Long-term acute-care hospitals face growing scrutiny

The Senate Finance Committee has launched an investigation into quality-of-care concerns at the nation's roughly 400 long-term acute-care (LTAC) hospitals. The committee oversees the Medicare program, which pays LTAC hospitals almost $5 billion a year (60 percent of the hospitals' total revenue).

Allegations of poor patient care, and even patient deaths, surfaced last month in an exposé by the New York Times. The Senate investigation centers on for-profit LTAC hospitals, and an early bull's-eye has already been painted on industry leader Select Medical Corp., a Mechanicsburg, Pa.-based provider that runs 89 LTAC hospitals.

In 2007 and 2008, Select's LTAC hospitals received four times more citations for serious Medicare violations than standard acute-care hospitals, according to the Times. Other LTAC hospitals were cited about twice as much as standard hospitals. The Times also documented several alleged incidents that spurred lawsuits against Select, including a case where nurses took 77 minutes to respond to a dying patient's heart alarm and a case where a patient received 10 times her prescribed insulin dose, fell into a coma and later died. The Times' unflattering portrait came just days before Select announced that income from operations grew 20.1 percent to $235.8 million for fiscal year 2009 ended Dec. 31.

On Monday, Sen. Max Baucus (D-Mont.), Finance Committee chairman, and Sen. Charles Grassley (R-Iowa), ranking member, sent a letter to Select CEO Robert Ortenzio asking the company to turn over records on staffing levels and quality of care at its LTAC hospitals. They are seeking information about the company's discharge policies, as well as its policies on patient monitoring, emergency situations and staffing, including physician involvement and staff turnover.

Select plans to cooperate with the inquiry, according to a company representative. The firm had previously rebutted the Times article as misleading.

Separately, Baucus and Grassley also asked the Government Accountability Office to review federal and state oversight of LTAC hospitals to ensure that patients aren't at "an unreasonable risk of harm."

For more:
- read the New York Times article
- read last month's exposé
- here's Select's statement
- check out Select's 2009 earnings release

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