Medicaid patients treated at long-term acute care hospitals (LTACs) are markedly different than the Medicare populations described in other LTAC studies, suggesting that prior research using Medicare patients may not be appropriate for informing state Medicaid policy.
On an ongoing basis, the Georgia Health Policy Center (GHPC) supports the Georgia Department of Community Health in conducting policy analyses and evaluations of its Medicaid programs. Researchers at GHPC characterized Georgia Medicaid patients treated at five state LTACs from January 2011 through December 2012. Georgia Medicaid fee-for-service claims for 458 LTAC patients were analyzed and compared to data for 808 acute care hospital (ACH) patients with select respiratory conditions and 208 patients who received care at both an ACH and an LTAC.
“Our study furthers the understanding of the role of LTACs in Medicaid’s continuum of care by helping to inform coverage decisions, payment models, prior authorization criteria, and coordination of care initiatives for state Medicaid programs,” says study co-author Carla Willis, Ph.D., a senior research associate at GHPC. “In addition, because many Medicaid LTAC patients are also eligible for Medicare, this research could inform federal-state joint policies intended to improve care for this vulnerable population.”
Patients typically cared for in LTAC facilities are chronically and critically ill with extended lengths of stays. Given the extensive, complex needs of these patients, care is expensive–in 2011 costing Medicare a median of $39,000 per LTAC visit.
The GHPC study, entitled “Long-Term Acute Care Hospitals and Medicaid: Utilization, Outcomes, and Cost,” found that Medicaid patients who received care in Georgia LTACs were:
- Likely to be dually eligible for Medicare and Medicaid services (52.2 percent).
- Younger than the typical Medicare patient (average age 56 years)
- Eligible for Medicaid due to blind or disabled (71.2 percent)
For care-related metrics, the researchers found that Medicaid patients were:
- Discharged to the community more frequently (22 percent for Medicare versus 34.3 percent for Medicaid patients)
- Had a lower mortality rate, compared to Medicare patients (12.3 percent versus approximately 50.2 percent)
- Had higher readmissions, compared to Medicare patients (23.6 percent versus approximately 10 percent)
- Had higher costs, compared to Medicare patients ($46,805 versus $39,0006)
Furthermore, Medicaid patients receiving respiratory care at an LTAC were distinct from Medicaid patients receiving similar care at an ACH in terms of patient condition, discharge location, length of stay, and costs. Generally, the average risk scores showed that Medicaid patients receiving respiratory care at LTACs are more seriously ill than those who receive similar care at an ACH.
“LTACs in Georgia appear to have restricted admissions to more complex patients; however, cost remains a concern,” says study co-author Bill Rencher, a research associate II at GHPC. “State Medicaid programs should consider bundled payment options for episodes involving a transfer to an LTAC to incentivize care coordination, reduce readmissions, and avoid paying two separate DRGs.”
Findings were previously presented at the AcademyHealth Annual Research Meeting (June 14–16, 2015; Minneapolis, Minn.). This work was co-authored by Carla Willis, Ph.D., GHPC senior research associate, Bill Rencher, J.D., GHPC research associate II, and Evan Cole, Ph.D., former associate project director at GHPC.