To determine the PAC bundled payments, all SNF, IRF, LTCH, HHA, carrier, and acute readmission amounts were aggregated for the 90-day postdischarge period.
For example, a hospital with 20 SNF, 20 HHA, and 5 LTCH admissions within 14 days of discharge has a denominator of 45 PAC admissions.
First, we examined the proportion of HAC and matched non-HAC episodes with all-cause 90-day readmissions and the proportions with inpatient PAC transfers, including LTCH
, SNF, IRF, and IPF claims.
In addition, current survey results in CMS's databases may be incomplete because these databases do not always accurately identify (1) the organization responsible for surveying each LTCH and (2) whether a facility is, in fact, an LTCH.
Recommendation: In order to improve the data available on the quality of care at LTCHs, the Administrator of CMS should improve the accuracy of the databases that track LTCH survey results by (1) working with AOs and state survey agencies to develop a complete and accurate list of the LTCHs that they each survey and an approach to ensuring that the list is updated in a timely manner, and (2) expanding the On-line Survey, Certification, and Reporting system (OSCAR) database to include the results of all LTCH surveys, such as those conducted by TJC, which are currently stored in the separate Accrediting Organization System for Storing User Recorded Experiences (ASSURE) database.
As a result, the LTCH patient population has a high level of comorbidities and infacility mortality.
Because of the importance of provision of mechanical ventilation for the LTCH industry and for facilities specializing in treating respiratory conditions, control of VAP is an important aspect of quality of care improvement in LTCHs.
Payment rates to LTCHs
are currently typically annually according to a separate market basket based on LTCH
-specific goods and services.
Index acute hospitalizations were defined as an acute hospitalization preceded by a 30-day period without Medicare acute or PAC service use, defined as LTCH
, IRF, SNF, and HHA.
At least some of the utilization growth in IRF and LTCH
services between 1997-1998 and 2000 may reflect a shift of services from SNF and home health care.
The combined rate for all other institutional settings of care--IRFs, LTCHs
, IPFs, and cancer hospitals--was 416 per 1,000 person-years.
The final rule, which would apply to approximately 3,330 acute care hospitals and approximately 430 LTCHs
, would affect discharges occurring on or after October 1, 2016.