Welcome
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America’s Long Term Acute
Care (LTAC) Hospitals
Timothy J. Rolsen
Chief Executive Officer
Regency Hospital Cleveland West
Regency Hospital, Akron
My background:
Prior Work Experience (20 Years)
• CEO - LTAC freestanding and HIH
• Regional Director – 17 Assisted Living Facilities in Ohio
• Regional Vice President – Skilled Nursing Facilities
• Licensed Nursing Home Administrator
• Former Trustee of Local Community Hospital
Educational Background
• Master in Business Administration
• Bachelor’s Degree in Gerontology with Long Term Care
Certificate
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Agenda
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What We Believe (Mission and Values)
About My Hospital in Cleveland, Ohio.
About All LTACH’s (freestanding vs. HIH)
Regulatory Guidelines
About the Host Hospital in an HIH
Symbiotic Relationship with the Host Hospital.
Relationship between LTACH and SNF’s
Into the future with regulation
Q&A
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Regency Hospital is part of
a large network of more than
120 specialized hospitals
owned or operated by Select
Medical.
108 of these hospitals are
long-term acute care
hospitals. The others are
medical rehabilitation
hospitals.
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Regency Hospitals are part of Select Medical’s health care system of more
than 1,000 locations across the United States.
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Approx. number of patients Select
Medical will treat today
in the United States
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That’s 4,000 patients in 120+ inpatient hospitals
15,000+ patients in nearly 1,000 outpatient centers
…and more than 10,000 people through
our contract therapy sites (mostly skilled
nursing homes).
ALL BY THE END OF TODAY.
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Regency and The Select Medical Way
Our Mission
Our Values
Select Medical will
provide an
exceptional
patient care
experience
that promotes
healing and recovery
in a compassionate
environment.
We deliver superior quality in
all that we do.
We treat others as they
would like to be
treated.
We are results oriented and
achieve our objectives.
We are team players.
We are resourceful in
overcoming obstacles.
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How We Interact With Those We Serve
I-CARE
Introduce self and role... connect with
everyone
Communicate what you will be doing
Ask/anticipate needs and concerns
Respond to requests
Exit courteously
Let’s focus on LTACH’s. What is a Long-Term Acute Care Hospital?
1. We are a small hospital offering specialized
care. We operate freestanding hospitals and
hospital-within-a-hospital models.
2. Our patients are very sick and medically
complex. Many of them are on mechanical
ventilators.
3. Many of our patients have Chronic
Critically Ill Syndrome.
4. These patients often barely survive
ICUs (which stabilize them). For the next
step of recovery, they require up to one
month or longer of extended hospital care.
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LTACH Industry Growth
• Fastest growing healthcare segment:
• 1995 there were 107 LTAC’s
• 2005 there were 307 LTAC’s
• 2008 there were 450 LTAC’s
CMS expenditure increased from:
• $700m in 1995
• Approximately $8B in 2012
• Government concerned about rapid growth but shows no interest
in savings until recent times of healthcare discussion.
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Benefits LTAC Provides to STAC
- Decreases length of stay at STAC
- Saves costs due to specialization in longer stay patients
thus reducing supply costs and increasing efficiency.
- LTAC monitors quality in this type of patient they serve.
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Regulatory Guidelines
All LTACHs are restricted to:
- 3 day rule of discharge.
- 10 day rule of discharge.
- over 25 days length of stay for all LTACs (The “Gold
Standard”)
Hospital-within-Hospital (HIH)
specific
-25% rule, 50% “grandfathered” from host.
- 5% Host readmit rate
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Regulatory Guidelines
HIH Only
• Admission Rules
– Host Admission Rule (referred to as the 534 Rule) –
Limits Medicare admissions to 25% to 75%
(depending on circumstances) from the Host facility.
– Non-co-located Rule (referred to as the 536 Rule) –
Limits Medicare admissions to 25% to 50%
(depending on circumstances) from a non-Host facility
when the LTCH is an HIH.
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Regulatory Guidelines
• 5% Return to Host Rule
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Regulatory Guidelines
• 3 and 10 day “interrupted stay” rules
– LTAC assumes costs of patients that do not return
within 3 days
– LTAC must discharge a patient that has not returned
within 10 days. Can affect 25 day Length of Stay
(LOS).
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Regulatory Guidelines
• Medicare 25 Day LOS Rule
– Traditional Medicare
– Medicare Advantage Patients – Included in
the LOS calculation for cost reporting periods
beginning on or after January 1, 2012.
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Regulatory Guidelines
Admission Criteria
– Examples are Interqual and Milliman.
However, Select has worked with Medicare to
create our own LTAC criteria tool.
– New admission criteria signed into law last
December takes effect the cost year after
10/1/15.
(will discuss under regulatory section.)
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Regulatory Guidelines
Reimbursement
– LTAC DRG, concurrent coding for Medicare
patients.
– Insurance – contractual
– Medicaid – percentage of charges.
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Regulatory Guidelines
• Joint Commission
– Accredited the same way as larger, short term acute
care hospitals.
– Visit every 3 years and information submitted in other
years.
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Nature of symbiotic relationship between general hospital
(Short-Term Acute Care) and a Hospital-Within-a-Hospital
(HIH)
- Lease Agreements
- HIH becomes Tenant.
- Purchase Service Agreements
- HIH needs services for patients and purchases
them from “Host” for patient.
- Benefit to patients and families
- One hospital provides all services. Physician
continuity from Host is maintained in HIH.
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Nature of Our Relationship with Skilled Nursing Facilities
(SNFs)
• We work together to assist Short Term Acute Care Hospital
with readmit measure. (Penalties involved here).
• The sequence is generally STACH
LTACH
SNF
for our type of patient (Chronically Critically Ill). However, if
patients become too acute then LTACH physicians can
admit directly from SNF.
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The Future of the Long-Term Acute Care
Hospital
Last year the U.S. Congress
passed H.J. Resolution 59 on
Dec. 26, 2013 which included:
-New LTACH Quality Measure.
-Non-vent patients must
have a 3 day ICU stay prior
to LTACH admit.
- Moratorium on new LTACH beds, satellites, or hospitals
starting 1/1/15.
- 25% rule – 4 yr relief on 25% rule for free standings and
50% rule for HIH’s.
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Thank you for
the opportunity
to offer this
presentation.
Questions?