The 40-bed specialty hospital proposed for the second floor of the Rehabilitation Hospital of Rhode Island in North Smithfield would be the first Long Term Acute Care (LTAC) hospital in the state if it is built, something that can happen only if proponents can convince a state review panel that it is needed and can satisfy other concerns the panel has raised.
One of the questions from members on the state’s Health Services Council at a project review meeting last week was whether the LTAC hospital would duplicate care given at institutions such as the Eleanor Slater Hospital in Cranston.
After meeting with representatives at Eleanor Slater Hospital, Mary MacIntosh, principal of VectorHMG in East Greenwich and consultant for the applicants, said “no significant issues were raised in our minds … that indicated that there really was a competition between the programs.”
Average length of stay at Eleanor Slater is about two to three years, MacIntosh said, whereas the average length of stay at LTAC hospitals is 25 to 26 days.
She said 33 patients at Eleanor Slater required LTAC services in 2005 at a facility that has 495 beds.
Members of the Health Services Council also asked where LTAC patients are located now, since there isn’t an LTAC hospital in Rhode Island.
To that MacIntosh responded that LTAC patients comprise about 2 percent of patients hospitalized annually in acute care hospitals such as Landmark Medical Center, Kent County Hospital and Rhode Island Hospital.
LTAC patients in those hospitals require a longer length of stay than the average acute-care patients, which stay on average about four to five days, she said. LTAC patients sometimes stay 100 days or more in acute-care hospitals.
The reason they end up staying so long is because they have multiple serious illnesses that prevent them from being discharged, MacIntosh said. Common diagnoses for those patients include chronic obstructive pulmonary disease, degenerative nervous system disorders, kidney and urinary tract infections, renal failure, pneumonia, respiratory infections and circulatory system and digestive system diagnoses.
“[LTAC patients] present issues for the hospital,” MacIntosh said. “Often because of the reimbursement structure the hospital sees less and less of its costs reimbursed for those extra days of stay, particularly for Medicare patients.”
During the 1980s the federal government recognized the special needs of LTAC patients and set up a new category for the patients, according to the certificate-of-need application submitted this summer by RehabCare Group Inc., based in St. Louis, and Landmark Health Systems Inc., which owns the Rehabilitation Hospital of Rhode Island. (READ MORE)
Since the 1980s the federal government has set up a payment system for LTAC facilities. But those facilities must be a Medicare-certified provider of LTAC care to receive reimbursement for care. To do so they must demonstrate in six months that the average length of stay at the LTAC facilities is 25 days.
RehabCare Group has been a provider of LTAC services since 1982, according to the application, and delivers care in 40 states. RehabCare Group would own an 80-percent controlling interest in the Rhode Island Specialty Hospital proposed in North Smithfield and will operate the facility. Landmark would own the remaining 20 percent.
But members of the Health Services Council questioned whether Landmark would be able to contribute its $763,000 portion of the $3.8 million in capital costs the new hospital will require because, on an ongoing operating basis, Landmark is losing money.
As of June, the company had a net loss in 2007 of about $7 million, according to the council committee.
Richard Charest, president and CEO of the Rehabilitation Hospital, said at last week’s meeting that the parent company, Landmark, is doing a number of things to improve its finances.
At last week’s meeting, members of the council presented additional questions to the ones it had asked in a previous meeting. The council committee will meet again with the applicants in January, before submitting a recommendation to the full council.
“The earliest a decision will be made is early in January,” said Michael Dexter, chief of the state’s Office of Health Systems Development.
The council’s recommendation will go to state Health Director Dr. David R. Gifford, who will make the final decision. •
