Specialized ICUs Reduce Readmissions
Kindred Hospitals, a national network of long-term acute care hospitals (LTACHs), provide specialized treatment and rehabilitation for medically complex patients.
LTACHs are equipped to treat many of the same conditions that are treated in traditional ICUs at short-term acute care hospitals (STACHs), but are designed to do so for a longer period of time. A look at the top diagnosis-related groups treated at STACH and LTACH ICUs reveals overlap between six of the top 10 conditions treated at each setting.1
| STACH ICU | LTACH ICU |
|---|---|
| Pulmonary Edema & Resp Failure | Pulmonary Edema & Resp Failure |
| Resp Infections & Inflammations w MCC | Resp Infections & Inflammations w MCC |
| Resp Sys Diagnosis w Ventilator Support <=96 Hours | Resp Sys Diagnosis w Ventilator Support <=96 Hours |
| Resp Sys Diagnosis w Ventilator Support >96 Hours | Resp Sys Diagnosis w Ventilator Support >96 Hours |
| Septicemia or Severe Sepsis w MV >96 Hours | Septicemia or Severe Sepsis w MV >96 Hours |
| Septicemia or Severe Sepsis w/o MV >96 Hours w MCC | Septicemia or Severe Sepsis w/o MV >96 Hours w MCC |
| Acute Myocardial Infarction, Discharged Alive w MCC | Trach w MV >96 Hours or PDX Exc Face, Mouth & Neck w/o Major O.R. Procs |
| Heart Failure & Shock w MCC | ECMO or Trach w MV >96 Hours or PDX Exc Face, Mouth & Neck w Major O.R. Procs |
| Infectious & Parasitic Diseases w O.R. Procs w MCC | Extensive O.R. Procs Unrelated to PDX w MCC |
| Intracranial Hemorrhage or Cerebral Infarction w MCC | Other Resp Sys O.R. Procs w MCC |
The Benefit of Timely Transfer
It is not only possible for LTACHs to treat patients requiring ICU-level care, but it is also beneficial.
When medically complex patients transfer to LTACHs, they receive specialized acute care and rehabilitation that can reduce their risk of readmission. This can be seen clearly when looking at readmission rates by Hierarchical Condition Category (HCC) tier at each setting.
HCC coding is a risk-adjustment model that helps communicate patient complexity, with higher scores reflecting greater complexity.2
The Advisory Board categorizes Medicare patients into Low, Mid, High, and Very High HCC tiers. According to this data, the average readmission rates for patients in the High or Very High HCC tiers are about 50% lower for patients transferred to an LTACH.3
LTACHs also specialize in treating patients with serious respiratory conditions, especially those on mechanical ventilation. In fact, one study found that a one-day delay in discharging to an LTACH after intubation is associated with an 11.6% reduction in the odds of weaning.4
Because LTACHs provide ICU-level treatment for complex conditions, it is beneficial for stable patients with multiple serious diagnoses to be transferred to our hospitals even while they are still in critical condition.
Elements of Kindred Hospitals’ ICUs
At Kindred, our physician-led interdisciplinary care teams with critical care expertise are fundamental to the level of care we provide.
Physicians:
- All treatment plans are led by physicians who visit patients daily
- Attending physicians have expertise in treating critically complex patients
- Physicians with specialties such as pulmonology, infectious disease, and general surgery participate in treatment plans as needed
Nurses:
- All nurses in our ICUs are certified in Advanced Cardiovascular Life Support
- Nurse-to-patient ratios in our ICUs resemble those in STACH ICUs
Respiratory Therapy:
- Respiratory therapists are available 24/7
- RTs provide around-the-clock weaning
Additional members of the interdisciplinary care teams may include:
- Physical and occupational therapists
- Speech-language pathologists
- Wound care nurses
- Dieticians
- Pharmacists
With our highly-skilled care teams, we are able to provide hospital services such as:
- Management and liberation from mechanical ventilation
- Placement, management, and removal of IV lines, catheters, and nasogastric tubes
- Radiology, telemetry, and dialysis
At Kindred, we take our care to the next level by achieving nationally recognized hospital certifications. All of our hospitals have disease-specific care certifications from The Joint Commission in at least one of the following categories: Respiratory Failure, Pulmonary Rehabilitation, Sepsis, Wound Care, or Brain Injury Rehabilitation.
With our expert care teams and high-quality treatment and rehabilitation, Kindred Hospitals can help improve outcomes and reduce readmissions for medically complex patients.
Want to learn more?
Read our latest Research & Insights articles or call 866.KINDRED to speak to a registered nurse.
References
- MedPAR, 2022 Traditional Medicare FFS and Medicare Advantage ICU and CCU Discharges, DRGs within the top 10 rearranged to show comparison.
- https://www.advisory.com/blog/2018/04/reimbursement
- The Advisory Board. The Post Acute Care Pathways Explorer. State Average Outcomes by HCC Score Tier. HCC tiers include Medicare FFS patients with a total HCC score in the following ranges: ‘Low’ between 0 and 2, ‘Mid’ greater than 2 and less than or equal to 4, ‘High’ greater than 4 and less than or equal to 6, and Very High’ greater than 6. Accessed June 2023.
- https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890 021 01454 1
By: Dean French, MD, CPPS – Chief Medical Officer
As executive vice president and chief medical officer for ScionHealth, Dr. Dean French provides strategic leadership while overseeing the company’s physician, clinical and quality strategies, with the goal of helping establish a lasting legacy of strong, compassionate clinical and physician leadership. Dr. French is an experienced physician executive − having previously served as Chief Medical Officer for multiple hospitals − and also has a long track record of operational and financial success as a hospital CEO.