The number of long-term acute care hospitals has exploded in the last 15 years because they are able to exploit a Medicare loophole. These facilities, which in 1993 billed the government $400 million, are expected this year to bill $4.8 billion. Yet there are serious questions about the quality of care given patients. A New York Times investigation suggests these hospitals deserve far greater scrutiny by regulators and a change in the rules regarding the way they are paid.
There are 23 long-term care hospitals in Florida, including two in Pinellas County and two in Hillsborough County. Long-term care hospitals take very sick patients who are stable but need hospital care for an average of at least 25 days. Traditional hospitals are happy to discharge patients into long-term care facilities, because it allows them to open beds to new admissions who bring in more money under Medicare reimbursement rules.
The New York Times found that the use of long-term care hospitals is driven more by financial incentives than by any evidence of what is best for patients. In fact, the investigation found that long-term care hospitals were cited twice as often for serious violations of Medicare rules than regular hospitals, and were more likely to have patients who suffered from bedsores and infections.
The for-profit, publicly traded companies, which include Kindred Healthcare and Select Medical Corp., raise the most serious questions. Kindred operates the four Tampa Bay-area long-term care hospitals and six others around the state. Select runs eight in Florida, none locally. According to the New York Times, the for-profits generally spend less on their patients than nonprofit long-term care hospitals and enjoy higher margins. The cost-cutting can result in patient injuries. Select was cited almost four times more often than regular hospitals for standard-of-care violations in 2007 and 2008.
In October in a Select hospital in Palm Beach, state inspectors found a woman on a feeding tube receiving only 600 calories a day. And in December in Tampa, state inspectors cited a Kindred hospital for failing to have nurses regularly assess the condition of a patient on a ventilator and for failing to provide any "consistent and accurate assessment" for another patient who had toes turn "100 percent black" while under its care.
What makes some of these facilities look even more like an attempt to game the Medicare payment rules is the way patients tend to be discharged right at the point when keeping them longer would cost the hospitals money. Long-term care hospitals are certified as such if most patients stay at least 25 days. Medicare pays long-term care hospitals a set amount for each patient, which means patients who remain after 25 days are draining profits. Select, according to the Times, has an average length of stay of about 24 days. Ex-employees say the 25th day is called the "magic day."
Due to the spiraling cost, Medicare imposed a three-year moratorium on new long-term care hospitals that will expire in December. This moratorium should be renewed, and new payment rules need to be adopted to take away the financial incentives to treat patients as profit machines.