1 00:00:00,080 --> 00:00:02,720 Hello, everyone. This is Erica Spicer Mason with 2 00:00:02,720 --> 00:00:03,620 Becker's Healthcare. 3 00:00:04,000 --> 00:00:05,359 Thank you so much for tuning in to 4 00:00:05,359 --> 00:00:07,459 the Becker's Healthcare podcast series. 5 00:00:08,000 --> 00:00:09,839 So today, we're going to talk about the 6 00:00:09,839 --> 00:00:12,400 role of long term acute care hospitals and 7 00:00:12,400 --> 00:00:14,339 partnerships in high acuity care. 8 00:00:14,734 --> 00:00:16,814 And joining me for this conversation is doctor 9 00:00:16,814 --> 00:00:17,795 Daniel DelPortal, 10 00:00:18,175 --> 00:00:20,974 senior vice president and chief clinical officer at 11 00:00:20,974 --> 00:00:23,614 Temple Health. Doctor DelPortal, it's great to have 12 00:00:23,614 --> 00:00:25,054 you on the podcast today. Thank you so 13 00:00:25,054 --> 00:00:27,054 much for being here. Yeah. Thanks so much 14 00:00:27,054 --> 00:00:28,355 for having me on the program. 15 00:00:29,059 --> 00:00:31,300 Really excited to have you. And before we 16 00:00:31,300 --> 00:00:33,219 get into our conversation, I wanted to give 17 00:00:33,219 --> 00:00:34,659 you the chance to share just a little 18 00:00:34,659 --> 00:00:36,340 bit more about yourself and your work in 19 00:00:36,340 --> 00:00:40,520 health care. Sure. Thanks. So, my clinical background 20 00:00:40,659 --> 00:00:42,920 is as an emergency physician. I'm a practicing 21 00:00:42,979 --> 00:00:43,719 ER doctor. 22 00:00:44,245 --> 00:00:46,484 I've been a medical staff leader having served 23 00:00:46,484 --> 00:00:48,565 as as president of the medical staff for 24 00:00:48,565 --> 00:00:49,625 our our hospital, 25 00:00:50,245 --> 00:00:52,725 and am now a a clinical executive leader 26 00:00:52,725 --> 00:00:54,885 as as the chief clinical officer of Temple 27 00:00:54,885 --> 00:00:57,219 Health, which is an academic health system, 28 00:00:57,700 --> 00:01:00,899 encompasses both academic and community hospitals. We've got 29 00:01:00,899 --> 00:01:03,940 six hospitals, including our urban safety net hospital, 30 00:01:03,940 --> 00:01:05,560 which is a level one trauma, 31 00:01:06,260 --> 00:01:09,505 accredited burn center, transplant center. We've got an 32 00:01:09,505 --> 00:01:12,725 NCI designated cancer center, a behavioral health hospital, 33 00:01:13,265 --> 00:01:15,284 and a and a large primary and specialty 34 00:01:15,424 --> 00:01:16,325 care network. 35 00:01:16,944 --> 00:01:18,885 I specialize really in clinical operations, 36 00:01:19,344 --> 00:01:21,605 so that includes optimizing capacity, 37 00:01:21,984 --> 00:01:24,780 access to care, efficiency of care delivery, 38 00:01:25,320 --> 00:01:27,180 timely progression of clinical care, 39 00:01:27,640 --> 00:01:29,880 and then really focusing on the transitions in 40 00:01:29,880 --> 00:01:32,359 and out of of inpatient care. So whether 41 00:01:32,359 --> 00:01:34,219 it's through the front door of the emergency 42 00:01:34,280 --> 00:01:34,780 department, 43 00:01:35,480 --> 00:01:37,340 or on the back end, 44 00:01:38,045 --> 00:01:40,525 linking patients from inpatient care to a post 45 00:01:40,525 --> 00:01:43,584 acute network of skilled nursing, acute rehab, 46 00:01:44,045 --> 00:01:46,525 and this interesting part of the continuum of 47 00:01:46,525 --> 00:01:48,125 care that we're gonna be talking about today, 48 00:01:48,125 --> 00:01:50,284 which is the, long term acute care hospital 49 00:01:50,284 --> 00:01:50,944 or LTCH. 50 00:01:51,325 --> 00:01:51,825 Yeah. 51 00:01:52,189 --> 00:01:53,549 Well, it's great to learn more about you, 52 00:01:53,549 --> 00:01:55,549 doctor DelPortal. Thank you so much for the 53 00:01:55,549 --> 00:01:57,549 overview, and sounds like you're wearing a lot 54 00:01:57,549 --> 00:01:59,230 of hats in your role. And I I'm 55 00:01:59,230 --> 00:02:00,049 eager to hear, 56 00:02:00,750 --> 00:02:02,350 kind of the role that long term acute 57 00:02:02,350 --> 00:02:04,614 care is playing at Temple. And so I 58 00:02:04,694 --> 00:02:06,534 I'd like to start there. You know, when 59 00:02:06,534 --> 00:02:08,715 we think about long term acute care hospitals 60 00:02:08,854 --> 00:02:11,175 or LTACs as many people call them and 61 00:02:11,175 --> 00:02:12,854 the role that they play in the broader 62 00:02:12,854 --> 00:02:15,254 continuum of care, how does that align with 63 00:02:15,254 --> 00:02:16,935 the needs of the patients that you're serving 64 00:02:16,935 --> 00:02:17,594 at Temple? 65 00:02:18,689 --> 00:02:21,409 Yeah. It's it's really about what each setting 66 00:02:21,409 --> 00:02:24,129 of care is designed to address. So short 67 00:02:24,129 --> 00:02:26,370 term acute care hospitals, what what most people 68 00:02:26,370 --> 00:02:28,689 think of as their local hospital where they 69 00:02:28,689 --> 00:02:30,469 go to the ER if they got sick, 70 00:02:30,995 --> 00:02:32,594 They're the right setting when there's a need 71 00:02:32,594 --> 00:02:35,555 to establish a diagnosis and treatment plan for 72 00:02:35,555 --> 00:02:38,194 emergency care, for, you know, a multi specialty 73 00:02:38,194 --> 00:02:41,174 consultation to establish a diagnosis and treatment plan, 74 00:02:41,234 --> 00:02:43,014 or for most surgical procedures. 75 00:02:43,949 --> 00:02:46,770 By contrast, long term acute care hospitals, LTAC, 76 00:02:46,830 --> 00:02:47,650 really specialize 77 00:02:48,110 --> 00:02:50,110 in the care of patients with serious medical 78 00:02:50,110 --> 00:02:53,310 conditions that are gonna require extended hospital level 79 00:02:53,310 --> 00:02:53,810 care. 80 00:02:54,270 --> 00:02:56,189 Usually, it's more than twenty five days. The 81 00:02:56,189 --> 00:02:58,525 average length of admission at an LTAC is 82 00:02:58,525 --> 00:03:00,925 gonna be much longer, weeks to months, than 83 00:03:00,925 --> 00:03:03,085 a short term acute care hospital, which typically 84 00:03:03,085 --> 00:03:04,444 has an average length of stay of a 85 00:03:04,444 --> 00:03:06,125 week or less for the majority of its 86 00:03:06,125 --> 00:03:06,625 patients. 87 00:03:07,325 --> 00:03:09,564 So the the model in many markets without 88 00:03:09,564 --> 00:03:12,064 LTACs is is that a patient who needs 89 00:03:12,330 --> 00:03:13,550 hospital level care 90 00:03:13,930 --> 00:03:15,530 will stay in a short term acute care 91 00:03:15,530 --> 00:03:17,870 hospital until that patient's ready to be discharged 92 00:03:18,409 --> 00:03:20,409 to home, to acute rehab, to a skilled 93 00:03:20,409 --> 00:03:21,310 nursing facility. 94 00:03:21,930 --> 00:03:24,775 For the more medically complex patients, that can 95 00:03:24,775 --> 00:03:26,615 be a really big transition, and it and 96 00:03:26,615 --> 00:03:28,134 it can prolong their stay in the short 97 00:03:28,134 --> 00:03:29,354 term acute care hospital. 98 00:03:30,134 --> 00:03:30,634 Oftentimes, 99 00:03:31,335 --> 00:03:33,014 that care can be delivered in other settings 100 00:03:33,014 --> 00:03:35,675 that are specifically designed for it, like ventilator 101 00:03:35,735 --> 00:03:36,715 weaning, tracheostomy 102 00:03:37,094 --> 00:03:37,594 care, 103 00:03:38,055 --> 00:03:39,754 intensive respiratory care, 104 00:03:40,189 --> 00:03:42,689 situations where there really isn't diagnostic uncertainty, 105 00:03:43,310 --> 00:03:45,650 but where the progression to rehab or home 106 00:03:45,709 --> 00:03:46,849 is gonna be slow. 107 00:03:48,030 --> 00:03:50,430 That's super helpful to know, doctor DelPortal. Thank 108 00:03:50,430 --> 00:03:52,750 you. And so from what you're describing, it 109 00:03:52,750 --> 00:03:54,449 sounds like some organizations, 110 00:03:54,830 --> 00:03:56,644 they can make the short term 111 00:03:57,424 --> 00:03:59,364 care work if they don't have an LTAC. 112 00:04:00,544 --> 00:04:02,064 But I'm I'm sure that there's more to 113 00:04:02,064 --> 00:04:03,664 it than that. So if if short term 114 00:04:03,664 --> 00:04:05,824 care can provide the level of care that 115 00:04:05,824 --> 00:04:07,504 you're describing, can you just say a little 116 00:04:07,504 --> 00:04:10,270 bit more about where and how LTACs are 117 00:04:10,270 --> 00:04:11,090 adding value? 118 00:04:11,870 --> 00:04:14,189 Yeah. Absolutely. So so keeping patients in short 119 00:04:14,189 --> 00:04:15,490 term acute care hospitals 120 00:04:16,350 --> 00:04:18,670 longer to meet those milestones, it's gonna create 121 00:04:18,670 --> 00:04:21,069 a few problems. The first is access to 122 00:04:21,069 --> 00:04:22,129 inpatient care. 123 00:04:22,435 --> 00:04:24,354 We know that inpatient capacity at short term 124 00:04:24,354 --> 00:04:26,454 acute care hospitals is strained nationally. 125 00:04:26,834 --> 00:04:29,634 Right? So hospital closures, including in the area 126 00:04:29,634 --> 00:04:30,774 where I work in Philadelphia, 127 00:04:31,154 --> 00:04:34,055 are reducing the number of available inpatient beds. 128 00:04:34,810 --> 00:04:37,610 Some community hospitals are trimming services or or 129 00:04:37,610 --> 00:04:40,009 even going to micro hospital models and sending 130 00:04:40,009 --> 00:04:42,490 more patients, referring them out to tertiary care 131 00:04:42,490 --> 00:04:45,129 centers, and that exacerbates that supply and demand 132 00:04:45,129 --> 00:04:45,629 mismatch 133 00:04:46,009 --> 00:04:47,310 for the inpatient beds. 134 00:04:48,105 --> 00:04:49,964 And that all leads to prolonged boarding, 135 00:04:50,345 --> 00:04:52,365 of admitted patients in emergency departments, 136 00:04:52,904 --> 00:04:55,384 for hours, sometimes days, and that's a national 137 00:04:55,384 --> 00:04:58,264 crisis that's that's well described. Mhmm. It strains 138 00:04:58,264 --> 00:05:00,745 emergency care resources, and it makes it really 139 00:05:00,745 --> 00:05:02,525 challenging for hospitals to provide 140 00:05:02,849 --> 00:05:06,129 stabilizing care to new arrivals while also continuing 141 00:05:06,129 --> 00:05:08,229 to manage dozens of admitted patients. 142 00:05:08,930 --> 00:05:11,509 So the longer patients with medical complexity 143 00:05:11,810 --> 00:05:13,909 stay in short term acute care hospitals, 144 00:05:14,370 --> 00:05:16,610 the more the community can struggle to access 145 00:05:16,610 --> 00:05:18,310 inpatient services they need. 146 00:05:19,055 --> 00:05:21,375 The second problem with keeping medically complex patients 147 00:05:21,375 --> 00:05:22,435 longer in a traditional 148 00:05:22,894 --> 00:05:24,354 short term acute care hospital, 149 00:05:24,975 --> 00:05:26,894 for example, to wean from a ventilator, which 150 00:05:26,894 --> 00:05:28,574 can take weeks or months, is that it 151 00:05:28,574 --> 00:05:30,975 threatens the financial stability of short term acute 152 00:05:30,975 --> 00:05:32,574 care hospitals, and that's based on the way 153 00:05:32,574 --> 00:05:34,274 that hospitals are paid. The diagnosis 154 00:05:34,709 --> 00:05:36,810 related group or DRG payments 155 00:05:37,110 --> 00:05:39,430 to short term acute care hospitals are based 156 00:05:39,430 --> 00:05:42,069 on a geometric mean length of stay. That's 157 00:05:42,069 --> 00:05:44,550 a formula that minimizes the impact of the 158 00:05:44,550 --> 00:05:47,269 outlier cases, and hospitals will get paid a 159 00:05:47,269 --> 00:05:48,569 fixed rate by Medicare, 160 00:05:49,165 --> 00:05:52,125 managed care, commercial insurance plans for the typical 161 00:05:52,125 --> 00:05:54,524 duration and expenses of caring for most patients 162 00:05:54,524 --> 00:05:55,584 with that same diagnosis. 163 00:05:56,444 --> 00:05:58,764 So under a DRG based payment model, hospitals 164 00:05:58,764 --> 00:06:00,685 aren't really reimbursed in a way that that 165 00:06:00,685 --> 00:06:02,444 covers the expenses of caring for the more 166 00:06:02,444 --> 00:06:03,904 medically complex patients, 167 00:06:04,459 --> 00:06:05,819 and it's not hard to see how that's 168 00:06:05,819 --> 00:06:08,060 gonna create a cycle, right, under reimbursement for 169 00:06:08,060 --> 00:06:11,180 longer stay patients, hastens hospital closures, which strains 170 00:06:11,180 --> 00:06:13,439 regional bed capacity like I just mentioned. 171 00:06:13,980 --> 00:06:15,279 And finally, and I'd argue 172 00:06:15,580 --> 00:06:17,920 most importantly from the perspective of the patient, 173 00:06:18,045 --> 00:06:19,965 is that in areas without an LTCH level 174 00:06:19,965 --> 00:06:21,645 of care or for patients who don't have 175 00:06:21,645 --> 00:06:23,324 it as a covered benefit in their insurance 176 00:06:23,324 --> 00:06:23,824 plan, 177 00:06:24,205 --> 00:06:26,205 they can get trapped, for lack of a 178 00:06:26,205 --> 00:06:27,884 better word, in in the short term acute 179 00:06:27,884 --> 00:06:30,764 care hospital, which, again, is designed perfectly for 180 00:06:30,764 --> 00:06:31,264 stabilization, 181 00:06:31,879 --> 00:06:35,259 making a diagnosis, coordinating multi specialty treatment plans. 182 00:06:35,720 --> 00:06:38,439 But LTACH, by contrast, is designed specifically to 183 00:06:38,439 --> 00:06:41,419 provide the ongoing care, the ventilator weaning, respiratory 184 00:06:41,479 --> 00:06:44,060 treatment, nutritional support, pulmonary rehab, 185 00:06:44,574 --> 00:06:47,454 without competing for resources and time with those 186 00:06:47,454 --> 00:06:50,574 unstable emergency patients that are always arriving twenty 187 00:06:50,574 --> 00:06:52,414 four seven, three hundred sixty five days a 188 00:06:52,414 --> 00:06:54,514 year at the short term acute care hospital. 189 00:06:54,974 --> 00:06:57,055 So by moving to a setting that's designed 190 00:06:57,055 --> 00:06:58,914 to focus on the longer term, sometimes 191 00:06:59,220 --> 00:07:00,759 slower aspects of recovery, 192 00:07:01,139 --> 00:07:02,980 the patient can often have a better experience 193 00:07:02,980 --> 00:07:05,379 than if the short term hospitalization was prolonged 194 00:07:05,379 --> 00:07:07,300 for months and months. So I'd say that 195 00:07:07,300 --> 00:07:09,300 really LTACH serve as a bridge between the 196 00:07:09,300 --> 00:07:10,759 short term acute care hospitalization 197 00:07:11,540 --> 00:07:12,040 and 198 00:07:12,564 --> 00:07:13,064 rehabilitation 199 00:07:13,365 --> 00:07:15,845 or home or skilled nursing level of care 200 00:07:15,845 --> 00:07:17,925 that really aren't equipped to handle the medical 201 00:07:17,925 --> 00:07:20,404 complexity of the patients we're talking about. We've 202 00:07:20,404 --> 00:07:22,805 sent a broad variety of patients to LTCH 203 00:07:22,805 --> 00:07:25,625 from trauma patients to those with severe pulmonary 204 00:07:25,685 --> 00:07:28,579 disease and ventilator dependent respiratory failure, 205 00:07:28,879 --> 00:07:30,399 those that are slow to wean off of 206 00:07:30,399 --> 00:07:30,899 ventilators, 207 00:07:31,680 --> 00:07:34,160 to those requiring longer courses of antibiotics for 208 00:07:34,160 --> 00:07:35,779 infections but that have significant 209 00:07:36,160 --> 00:07:38,720 active comorbid illness that can't really be well 210 00:07:38,720 --> 00:07:40,660 controlled in a nonhospital setting. 211 00:07:42,134 --> 00:07:44,555 Yeah. Doctor DelPortal, it's a really helpful 212 00:07:44,935 --> 00:07:46,295 it's really helpful the way that you just 213 00:07:46,295 --> 00:07:47,495 broke all of this down. 214 00:07:47,975 --> 00:07:51,035 It's fascinating to learn how just that mismatch 215 00:07:51,335 --> 00:07:53,435 of patient acuity to facility, 216 00:07:53,870 --> 00:07:56,110 how that can cascade into these areas like 217 00:07:56,110 --> 00:07:57,009 patient access, 218 00:07:57,870 --> 00:07:59,089 the economics and reimbursement 219 00:07:59,790 --> 00:08:01,810 piece, and then also patient experience. 220 00:08:02,350 --> 00:08:05,149 So, again, appreciate you digging in there and 221 00:08:05,149 --> 00:08:07,745 elaborating a bit. And I wanna explore the 222 00:08:07,745 --> 00:08:09,605 clinical part a little bit more too. 223 00:08:11,024 --> 00:08:13,024 You you've mentioned some conditions that you've seen 224 00:08:13,024 --> 00:08:13,524 patients, 225 00:08:13,904 --> 00:08:17,024 effectively be treated for in LTCH. So are 226 00:08:17,024 --> 00:08:19,524 there specific conditions or treatments that you've seen 227 00:08:19,560 --> 00:08:21,720 or that you've been most surprised to see 228 00:08:21,720 --> 00:08:24,279 LTACH handle effectively? And if one comes to 229 00:08:24,279 --> 00:08:25,959 mind, could you just share a patient story 230 00:08:25,959 --> 00:08:28,120 or anything that you think could help illustrate 231 00:08:28,120 --> 00:08:28,620 that? 232 00:08:29,160 --> 00:08:30,759 Sure. Yeah. I mean, they you look. This, 233 00:08:30,919 --> 00:08:32,934 this was an education for me as an 234 00:08:32,934 --> 00:08:35,754 emergency physician. I wasn't often seeing the the, 235 00:08:35,815 --> 00:08:37,975 you know, back end of, you know, the 236 00:08:37,975 --> 00:08:39,975 transition out of the hospital. And and over 237 00:08:39,975 --> 00:08:41,975 the past decade or so, I've I've learned 238 00:08:41,975 --> 00:08:43,995 about the capabilities of different facilities. 239 00:08:44,695 --> 00:08:47,210 I think sometimes providers and patients tend to 240 00:08:47,210 --> 00:08:48,029 lump facilities 241 00:08:48,570 --> 00:08:50,889 together that are actually very different. For example, 242 00:08:50,889 --> 00:08:52,809 if they think of LTCH as a skilled 243 00:08:52,809 --> 00:08:55,129 nursing facility that handles ventilators, when it's really 244 00:08:55,129 --> 00:08:55,950 more than that. 245 00:08:56,330 --> 00:08:58,570 So I sometimes see physicians wanting to keep 246 00:08:58,570 --> 00:09:00,429 patients longer in the hospital 247 00:09:00,809 --> 00:09:03,345 for things like a tracheostomy change or a 248 00:09:03,345 --> 00:09:05,745 feeding tube placement or because they're worried that 249 00:09:05,745 --> 00:09:06,884 a patient may require 250 00:09:07,264 --> 00:09:09,924 blood pressure support or even intensive care. 251 00:09:10,384 --> 00:09:12,945 LTAC can do all of those things. So 252 00:09:12,945 --> 00:09:15,184 many of those patients can be considered for 253 00:09:15,184 --> 00:09:15,684 LTAC. 254 00:09:16,269 --> 00:09:18,669 And sometimes I I have to remind, our 255 00:09:18,669 --> 00:09:21,649 clinicians of the the sort of broad capabilities 256 00:09:21,710 --> 00:09:22,529 of an LTCH, 257 00:09:23,309 --> 00:09:24,610 that that they can handle. 258 00:09:24,990 --> 00:09:27,149 You asked for a patient story. We had 259 00:09:27,149 --> 00:09:29,164 one patient who had who had suffered a 260 00:09:29,164 --> 00:09:31,565 really serious aortic dissection, a a tearing of 261 00:09:31,565 --> 00:09:34,065 his main artery, and he was critically ill 262 00:09:34,205 --> 00:09:35,884 and had to have surgery to fix his 263 00:09:35,884 --> 00:09:38,225 aorta. And we were able to stabilize him, 264 00:09:38,524 --> 00:09:40,125 but he ended up on a ventilator for 265 00:09:40,125 --> 00:09:42,549 a prolonged period, and he had a doppoff 266 00:09:42,549 --> 00:09:44,629 tube, a special kind of feeding tube that 267 00:09:44,629 --> 00:09:47,209 skilled nursing facilities and rehabs just won't touch. 268 00:09:47,829 --> 00:09:50,309 And so through our partnership with Kindred LTAC, 269 00:09:50,309 --> 00:09:52,950 we were able to transfer him there. And 270 00:09:52,950 --> 00:09:55,095 he's over the next twenty eight days, got 271 00:09:55,254 --> 00:09:55,754 multidisciplinary 272 00:09:56,134 --> 00:09:58,294 support. He weaned off the ventilator to breathe 273 00:09:58,294 --> 00:09:58,794 independently. 274 00:09:59,174 --> 00:10:00,074 He got his tracheostomy 275 00:10:00,454 --> 00:10:00,954 removed. 276 00:10:01,414 --> 00:10:04,054 He ultimately transitioned from the feeding tube to 277 00:10:04,054 --> 00:10:06,855 a regular diet. He got physical therapy, and 278 00:10:06,855 --> 00:10:09,414 he was discharged to acute rehab before going 279 00:10:09,414 --> 00:10:09,914 home. 280 00:10:10,340 --> 00:10:12,259 So there was a lot of hospital days 281 00:10:12,259 --> 00:10:12,759 saved, 282 00:10:13,540 --> 00:10:15,639 for for, you know, this patient's recovery. 283 00:10:16,340 --> 00:10:18,500 And it was it was transitioning him from 284 00:10:18,500 --> 00:10:21,080 the acute care short term acute care hospital 285 00:10:21,460 --> 00:10:23,940 to a place really designed to meet his 286 00:10:23,940 --> 00:10:25,559 remaining needs in his recovery. 287 00:10:26,154 --> 00:10:28,235 And, oh, I think, you know, when the 288 00:10:28,235 --> 00:10:30,554 data I've seen, that we share within our 289 00:10:30,554 --> 00:10:33,434 partnership shows we're really saving thousands of days 290 00:10:33,434 --> 00:10:34,174 in the hospital, 291 00:10:34,794 --> 00:10:36,875 for for patients who meet the criteria for 292 00:10:36,875 --> 00:10:37,375 LTCH. 293 00:10:37,914 --> 00:10:38,414 Yeah. 294 00:10:39,080 --> 00:10:41,080 It's a great example, and I really appreciate 295 00:10:41,080 --> 00:10:42,540 you sharing that, doctor DelPortal. 296 00:10:43,160 --> 00:10:45,480 I know we're talking here about some of 297 00:10:45,480 --> 00:10:48,440 the clinical outcomes and, especially days saved in 298 00:10:48,440 --> 00:10:50,440 the hospital. But I also wanted to give 299 00:10:50,440 --> 00:10:52,300 you the chance to highlight any other 300 00:10:52,715 --> 00:10:55,355 benefits to or changes in hospital operations that 301 00:10:55,355 --> 00:10:57,915 you've noticed as a result of getting support 302 00:10:57,915 --> 00:10:59,054 from LTAC partnerships. 303 00:11:00,075 --> 00:11:01,754 Yeah. I mean, I think it's really helpful 304 00:11:01,754 --> 00:11:03,054 to establish a partnership. 305 00:11:03,595 --> 00:11:05,529 You know, that gives us regular reporting of 306 00:11:05,529 --> 00:11:08,730 metrics, including time from referral to acceptance of 307 00:11:08,730 --> 00:11:09,389 a patient, 308 00:11:09,769 --> 00:11:11,610 the length of stay of a patient here 309 00:11:11,610 --> 00:11:13,370 in the short term acute care hospital and 310 00:11:13,370 --> 00:11:15,309 how long they stay at the LTAC, 311 00:11:15,690 --> 00:11:17,309 and also to track any readmissions. 312 00:11:17,929 --> 00:11:19,605 You know, what are the reasons if if 313 00:11:19,605 --> 00:11:21,865 somebody's not, successful at LTCH, 314 00:11:22,565 --> 00:11:24,084 that that they need to come back to 315 00:11:24,084 --> 00:11:26,404 the short term acute care hospital. That gives 316 00:11:26,404 --> 00:11:28,325 us the ability to share outcomes data with 317 00:11:28,325 --> 00:11:30,825 our specialty teams that are referring patients, 318 00:11:31,284 --> 00:11:32,804 and it helps to build confidence in the 319 00:11:32,804 --> 00:11:34,485 high level of care that an LTCH can 320 00:11:34,485 --> 00:11:34,985 provide. 321 00:11:35,820 --> 00:11:37,899 We can identify areas of support that are 322 00:11:37,899 --> 00:11:39,660 needed. So, for example, having one of our 323 00:11:39,660 --> 00:11:40,160 pulmonologists 324 00:11:40,620 --> 00:11:41,680 round at the LTCH 325 00:11:42,059 --> 00:11:43,580 at least once a week to check on 326 00:11:43,580 --> 00:11:46,300 our patients, support the clinical care there, and 327 00:11:46,300 --> 00:11:48,300 really link back and give feedback to his 328 00:11:48,300 --> 00:11:50,985 colleagues about the patients that they've referred and 329 00:11:50,985 --> 00:11:53,065 how they're doing after hospital discharge. I think 330 00:11:53,065 --> 00:11:55,085 that's really meaningful for for our clinicians. 331 00:11:55,544 --> 00:11:58,365 Mhmm. And, look, we have a a liaison 332 00:11:59,065 --> 00:12:01,464 from from our LTACH partner that's dedicated to 333 00:12:01,464 --> 00:12:02,524 our hospital, and 334 00:12:02,904 --> 00:12:05,565 we can leverage our our electronic medical record 335 00:12:05,769 --> 00:12:07,929 and create lists of patients who may meet 336 00:12:07,929 --> 00:12:08,429 criteria 337 00:12:08,809 --> 00:12:10,970 and have them followed by that clinical liaison 338 00:12:10,970 --> 00:12:13,610 who works closely with our case management team. 339 00:12:13,610 --> 00:12:15,709 They work with our clinical staff to coordinate 340 00:12:15,850 --> 00:12:17,289 some of those aspects of care that I 341 00:12:17,289 --> 00:12:19,309 mentioned that are sometimes seen as barriers, 342 00:12:19,945 --> 00:12:21,384 when really they don't they don't need to 343 00:12:21,384 --> 00:12:21,884 be. 344 00:12:22,424 --> 00:12:25,065 They help support the families of patients. They 345 00:12:25,065 --> 00:12:27,304 offer tours of their facilities, and they answer 346 00:12:27,304 --> 00:12:29,704 questions so that it makes the transition from 347 00:12:29,704 --> 00:12:32,605 short term to long term acute care hospital 348 00:12:32,825 --> 00:12:35,200 less frightening and overall makes the care better 349 00:12:35,200 --> 00:12:37,440 coordinated. So, you know, having a a robust 350 00:12:37,440 --> 00:12:39,299 partnership, I think, does have a really, 351 00:12:39,919 --> 00:12:42,899 important impact on hospital operations and clinical quality. 352 00:12:44,320 --> 00:12:46,500 Doctor DelPortal, this has been such an informative 353 00:12:46,720 --> 00:12:47,220 conversation. 354 00:12:47,804 --> 00:12:50,125 I've learned a lot about the differences between 355 00:12:50,125 --> 00:12:52,125 short term care and what's possible in long 356 00:12:52,125 --> 00:12:53,184 term acute care. 357 00:12:53,964 --> 00:12:56,125 So with all of this in mind, and 358 00:12:56,125 --> 00:12:58,464 I know we've covered a lot of ground, 359 00:12:58,605 --> 00:13:00,044 I'd love to kind of get your forward 360 00:13:00,044 --> 00:13:02,899 looking perspective here. Where is the continuum of 361 00:13:02,899 --> 00:13:04,899 care headed, and how do you expect that 362 00:13:04,899 --> 00:13:07,779 LTACH partnerships like the one you've described will 363 00:13:07,779 --> 00:13:10,120 evolve as patient needs are growing more complex? 364 00:13:11,059 --> 00:13:12,980 Well, you know, I think if you think 365 00:13:12,980 --> 00:13:13,799 about how 366 00:13:14,285 --> 00:13:16,925 hospitals and health systems and the the challenge 367 00:13:16,925 --> 00:13:18,925 before them has evolved over time, right, 368 00:13:19,485 --> 00:13:21,325 you know, hospitals are being charged with doing 369 00:13:21,325 --> 00:13:23,245 so much more now than they were decades 370 00:13:23,245 --> 00:13:25,404 ago. We have community health workers that are 371 00:13:25,404 --> 00:13:26,545 assigned to help patients 372 00:13:27,320 --> 00:13:29,480 with the social barriers to health, you know, 373 00:13:29,480 --> 00:13:29,980 the 374 00:13:30,279 --> 00:13:31,100 the transportation, 375 00:13:31,559 --> 00:13:32,460 food insecurity, 376 00:13:33,399 --> 00:13:35,639 the things that that really contribute to to 377 00:13:35,639 --> 00:13:38,279 making them sick. We've got value based and 378 00:13:38,279 --> 00:13:41,095 risk arrangements now that hospitals are more financially 379 00:13:41,095 --> 00:13:43,115 at risk for patient outcomes like readmission, 380 00:13:43,495 --> 00:13:46,315 complications, and and frequent acute care utilization. 381 00:13:47,014 --> 00:13:49,355 And we've got shrinking margins and a reimbursement 382 00:13:49,495 --> 00:13:51,654 structure that isn't really keeping pace with supply 383 00:13:51,654 --> 00:13:54,279 and labor costs in health care. So short 384 00:13:54,279 --> 00:13:56,620 term hospitals can't do all that alone. 385 00:13:57,080 --> 00:13:58,519 Part of my job is is looking at 386 00:13:58,519 --> 00:14:00,279 where the gaps are in that continuum of 387 00:14:00,279 --> 00:14:02,300 care and finding sustainable ways 388 00:14:02,759 --> 00:14:05,399 to provide ongoing care outside the short term 389 00:14:05,399 --> 00:14:07,480 acute care hospital setting and to smooth the 390 00:14:07,480 --> 00:14:10,674 transitions of care. And my experience with LTCH 391 00:14:10,674 --> 00:14:12,355 is that they can serve as a really 392 00:14:12,355 --> 00:14:14,754 helpful role in bridging patients who are too 393 00:14:14,754 --> 00:14:15,735 sick from home, 394 00:14:16,115 --> 00:14:18,835 rehab, or skilled nursing, but don't really need 395 00:14:18,835 --> 00:14:20,674 all the resources of a short term acute 396 00:14:20,674 --> 00:14:21,415 care hospital. 397 00:14:22,679 --> 00:14:24,600 By establishing these partnerships, we we can really 398 00:14:24,600 --> 00:14:26,959 help patients to progress through their recovery at 399 00:14:26,959 --> 00:14:28,939 the same time as we can preserve access 400 00:14:29,319 --> 00:14:32,059 to that emergency stabilizing treatment for the communities 401 00:14:32,120 --> 00:14:33,019 that we're serving. 402 00:14:33,480 --> 00:14:34,919 And if it's put together the right way, 403 00:14:34,919 --> 00:14:36,695 I think it's really a win win. So 404 00:14:36,695 --> 00:14:37,595 I think the future 405 00:14:38,054 --> 00:14:40,375 of, you know, where LTACH fits in there 406 00:14:40,375 --> 00:14:41,754 is, you know, potentially 407 00:14:42,134 --> 00:14:45,274 an expanded role in, you know, offloading 408 00:14:45,815 --> 00:14:48,934 some of the the work that acute care 409 00:14:48,934 --> 00:14:51,034 hospitals, the short term acute care hospitals, 410 00:14:51,790 --> 00:14:55,230 are currently doing because they're we're being tasked 411 00:14:55,230 --> 00:14:57,649 with doing a lot more and and expanding 412 00:14:57,790 --> 00:14:59,970 our care beyond the walls of the hospital. 413 00:15:01,470 --> 00:15:03,710 It's such an important perspective that you're raising, 414 00:15:03,710 --> 00:15:06,074 doctor DelPortal. I know the capacity crisis in 415 00:15:06,074 --> 00:15:09,134 health care isn't going anywhere anytime soon, and, 416 00:15:09,514 --> 00:15:12,634 we know that patient needs seemingly are only 417 00:15:12,634 --> 00:15:15,274 growing more complex by the day. So it 418 00:15:15,355 --> 00:15:18,289 just kind of hearing your vision for what 419 00:15:18,289 --> 00:15:20,209 this would look like in action, you know, 420 00:15:20,209 --> 00:15:22,769 these stronger LTCH partnerships and how that can 421 00:15:22,769 --> 00:15:25,329 offload some burden on other areas of health 422 00:15:25,329 --> 00:15:27,329 care, it's fascinating to hear about. And I 423 00:15:27,329 --> 00:15:29,250 just wanna thank you again for for joining 424 00:15:29,250 --> 00:15:30,870 us for the conversation today. 425 00:15:31,674 --> 00:15:33,355 Is there anything that we glossed over too 426 00:15:33,355 --> 00:15:35,274 quickly or any final thoughts that you wanted 427 00:15:35,274 --> 00:15:36,334 to share with our listeners? 428 00:15:37,274 --> 00:15:39,674 I think only that that, you know, from 429 00:15:39,674 --> 00:15:41,134 the physician perspective, 430 00:15:41,514 --> 00:15:43,709 our physicians are so invested in in the 431 00:15:43,709 --> 00:15:45,629 care and recovery of their patients that they 432 00:15:45,629 --> 00:15:47,009 really need to have confidence, 433 00:15:47,709 --> 00:15:48,990 in those that are gonna take care of 434 00:15:48,990 --> 00:15:51,490 their patients after discharge from the hospital. So, 435 00:15:51,789 --> 00:15:53,809 you know, the the importance of partnerships, 436 00:15:54,429 --> 00:15:56,669 you know, really strong partnerships is is really 437 00:15:56,669 --> 00:15:57,870 that, you know, any way we can build 438 00:15:57,870 --> 00:16:00,745 bridges beyond our walls that touch and care 439 00:16:00,745 --> 00:16:01,644 for our patients, 440 00:16:02,105 --> 00:16:04,425 it can be really helpful to to find 441 00:16:04,425 --> 00:16:06,264 and address any gaps or concerns so our 442 00:16:06,264 --> 00:16:08,185 patients can get the care they need, and 443 00:16:08,185 --> 00:16:10,185 our doctors can get the feedback and follow 444 00:16:10,185 --> 00:16:12,105 through to know that someone that they've been 445 00:16:12,105 --> 00:16:13,865 so dedicated to caring for is on the 446 00:16:13,865 --> 00:16:15,829 right path in in their recovery. 447 00:16:16,209 --> 00:16:18,450 The best partnerships we have are truly focused 448 00:16:18,450 --> 00:16:21,429 on patients' needs, and they're attentive to those 449 00:16:21,490 --> 00:16:24,450 expert physician opinions and and those of other 450 00:16:24,450 --> 00:16:27,089 caregivers. And so, we really appreciate that. I 451 00:16:27,089 --> 00:16:29,355 think it's a really important piece of of 452 00:16:29,355 --> 00:16:30,095 this conversation 453 00:16:30,714 --> 00:16:32,475 is not just the existence of LTACs, but 454 00:16:32,475 --> 00:16:34,414 really how to establish a strong partnership 455 00:16:34,875 --> 00:16:36,794 with data sharing back and forth to make 456 00:16:36,794 --> 00:16:39,514 sure that we build that confidence and smooth 457 00:16:39,514 --> 00:16:40,894 those transitions of care. 458 00:16:41,730 --> 00:16:43,730 Well, it's been great to hear what those 459 00:16:43,730 --> 00:16:45,990 partnerships are looking like right now at Temple 460 00:16:46,129 --> 00:16:47,809 Doctor. Dell portal. So I wanna thank you 461 00:16:47,809 --> 00:16:49,809 again for for sharing all of your insights 462 00:16:49,809 --> 00:16:51,750 with our listeners and for this great conversation. 463 00:16:52,529 --> 00:16:54,370 Thanks again for having me. Great to join 464 00:16:54,370 --> 00:16:54,794 you. 465 00:16:55,274 --> 00:16:57,054 And we'd also like to thank our podcast 466 00:16:57,115 --> 00:16:59,134 sponsor for today, Scion Health. 467 00:16:59,595 --> 00:17:01,674 Listeners, be sure to tune into more podcasts 468 00:17:01,674 --> 00:17:04,315 from Becker's by visiting our podcast page at 469 00:17:04,315 --> 00:17:06,654 beckershospitalreview.com.