Where Do Hospitalized Elders Go When They're Too Sick to Go Home?

Long-term acute care hospitals (LTACs) are the fastest growing segment of postacute care in the U.S. For example, an otherwise-stable respiratory patient who requires prolonged ventilator weaning would be an appropriate admission to an LTAC. Given their higher intensity of care (e.g., stepdown capability and higher nurse-to-patient ratios), LTACs are reimbursed at a several-fold higher rate than are skilled nursing facilities (SNFs) for equivalent diagnoses. Understanding what factors contribute to transferring patients to LTACs as opposed to SNFs has important policy implications for payer networks.

Researchers performed an observational cohort study of more than 65,000 Medicare patients from 2010 to 2012. Notable differences between LTAC a…