Long-term acute care facility

A long-term acute care hospital (LTACH) is a specialized hospital that provides extended hospitalization for patients with complex care needs. These hospitals have been in existence for many years, initially as sanatoriums for patients with tuberculosis and other chronic diseases. The modern LTACH was established through the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999. This act defines an LTACH as a hospital with an average inpatient length of stay of greater than 25 days.

LTACHs primarily care for patients requiring prolonged mechanical ventilation. They can be physically located within a short-term acute care hospital or be free-standing buildings. LTACHs can be non-profit or for-profit and may be associated with a healthcare system, post-acute care system, or a network of LTACHs.

The payment system for LTACH services is complex. Medicare reimburses LTACHs through the Prospective Payment System (PPS), based on an average patient length of stay of 25 days. LTACHs receive adjusted DRG payments for patients, reflecting the higher cost of care for patients with complex needs. Generally, LTACHs have higher reimbursement rates and operating margins compared to short-stay hospitals.

LTACHs are required to report quality measures set by CMS as part of the Affordable Care Act. Failure to report quality data results in a 2 percent reduction in CMS payment. However, the evidence supporting the superior care provided by LTACHs is limited, and there are concerns about the higher frequency of serious infections in these hospitals compared to conventional hospitals.

Overall, LTACHs play a crucial role in providing extended care for patients with complex needs, but further research is needed to evaluate their effectiveness and address concerns about infection rates.