Appropriateness of Long-Term Acute Care Hospital Transfer: A Multicenter Study of Medicare ACO Beneficiaries.
Ross C Schumacher, Michael Chiu, Jean de Leon and 2 others
PMID 33617790WHAT IT FOUND
Only 31.4% of LTACH transfers were clinically appropriate.
Most inappropriate transfers involved wound care or IV infusions manageable in skilled nursing facilities. Current Medicare payment criteria poorly distinguish appropriate cases, though stricter ICU stay requirements improve identification.
Key findings
01Just 31.4% of the 105 reviewed LTACH transfers were considered clinically appropriate.
02Inappropriate transfers were frequently driven by patient or physician preference and specialized wound care needs that could be managed in less intensive settings.
03Meeting current Medicare payment criteria had a positive predictive value of 55.3% for appropriate transfers, but applying an 8-day minimum ICU stay criterion increased this to 76.9%.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPsWhat it means for RNs
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What it does not show
The study was conducted in a single high-LTACH-use region within one accountable care organization, limiting generalizability to other areas or healthcare systems. Appropriateness was determined by physician review without validated objective criteria, introducing potential subjectivity despite consensus methods. The retrospective design may have missed undocumented reasons for transfer, although discharge plans were routinely documented by social workers and case managers. The study could not assess whether intensive care aligned with patients' personal goals, which is a key component of appropriate care.
Declared interests
One author received travel expenses and a research grant from the National Association of Long Term Hospitals, an organization that advocates for LTACHs. The authors otherwise declared no competing interests.
The easy way to misread this
Do not assume that meeting Medicare payment criteria guarantees a patient needs LTACH care. The current criteria correctly identified only 55.3% of appropriate transfers, meaning nearly half of patients meeting the financial thresholds were clinically inappropriate for LTACH admission.