Extended Acute Care: Community Need For Long-Term Care Hospital/s In The Finger Lakes Region

1. Extended Acute Care:Community Need For Long-Term Care Hospital/sIn The Finger Lakes Region Kathryn Votava, PhD, RN GoodCare.com™ Washington, DC PREPARED FOR: THE FINGER LAKES HEALTH SYSTEMS AGENCY ROCHESTER, NY October 1, 2007

2. FLHSA Long-Term Care Hospital Community Needs Assessment Project Staff

3. Finger Lakes Health Systems Goal • “to provide all people the right care, at the right time, in the right place for the right price.”

4. According to Medicare: What is a LTCH? • Acute hospital with ALOS ≥ 25 days • It’s not a “unit” • Has its own staff, administration & board of directors • Can co-locate within another hospital or on a campus with other Medicare providers • Hospital-within-hospital (HWH) • Satellite HWH • If owned by another acute hospital: • Restricted to 25% admissions from acute hospital owner

5. What is Extended Acute Care (EAC)? Does a LTCH fit in the acute care puzzle? • Acute Hospital Stay beyond the “average” DRG. • Aggregate of Need – • Multiple diagnoses • Complex acute care • Higher level of care than ALC or complex SNF

6. Do Long Term Care Hospitals fit in the Extended Acute Care picture in the Finger Lakes region? • What is the clinical profile of EAC patients? • What are their acute hospital service use patterns? • Is their a community need for Long-Term Care Hospitals (LTCH/s)? • What might the LTCH CON recommendations be?

7. EAC Community Needs Assessment Inclusion Criteria: • Finger Lakes region SPARCS acute hospital episode 2003 – 2006: • Discharged from region acute hospital • Region resident with acute hospital outside the Finger Lakes region • > 17 years of age • Top 50 LTCH DRGs • Acute hospital LOC ≥ 75th percentile

8. Community Needs Assessment Method – Stage 1

9. Community Needs Assessment Method - Stage 2

10. EAC Demographics 2003-2006 Ethnicity Sex Age Groups %

11. EAC Clinical Groups • Medical EAC Groups: • Complex: • Wounds • Infectious Disease • Heart Failure • Respiratory or Ventilator • Psycho-Behavioral

12. EAC Clinical Groups 2003-2006

13. Top EAC Major Diagnostic Categories 2003-2006

14. Top EAC Diagnostic Related Groups 2003-2006

15. EAC Acute Hospital Reimbursement 2003-2006

16. LTCH Candidates Inclusion Criteria • LTCH Clinical Admission Criteria Per Medicare: • Clinical stability • Need 24 hr. skilled care • Need 24 hr. laboratory service • 80% of acute hospital episodes meet criteria at some point during acute hospital stay.

17. Community Needs Assessment Method – Stage 3

18. Acute Hospital Days Saved Estimate Assumptions • Acute hospitals will discharge clinically ready patients to LTCH to optimize acute DRG payment. • LTCH occupancy will be 90%.

19. N ∑ K = 1 [Acute Hospital LOS – (2007 Medicare GLOS – 1day)] Acute Hospital Discharge Clinical Readiness Acute Hospital Days Saved Acute Hospital Days Saved Estimate • Acute Hospital Discharge Clinical Readinessestimated on a range of additional LOS above the “average” acute DRG: • 5% = Prompt Clinical Readiness • 15 % = Mid-range Clinical Readiness • 25 % = Late Clinical Readiness

20. LTCH Bed Need Estimate by EAC

21. LTCH Bed Need EstimateMedical EAC Total

22. LTCH Bed Need in Finger Lakes Sub-areas • Monroe/Livingston Monroe and Livingston • Southern Tier Chemung, Schuyler & Steuben • Central Region Ontario, Seneca, Wayne & Yates • Western Region Genesee, Orleans & Wyoming

23. Finger Lakes Sub-area LTCH Bed Need Estimate

24. LTCH Business Case • Geographic Distribution of LTCHs • Concentrated in Monroe/Livingston and Southern Tier • Facilitated discharge planning and enhanced clinical outcomes when families have easier access to patient while in hospital • Financial Viability of LTCH • LTCH Reimbursement • Bundled Reimbursement • Payors other than Medicare • Potential LTCH back-up • 25% referral restriction

25. LTCH Business Case continued • Capital, Construction and Renovation Costs • Converting existing space vs. new construction • Acute Hospital Opportunity Cost • EAC patients as outliers in the acute hospital • Blocking beds for new acute admissions • Potential Impact of LTCH in acute hospital market • Better clinical outcomes for LTCH patients • Opportunity cost to acute hospital market

26. Where might Extended Acute Care be delivered?

27. How does a LTCH fit in the acute hospital care puzzle? • “to provide all people the right care, at the right time, in the right place for the right price.”