Protecting Access to Care for Our Most Severely Ill Patients

Few patient populations are more vulnerable to the shifting winds around health care today than Medicare beneficiaries who need specialized, high-acuity and long-stay care.

The Essential Role of Long‑Term Care Hospitals in Today’s Health System

Long-term care hospitals fill a vital role in the care continuum by providing care for the most severely ill Medicare beneficiaries who require extended hospitalization, offering an intensive level of care that is not generally available in other settings. LTCH patients, on average, have higher rates of multiple organ failure, ventilator use, and comorbidities and complications compared to beneficiaries in other care settings.

Despite LTCHS’ unique and necessary role, the current policy environment presents challenges for patients trying to access care and negatively impacts these hospitals’ financial stability. Much of this is attributable to the dual-rate payment system implemented in 2016, which, for many patients, provides reimbursement to LTCHs that is well below the cost of caring for them. Today, annual Medicare spending on LTCH care is about 45% lower than it was prior to the dual-rate payment system, resulting in more than 25% of the nation’s LTCHs closing in the last 10 years.

Policy Reforms Needed to Protect Access for High‑Acuity Medicare Patients

In response to this and other structural issues that threaten access to care for those who need it most, the AHA has worked to bring together the Coalition of Long-Term Acute-Care Hospitals, the National Association of Long Term Hospitals, and the Federation of American Hospitals to develop and release Long-term Care Hospital Reform Policy Principles.

The principles are designed to guide and inform Congress on ways to better support LTCHs and patients by addressing current challenges and offering solutions to strengthen LTCHs’ care delivery. Solutions include ensuring access for certain high-acuity beneficiaries by expanding payment criteria, improving the accuracy of the LTCH prospective payment system, making a potential change to the 25-day average length of stay requirement, restructuring the LTCH outlier system, expanding rural access to LTCHs, and reining in harmful Medicare Advantage practices. The AHA released an infographic highlighting these reform proposals.  

Along with our partners in this effort, the AHA is urging lawmakers to enact policy solutions that will help sustain the irreplaceable role LTCHs play in caring for beneficiaries needing intensive care.

America’s most critically ill patients need timely access to the care that best meets their needs. As demand continues to rise, it is essential to address barriers and reinforce access to LTCHs, which can enable faster transitions from acute hospitals, ease capacity strain and improve patient outcomes.