Healthcare Reform and the Future of Long-term Acute Care Hospitals: Q & A with Grant Asay of LifeCare Hospitals
Q: You were recently promoted to oversee the operations of all of LifeCare's 19 facilities. What are some of your goals for the position?
Grant Asay: This opportunity gives me the ability to share operational and clinical best practices across all of our facilities. For example, many of our hospitals have very unique programs to assure outstanding patient and physician satisfaction while others have developed innovative ways to control costs or maximize other efficiencies. With a system the size of ours, we have a great opportunity to identify these practices and not only share them across our system but also find a way to operationalize them so that they benefit a greater number of patients. This is something we have done successfully on a regional basis, and we will work to broaden this practice in my new role.
Q: Can you give an example of one of these best practices you plan to implement system wide?
GA: Sometimes it's the small things that make a big difference. For example, one of our facilities is doing an outstanding job at preventing patient falls simply by increasing the level of awareness among staff. Each patient’s risk is assessed and simple discrete communication is placed at the patient’s doorway that notes each patient’s risk level for falls. It's a great practice that gives employees an acute awareness about a patient's individual risk level and allows them to take appropriate precautions. Patient falls continue to decline in this hospital.
Another example of a best practice relates to efficient resource management. In one of our hospitals, we are analyzing the individual patient charge and revenue detail and then correlating lab and radiology services and specific medications with a particular admitting diagnosis. We are able to show this data in a per patient day format by attending physician. We then communicate trends and patterns in the utilization of services to the hospital’s medical leadership. This is proving to be a successful tool in eliminating waste and assuring appropriate clinical resource management.
Q: What are some possible effects that current healthcare reform efforts will have on long-term acute care hospitals?
GA: Healthcare reform could benefit our industry in several ways. The push toward controlling spending will help raise awareness of specialty acute-care hospitals like ours and the important role they play in the healthcare continuum. Readmissions are one of the largest sources of cost for Medicare, and a recent New England Journal of Medicine study found that approximately one-third of all inpatient Medicare patients had unplanned readmissions, costing Medicare $17 billion annually. By providing extensive rehabilitative and critical care services, facilities like ours help reduce readmissions while ensuring that patients receive the care they need in the most appropriate and cost-effective setting.
I am also hopeful that specialty acute-care hospitals will be able to participate in the sharing of electronic patient information across institutions or care settings. Our industry has not yet been able to access the funding available to implement electronic medical records and this is something that is often very expensive for small hospitals like ours.
In the long term, I'd like to see some of the rigid regulatory requirements regarding the approximately 550 long-term acute care hospitals in the country become less arbitrary so that patients can continue to access this level of acute care. Over the years, we have had a 15 percent host expense rule, a 25 percent host admission rule, a 25 day patient length of stay rule, a 250 yard rule, etc. In some states, our patient lengths of stay must be between 25 and 30 days. Admissions should not be determined based on arbitrary measurements or criteria, but through well defined medical and clinical indicators. We take care of the sickest of the sick, and I think that healthcare reform is going to allow our industry to demonstrate cost-effective services and great patient outcomes on a population that presents with so many complex medical conditions.
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