As president and chief of the medical staff at Hospital for Special Care, a freestanding 228 — bed long-term acute care hospital based in New Britain with a satellite facility serving the greater Hartford area, I am responsible for more than 20 full-time employed physicians and neuropsychologists, a staff of more than 1,000 Connecticut citizens and more than 100 consulting physicians in all subspecialties. In addition, I oversee the quality of care for all our inpatient and outpatient programs.
Today, I am writing on the important and unique role of long-term acute care hospitals in our healthcare system — a system in the midst of proposed reforms designed to wring out its inefficiencies and sometimes ineffectiveness. Policymakers have proposed ways to change the way post-acute care is reimbursed, which would very likely impact the way and whether that care is delivered.
As you read this article, think about the unique care that my hospital provides, and ask yourself how some of the proposed reform ideas would affect that care, our patients and their families as well as the community.
A Healthcare Bridge
Hospital for Special Care (HSC) provides long-term acute care and rehabilitation for very serious health conditions such as life-threatening pulmonary disease, serious acquired-brain-injury disorders, complex pediatric illnesses, significant neuromuscular disease (such as ALS and muscular dystrophy) and life-altering spinal cord injuries. We are the place that general hospitals send patients who need to rebuild their lives after experiencing a traumatic event or onset of a very serious disease.
At HSC, our goal has been to develop programs for specialty patient populations that answer the needs of the community and general hospitals throughout the state. It is our mission to provide appropriate care to Connecticut’s most fragile and compromised residents ranging from infants younger than nine weeks to senior citizens over 90 years old.
The notion of finding an alternative post acute care setting for many of our patients is daunting. After they overcome the first state of treatment for an acute illness or injury, our patients continue to have significant medical and rehabilitation needs. These complex patients could not be cared for adequately in any other setting, including a skilled nursing facility.
Because we have identified specific complex medical issues not adequately served in other parts of the healthcare system, we have been successful in providing superior quality care for patients recovering from traumatic injury or battling life-threatening diseases. And this care is cost effective for commercial and governmental funding sources and often returns people to the community rather than to institutions designed to shelter them indefinitely.
Currently, I serve as the president of the National Association of Long Term Hospitals (NALTH). At HSC and NALTH, we agree the government should fund only that care which best meets a patient’s needs — not more, but NOT less care. To ensure that the most clinically appropriate patients are treated at long-term acute care hospitals (LTCHs), NALTH advocated for increased medical necessity review by government-sponsored quality improvement organizations. These organizations help safeguard the integrity of the Medicare/Medicaid system and the patients it serves. This is incremental reform that makes sense.
Further, NALTH has conducted quality and outcome studies of long-term acute care hospitals, including a ventilator weaning outcomes study of patients who were dependent on mechanical ventilation. The results showed that LTCHs are very successful in weaning ventilator patients who previously had failed multiple weaning attempts at general and community hospitals.
What’s more, the state of Connecticut Office of Healthcare Access (OHCA) conducted and published a study of the cost benefit of HSC’s LTCH satellite, which is co-located with a general hospital. This was part of a demonstration project that investigated the utility of such facilities in Connecticut. OHCA reported that there was a significant cost benefit to the state offered by our satellite in Hartford, and that the clinical outcomes of the patients we served improved. That’s a win-win for our state and our citizens.
A Delicate Balance
Connecticut has the luxury of having two high-quality LTCHs in the state, which take patients from all 30 general and community hospitals. Although our hospital has been financially stable in previous years, healthcare “reform” that could make it impossible to deliver complex post-acute care in LTCHs would significantly challenge our financial stability, and in turn, deny patients the specialized care LTCHs provide.
It is possible that federal healthcare reform will motivate the alignment of acute care providers with post-acute providers. However, because many LTCHs often operate at break even or worse, any changes that upset the delicate balance of our very specialized corner of the healthcare market need to be fully understood before they become reality. It’s a prospective reality that could harm many of the most vulnerable of our state’s and nation’s citizens.
John J. Votto, D.O., F.C.C.P. is president, chief executive officer and chief of medical staff at Hospital for Special Care in New Britain.
