcare providers report that LTAC hospitals have leveraged existing capacities – including advanced infection control protocols, PPE training, and specialty respiratory care – to pivot to the needs of their local STACH partners. The CARES Act-Section 3711 waivers and prior authorization relief from health plans have facilitated collaboration between STACHs and LTAC hospitals, enabling them to deliver more seamless patient transitions. Speed to care has been important in certain markets where, at points, LTAC hospitals are the only facilities accepting COVID-19 positive patients. In terms of outcomes, early data show that LTAC hospital 30 day All-Cause readmission rates are generally ~500 basis points below SNFs from January – May 2020.
At the same time, preliminary admissions data (CMI and average length of stay) also indicate that LTAC hospitals have remained a specialty setting appropriate for patients with a high level of need, and that operators have not misused the flexibility they received under the waivers and prior authorization relief.
Our research has revealed the public health imperative of maintaining a flexible provider asset class that the healthcare delivery system can activate as an inpatient hospital extender during public health crises and then repurpose to meet non-emergent delivery system needs at other times. The CARES Act-Section 3711 waivers have served as the switch that allowed for this activation, reasserting fluid patient transitions and clinical collaboration between STACHs and LTAC hospitals. Our research indicates that the clinical capabilities in LTAC hospitals have been particularly well suited to extend STACH capacity and fill COVID-related gaps in the post-acute care continuum.
Our findings, though preliminary, have implications for local care delivery systems, LTAC hospitals and policymakers moving forward to maximize LTAC hospital contributions to the healthcare delivery system during and after the PHE.
Note: Claims analysis for this report reflects data through May 2020, is preliminary, and will be enhanced significantly as additional months of data become available.