In most cases, the sickest patients are seeing better outcomes at the same or lower cost to Medicare when treated at a long-term acute care hospital, according to a new study commissioned by the National Association of Long Term Hospitals.
The study found lower mortality rates for most non-ventilator patients with multiple organ failure, and those who had spent three or more days in an acute-care hospital's intensive care unit prior to transfer to the long-term acute care hospital. It also found the cost to Medicare to be similar or lower compared to care in skilled nursing facilities and inpatient rehabilitation facilities.
Medicare cost differences ranged from $13,806 to $20,809 over an episode of care among patients with multiple organ failure, those treated for circulatory, digestive and musculoskeletal and connective tissue conditions at a long-term care hospital.
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Cost differences were statistically insignificant for patients with respiratory and infectious and parasitic conditions who had multiple organ failure.
Those with three or more days in an ICU and with respiratory and infectious and parasitic conditions had higher costs at an LTCH, according to the study.
The study, published in July in Medical Care, is the first peer-reviewed, published study to evaluate costs and outcomes of non-ventilator patients receiving care at a long-term care hospital.
“As our population ages and the incidence of chronic disease increases, critically ill and medically complex patients will represent a growing segment of the Medicare population,” said Dr. Lane Koenig, director of Policy and Research for NALTH, and the study's lead author. “Because care for these patients requires a significant amount of healthcare resources, it's important to identify cost-effective treatment approaches.”
Using 2009-2011 Medicare data, researchers identified the five most common major diagnostic categories for non-ventilator patients treated in LTCHs: respiratory, circulatory, digestive, musculoskeletal and connective tissue, and infectious and parasitic diseases and disorders.
Within these five categories, researchers further reviewed those cases in which patients had spent three or more days in a standard hospital ICU and those with multiple organ failure.
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The study found lower mortality rates at an LTCH for patients with multiple organ failure who had musculoskeletal and connective tissue, circulatory, and respiratory conditions.
Mortality rate gaps were statistically insignificant for patients with digestive issues and infections and parasitic diseases and disorders who had multiple organ failure.
Overall, researchers concluded that LTCH care is the superior treatment option for seven out of 10 high-severity, non-ventilator patient groups reviewed. For two of the patient groups reviewed, mortality is reduced at a LTCH, but at a higher cost. For one group, LTCH care is associated with similar mortality and cost relative to care at other settings.
Twitter: @SusanMorseHFN