The one common denominator between these two types of long term care hospitals is that, on average, their patient stays are 25 or more days. Typically, LTAC hospitals' patients have multiple body system complications and failures which require daily physician visits and significant ancillary and nursing services. Many of these LTAC hospital patients have respiratory problems and are ventilator-dependent. The goal for treatment is maximum medical recovery and a return to home and family. Despite this heterogeneity, long-term care hospitals generally fall into two major categories.
Some facilities tend to treat more chronic types of patients who require less intensive services.
The LTAC Hospital Association has recommended to HCFA and ProPAC that, to be designated as an LTAC hospital, such a hospital must, at minimum, have an intensive care unit, be capable of treating ventilator-dependent cases, and have at least 30 percent of its patients with respiratory problems. Such peer groupings of long term hospitals will result in a more equitable application of any payment reductions which are based on average cost per discharge. Proposals to cap target payment amounts or base year cost calculations by using an overall group average will, by definition, discriminate against those providers that treat sicker Medicare beneficiaries who require more intensive resources. Because of this and the pressure of the payment limits over time, older hospitals have lower costs per case than newer ones. Such a system not only would form the basis for a prospective payment system for these providers, but also would be an essential tool for analyzing differences in patient resource use and costs among long-term care hospitals.