LTCHSLindsay Thurber Comprehensive High School (Red Deer, Alberta, Canada)
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For the concentration index, the different types of PAC sites (SNFs, HHAs, IRFs, and LTCHs) are counted without distinction.
Index hospital fixed effects ([[mu].sub.h]) are added to account for differences in index payments due to hospital characteristics, such as the resident-to-bed ratio, and also variations in practice patterns that can affect payments and referral patterns (e.g., LTCH use is greater at some hospitals than others).
Engagement in ACP is important in LTCHs for reasons such as compliance with policy or legislation, the increasing prevalence of dying residents, and residents' desire to communicate their wishes.
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.
Medicare LTCHs are distinguished by having a Medicare LOS of 25 days or more.
NALTH also objected to a proposal from CMS to impose a one-time 3.75% reduction at the end of a three-year period ending December 29, 2010, arguing that LTCH payments and costs have already been aligned for budget neutrality purposes as required by law.
If a hospitalization is avoided, then this will also lower postacute care in SNFs, IRFs, and LTCHs. Similarly, even after a hospitalization, the GH home might be able to deliver postacute care more efficiently to allow the elder to transition more rapidly out of postacute care.
Though the per hospital discharge payments for LTCH are quite small, the payments for those who use LTCHs are much higher.
For example, when the relatively fiscally stringent SNF PPS and the home health IPS were implemented, IRFs and LTCHs continued to be paid on a cost basis.
Beneficiaries typically spend far fewer days in skilled nursing facilities (SNFs) and "other inpatient" settings, such as IRFs, LTCHs, and IPFs, than in other settings due to the key role those inpatient settings play in stabilizing and rehabilitating complex patients.
Every year millions of Medicare beneficiaries are discharged from acute care hospitals into institutional postacute care (PAC) in inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and long-term care hospitals (LTCHs).