What Is Long-Term Acute Care?

    Long-term acute care (LTAC) is the type of care provided in Kindred Transitional Care Hospitals. More than 20 years ago, Kindred helped to pioneer the long-term acute model of care. Today, Kindred has a nationwide network of transitional care hospitals unique in their ability to care for medically complex patients who benefit from extended recovery time.

    LTAC differs from the care provided at acute care general hospitals in that it is for patients who stay, on average, about 25 days. Care levels extend from ICU beds (at most of our hospitals) to monitored beds to general medical care. Most of our hospitals have ORs or treatment rooms for invasive and minor surgical procedures such as G-tube placement and wound debridement.

    What Is a Transitional Care Hospital?

    Transitional care hospitals, (certified as long-term acute care hospitals) are unique in their ability to care for difficult to treat, chronically critically ill patients who require specialized and aggressive goal-directed care over an extended recovery period. Typical patients have multiple co-morbidities, multi organ system failure, and significant loss of independence, most following a traditional hospital stay.

    Transitional care hospitals are licensed as acute care hospitals with additional Medicare certification that supports a length of stay measured in weeks (more than 25 days on average for Medicare patients) as compared to the typical five day stay for patients in traditional hospitals. We are consequently unique in our ability to care for critically ill patients who require specialized, aggressive, goal-directed care over an extended recovery period. Transitional care hospitals provide long-term acute care (LTAC) to complex medically complex patients who require an extended stay in a hospital setting.

    Nationally, Kindred have two types of transitional care hospitals. The first is a freestanding hospital, which typically has 50-80 patient beds. The second is an HIH, or hospital in a hospital. This is a transitional care hospital located inside or on the same campus as a general acute care hospital. These tend to range from 30-45 beds. Both operate as independently licensed, certified and accredited hospitals.

    What Is Unique About Long-Term Acute Care?

    LTAC is unique for many reasons, including:

    • The acute level of services are provided by the physicians, nurses and clinical staff on a daily basis
    • The multidisciplinary approach to patient care is through care teams, rounding and family meetings
    • Extended recovery time
    • Provides the ability to work collaboratively with the leadership team and the opportunity to play an administrative role in patient care

    Who Are LTAC Patients?

    The typical LTAC patient is older with three to six concurrent active diagnoses, or someone who has suffered an acute episode on top of several chronic illnesses. Over 95% of our patients are admitted from a STAC (short-term acute care) hospital. Approximately 25% of our patients are on mechanical ventilation, 25% have at least one wound, and almost 50% have a central line. Approximately 40% of our patients are, on admission, colonized with MRSA, VRE, resistant gram-negative organisms or C. difficile.

    Most of our patients have already undergone extensive work-ups at the STAC and have developed and initiated a treatment plan with the referring physician team. Common conditions include but are not limited to ventilator weaning, severe infection, complex wound care, CHF, COPD and renal insufficiency. As many as 10% of our patients may require acute hemodialysis at some time during their stay.

    Patients receive long-term acute care through treatment delivered according to their individual needs. Our board-certified physicians see patients daily to assure the best outcomes possible. The majority of our patients are admitted after a stay in a short-term hospital, often from intensive care and step-down units. Kindred Hospitals specialize in caring for patients with:

    • an average length of stay of 25-30 days
    • three to six concurrent active diagnoses and an acute episode on top of several chronic illnesses and co-morbidities that cannot be treated effectively at an alternative level of care
    • multiple acute complexities as determined by a physician assessment and subsequent documentation requiring daily physician intervention

    What Distinguishes the LTAC Model?

    Unlike STACs, transitional care hospitals providing long-term acute care are designed instead for the development, administration and adjustments of prolonged medical treatment plans carried out by a multidisciplinary team including nurses, respiratory therapists, pharmacists, rehabilitation therapists and specialty physicians such as cardiologists, neurologists, gastroenterologists and ENT physicians. The main attending physician is generally a hospitalist, internist or pulmonologist.

    In addition, due to the size of our hospitals, the Chief Executive Officer, Chief Clinical Officers and Quality Managers are actively involved in the daily care of patients.

    How Is the Transitional Care Hospital Paid?

    Medicare patients are paid under a modified DRG system. About 50% of the patients receive a DRG payment. Non-Medicare patients are paid by a contracted or negotiated rate between the transitional care hospital and the insurer.

    As with traditional inpatient care, prudent use of tests, prevention of complications, and attention to patient safety are essential. We encourage and promote the Medical Staff involvement in the hospital care teams such as Quality Committee, Medical Executive Committee, Infection Control and Utilization Review.

    How Is the Physician Paid?

    LTAC reimbursement for Medicare patients (70%) follows the usual Medicare in-patient Evaluation and Management (E&M) fee schedule. Therefore, reimbursement for a given E&M code is the same as if that care was provided in a short-term acute care hospital. For managed care patients (15-25%), fees are set by each insurance company, and vary between the in- network and out-of-network fee schedule. Therefore, it is not necessary to be on a panel to receive reimbursement. A few states have Medicaid rates for transitional care hospitals providing long-term acute care, and those transitional care hospitals accept Medicaid patients. Physicians are paid according to that state’s fee schedule.

    What Physician Opportunities Are in a Kindred Transitional Care Hospital?

    There are several types of physician opportunities available at Kindred.


    • Volunteer physicians attend or consult at facilities where privileged (applications available at each hospital)
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