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Poor Outcome from Long-Term Acute Care Hospitalization

People recovering from serious illness used to recuperate in a traditional hospital, no matter how long it took. But in the past 15 years, a new form of hospital–the long-term acute care hospital–has emerged. These hospitals can provide intensive and specialized care for patients who don’t necessarily need all of the services offered by a medical-surgical hospital.

Sounds great, right?  Well, not always.

An article published this week in the Journal of the American Medical Association (JAMA) tracked the admissions and outcomes of Medicare patients transferred to long-term acute care hospitals between 1997 and 2006. Researchers (including Dr. Shannon S. Carson from the University of North Carolina Medical School, Chapel Hill) found that during this time, the number of patients transferred increased, and the one-year mortality rate increased.

The researchers state that there has been no sign that long-term acute care hospitals do a better job at caring for very sick patients than other forms of care, including traditional hospitals. So why are they becoming more prevalent? According to the article:

“In the absence of demonstrated efficacy, long-term acute care hospital expansion may possibly be driven by financial incentives that favor out-of hospital transfer after critical illness. Compared with short-stay hospitals, long-term acute care hospitals operate with relatively high margins and are a profitable sector of the health care market. Additionally, under prospective payment, short-stay hospitals financially benefit by discharging patients with severe acute illness early in their course.”

In other words, it probably all comes down to money. Traditional hospitals often benefit from discharging patients early, and long-term acute care hospitals make more money from doing the same job.

None is this is good for sick people. We know from experience that when money becomes the primary part of the equation, the outcome is never good for patient care–it becomes too easy to cut corners to save a dime. We have seen this happen in nursing homes, where quality care is more and more difficult to find.

The attorneys of HensonFuerst agree with the final analysis of the researchers who wrote the JAMA report: The medical system is capable of innovation, but we should evaluate the effectiveness of all new programs before turning over sick patients to what might turn out to be substandard care. Patients shouldn’t be sacrificed to reduce costs–the standard of care should always be survival over dollars.

(JM Kahn, NM Benson, D Appleby, SS Carson, TJ Iwashyna. Long-term acute care hospital utilization after critical illness. JAMA 2010;303(22):2253-2259.)

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