OIG: 46% of Medicare Patients in LTACs Experience Harm

Almost half of Medicare patients experience either adverse events or temporary harm events inside the walls of a long-term care hospital (LTCH) according to a November report from the Department of Health and Human Services (HHS).

The Office of Inspector General (OIG) found that 21% of Medicare patients in LTCHs — also known as long-term acute care hospitals, or LTACs — experienced adverse events, defined as particularly serious instances of patient harm that result from medical care. An additional 25% of patients experienced temporary harm events, which are defined as patient harm that was not lasting but required medical intervention.

The resulting percentage of patients in LTCHs who experienced either sort of harm — at 46% — is higher than the percentage the OIG found in hospitals at 27%, skilled nursing facilities at 33% or rehabilitation hospitals at 29%.


The OIG also found that of the adverse and temporary harm events, 54% were preventable; 58% of preventable harm events were related to substandard care, while 34% were related to medical errors.

The OIG recommended that the Centers for Medicare & Medicaid Services (CMS) and Agency for Healthcare Research and Quality (AHRQ) collaborate to build and distribute a list of potential harm events in LTCHs; it also recommended CMS include information on patient harm in its outreach to LTCHs.

LTCHs have come under fire over the course of the last year, particularly when stacked against SNFs. A working paper from the National Bureau of Economic Research found that replacing LTCHs with SNFs, or paying them the same way SNFs receive reimbursements, could save the government $4.6 billion.


Despite this, a February study in JAMA Internal Medicine found that regional factors, rather than patient characteristics, play into about half the variation in LTCH use. In other words, patients who could receive care in a SNF end up being sent to an LTCH instead.

Capturing residents who might otherwise go to LTCHs could present an opportunity for SNFs, particularly since they can take care of those patients’ needs just as well for less money, Steven Littlehale, executive vice president and chief clinical officer at PointRight Inc., argued at the National Investment Center for Seniors Housing & Care (NIC) fall conference earlier this year.

“Skilled nursing is going to come out as the biggest, cheapest game in town,” he predicted at the event.

His remarks echoed those of Sabra Health Care REIT (Nasdaq: SBRA) CEO Rick Matros at NIC’s Spring Investment Forum in Dallas earlier this year, where he described LTCHs as a fading asset class.

“The skilled nursing facility isn’t a nursing home,” he said at the forum. “It’s more of a step-down unit from an acute care hospital.”

Written by Maggie Flynn

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