Hospitals for the long haul win over patients, families
Carol Ziolkowski and her family could not have been prepared for what happened to her mother, Mary Snyder on Dec. 18, 2004. Diagnosed with a tumor on her optic nerve, Snyder, then 84, needed surgery to save sight in her left eye.
The prognosis for recovery was good, but after the procedure, Snyder suffered a number of serious setbacks. After more than two weeks in the hospital, Snyder was transferred to Kindred/Pittsburgh, a long-term acute care hospital in Oakdale.
Transferring patients to long-term acute care facilities is becoming more and more common in Western Pennsylvania and nationwide. The number of such hospitals, which provide the same intensity of care as general hospitals, but for a much longer period of time, has more than tripled to more than 350 since 1992.
In the Pittsburgh area, two long-term acute care hospitals opened last year, with two more set to open later this year, bringing to 10 the number of these facilties open for business.
Snyder's experiences are not unique. Particularly with elderly patients, surgery often leads to complications, which leads to more time spent in the hospital. Increasingly, patients -- particularly the elderly -- are being relocated to long-term acute care facilities.
"(These) hospitals are for people who need an acute level of care, but for a longer period of time than hospitals," said Jason R. Levine, a consultant with Murer Consultants, Chicago.
"Patients (in long-term acute care hospitals) are medically fragile," said Greg Kuntz, chief executive of Kindred/Pittsburgh.
Louisville, Ky.-based Kindred is one of the largest long-term acute care facility owner-operators in the U.S., with 73 hospitals in 24 states. Kindred operates two facilities in this region, and later this year will open a new hospital on the North Side, in the former Divine Providence Hospital.
"General ... hospitals were doing what they do best -- diagnostic work and then beginning care of the patient," said Tom Buckingham, chief operating officer for Select Medical Corp., another of the country's largest long-term acute care providers. Based in Mechanicsburg, Cumberland County, the company operates four long-term acute care hospitals in this region, and 97 nationwide.
"LTACHs (long-term acute care hospitals) complement the patient's continuum of care," Buckingham said.
There's a good chance hospital patients or their families in Western Pennsylvania don't know there are eight long-term acute care facilities nearby. Five of the eight in this region occupy space within an existing general hospital. Such a facility is known as an HWH, a hospital within a hospital. The only physical sign indicating traditional hospital care ends and long-term acute care facility care begins may be a small plaque near the area's entrance.
Space is leased from the host hospital with the long-term care hospital providing all administrative and nursing services personnel, physicians with privileges at both, along with general maintenance, housekeeping and dietary services.
Hospitals within hospitals are located at the Medical Center of Beaver County, Westmoreland Regional Hospital in Greensburg, Mercy Hospital in Pittsburgh, McKeesport Hospital and at UPMC Montefiore in Oakland. Freestanding long-term acute care hospitals are in Oakdale, Monroeville, and Wilkinsburg. The former Pittsburgh Specialty Hospital in East Liberty has been proposed as a freestanding long-term acute care facility.
According to figures from the Centers for Medicare & Medicaid Services, the number of long-term acute care hospitals has blossomed since 1992, when 97 facilities were accepting patients. As of 2004, that figure had grown to 307 -- more than triple the number 12 years earlier -- with 2005's total estimated at some 360.
One reason for the rapid growth is that there are few specific regulations for long-term acute care hospitals. They must meet the same conditions to participate in Medicare funding as do general hospitals, and their patients must have an average Medicare length of stay greater than 25 days.
Adding to increased numbers, a larger aging population and payments that continue to be what health care consultant Frances Fowler called "really good." The base payment rate for a typical patient for the year ending June 30, 2006, is $38,086 -- $1,522.44 per day based on a 25-day stay.
While the Centers for Medicare and Medicaid Services have been tightening the long-term acute care hospital payment system, including what percentage of patients a facility within an acute care hospital can receive from its host, experts say such facilities will not go away.
Patients and their families agree. "I was with my mother every day she was in the hospital," Ziolkowski said. "She received such attention at Kindred, they were so understanding."