Rules Redevelopment Illinois Health Facilities Planning Board 1 “Long-Term (Acute) Care...

Illinois Health Facilities Planning Board

1

Rules Redevelopment

“Long-Term (Acute) Care Hospitals”

Follow-up Meeting

Open Meeting on Rules Redevelopment


April 23, 2007

James R.Thompson CenterConference Room 039, 9th Floor

160 West Randolph StreetChicago, Illinois

Teleconference:Illinois Department of Public Health

2nd Floor Conference Room525 West. Jefferson Street

Springfield, Illinois


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Rules Redevelopment

Rules Process

Open Meetings/Public Participation-Input Draft Rules Reviewed and Approved by Board Submission to JCAR Publication in the Illinois Register Formal Public Hearings and Comment Period Reconsideration by the Board Consideration and approval by JCAR


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Rules Redevelopment

Meeting Protocols

Comments/Discussion Limited to Current Topic

All Interested Parties Invited to Participate

Written Comments Requested Time Limitations - As Required Check with website

http://www.idph.state.il.us/about/hfpb/hfpbrules.htm


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Rules Redevelopment

Statutory Authority Health Facilities Planning Act - 2004:

Purpose of the Act Establish a procedure designed to reverse the trends of

increasing costs of health care resulting from unnecessary construction or modification of health care facilities.

Improve the financial ability of the public to obtain necessary health services.

Establish an orderly and comprehensive health care delivery system which will guarantee the availability of quality health care to the general public.

The Procedure Requires a person establishing, constructing or modifying a

health care facility to have the qualifications, background, character and financial resources to adequately provide a proper service for the community,

Promotes orderly and economic development of health care facilities that avoids unnecessary duplication of such services.

Promotes planning for and the development of health care facilities needed for comprehensive health care, especially in areas where the health planning process has identified needs.

Carries out these purposes in coordination with the Agency and the comprehensive State health plan developed by that Agency.


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Rules Redevelopment

Meeting Objectives

Review characteristics and utilization statistics of Long-Term (Acute) Care Hospitals in Illinois.

Discuss working draft of proposed LTCH rules.

Definition Planning Policies Category of Service Review

The discussion will be limited to the topic identified.


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Rules Redevelopment

LTCHs in Illinois (Beds by Category of Service)Facility City HSA MS ICU AMI Subacute Total

Kindred-Sycamore Sycamore I 69 69

Regency Hospital Rockford I 44 44

Kindred – Springfield Springfield

III 44 6 50

Kindred-Central Chicago VI 107 7 114

Kindred-Lakeshore Chicago VI 103 103

Kindred-North Chicago VI 126 8 48 182

Advocate Bethany Chicago VI 81 6 87

Kindred-Northlake Northlake VII 94 94

RML Specialty Hospital Hinsdale VII 174 174

Holy Family Med. Ctr. DesPlaines

VII 220 18 238

Total 959 45 48 103 1,155

(1) Regency Hospital Rockford received permit September 12, 2006.

(2) Kindred Hospital Springfield received permit August 4, 2005.

(3) Holy Family received permit to discontinue OB November 1, 2005.

(4) Advocate Bethany received permit to discontinue OB and AMI September 12, 2006.


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Rules Redevelopment

Hospital Discharges (by DRG) to LTCHDRG Code DRG Description

2005 Total Illinois Cases

Cases Discharged

to LTCH

# of DRGs Discharged to LTCH/Total

Discharged to LTCH

430 PSYCHOSES (See Notes p. 10) 85,711 984 17.5%

542TRACH W MV 96+HRS OR PDX EXC FACE MTH&NECK DX W/O M OR 1,993 621 11.0%

541TRACH W MV 96+HRS OR PDX EXC FACE MTH&NECK DX W/MAJ OR 2,176 438 7.8%

416 SEPTICEMIA AGE >17 20,804 268 4.8%

475RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT 9,813 214 3.8%

415O.R. PROCEDURE FOR INFECTIOUS & PARASITIC DISEASES 4,841 150 2.7%

296NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W CC 19,454 123 2.2%

089 SIMPLE PNEUMONIA & PLEURISY AGE >17 W CC 40,992 114 2.0%

320 KIDNEY & URINARY TRACT INFECTIONS AGE >17 W CC 16,323 111 2.0%

127 HEART FAILURE & SHOCK 46,935 97 1.7%

188OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W CC 8,609 91 1.6%

088 CHRONIC OBSTRUCTIVE PULMONARY DISEASE 28,823 76 1.4%

144 OTHER CIRCULATORY SYSTEM DIAGNOSES W CC 9,137 71 1.3%

079RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W CC 10,162 69 1.2%

024 SEIZURE & HEADACHE AGE >17 W CC 8,329 68 1.2%

271 SKIN ULCERS 1,969 68 1.2%

174 G.I. HEMORRHAGE W CC 17,979 67 1.2%

263SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR CELLULITIS W CC 1,983 58 1.0%

462 REHABILITATION 25,671 55 1.0%


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Rules Redevelopment

Hospital Discharges (by DRG) to LTCH

DRG Code DRG Description


Cases Discharged

to LTCH


Discharged to LTCH

182ESOPHAGITIS GASTRO & MISC DIGEST DISORDERS AGE >17 W CC 30,062 53 0.9%

316 RENAL FAILURE 14,459 46 0.8%

180 G.I. OBSTRUCTION W CC 7,256 45 0.8%

217 WND DEBRID & SKN GRFT EXCEPT HAND FOR MUSC & CONN TISS 1,991 42 0.7%

277 CELLULITIS AGE >17 W CC 12,489 41 0.7%

076 OTHER RESP SYSTEM O.R. PROCEDURES W CC 3,736 40 0.7%

395 RED BLOOD CELL DISORDERS AGE >17 13,382 40 0.7%

014INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION 20,814 39 0.7%

143 CHEST PAIN 34,330 36 0.6%

130 PERIPHERAL VASCULAR DISORDERS W CC 8,111 35 0.6%

148 MAJOR SMALL & LARGE BOWEL PROCEDURES W CC 10,954 35 0.6%

294 DIABETES AGE >35 10,966 35 0.6%

012 DEGENERATIVE NERVOUS SYSTEM DISORDERS 5,658 34 0.6%

295 DIABETES AGE 0-35 3,997 34 0.6%

113AMPUTATION FOR CIRC SYSTEM DISR EXCEPT UPPER LIMB & TOE 1,776 30 0.5%

331OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE >17 W CC 4,682 29 0.5%

468 EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DX 4,282 29 0.5%


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Rules Redevelopment

Hospital Discharges (by DRG) to LTCH

DRG Code DRG Description


Cases Discharged

to LTCH


Discharged to LTCH

478 OTHER VASCULAR PROCEDURES W CC 5,584 28 0.5%

489 HIV W MAJOR RELATED CONDITION 2,360 26 0.5%

120OTHER CIRCULATORY SYSTEM O.R. PROCEDURES 1,989 23 0.4%

477 NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRIN DX 2,864 23 0.4%

ALL OTHER DRGs 1,157,319 1,135 20.2%

TOTAL 1,720,765 5,621 100.0%

Notes:

Kindred North has 48 AMI beds; therefore, a high volume of cases ( DRG 430 Pyschoses) are discharged to this LTCH .

Total Illinois Cases – all hospitals in Illinois with the exclusion of LTCH facilities.

Utilization statistics for Kindred-Lakeshore were not included. This facility is a sub-acute care facility and is considered a remote facility of Kindred-Central.

Source: Illinois Discharge Dataset


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Rules Redevelopment

LTCH 2005 Utilization 2005 Utilization Discharge Status

Hospital City CasesPatient Days ALOS Home

Home Health SNF Rehb

Other Acute LTCH Exp. Other

Kindred Hospital Central Chicago 483 14,358 29.7 2.3% 13.9% 42.2% 3.3% 17.2% 0.4% 18.8% 1.9%

Kindred Hospital North Chicago 2,044 45,165 22.1 15.6% 1.5% 56.7% 2.7% 13.2% 0.0% 10.0% 0.3%

Kindred Hospital Northlake Northlake 605 20,891 34.5 4.1% 6.3% 35.7% 4.5% 28.3% 1.0% 19.5% 0.7%

Kindred Hospital Sycamore Sycamore 480 15,729 32.8 5.8% 10.4% 37.7% 9.0% 16.0% 0.2% 19.8% 1.0%

RML Specialty Hospital Hinsdale 656 25,786 39.3 1.4% 13.3% 31.3% 17.8% 19.1% 0.2% 11.4% 5.6%

Total 4,268 121,929 28.6 9.2% 6.4% 46.0% 6.1% 17.0% 0.2% 13.7% 1.5%

Note:

Kindred Lakeshore is considered a subacute facility; therefore, utilization information is not available.

Source: Illinois Discharge Dataset (Calendar Year 2005)


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Rules Redevelopment

CMS Proposed Rule for LTCHs 2008

Extension of the threshold to freestanding LTCHs proposed.

LTCHs cannot accept more than 25% of its patients from a single hospital.

50% threshold for rural hospitals. Propose LTCH PPS Federal rate be updated

by 0.71 percent to $38,356 for Medicare discharges.

Changes to short-stay outliers and high-cost outlier threshold.


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Rules Redevelopment

LTCH Definition - Draft

“Long-Term (Acute) Care Hospital” means a category of service provided in a Medicare-certified acute care hospital with an average Medicare length of inpatient stay greater than 25 days that is primarily engaged in providing long-term medical care to patients who are clinically complex and may suffer multiple acute or chronic conditions. Services typically include respiratory therapy, head trauma treatment, and pain management.


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Rules Redevelopment

LTCH Planning Policies - Draft

Planning Areas HSA 1 HSAs 2 and 10 HSAs 3 and 4 HSAs 5 and 11 HSAs 6, 7, 8 and

9


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Rules Redevelopment


Planning Area Beds

HSA 1 (Kindred Sycamore, Regency Hospital Rockford)

113

HSAs 2 and 10 (None) 0

HSAs 3 and 4 (Kindred Springfield) 50

HSAs 5 and 11 (None) 0

HSAs 6, 7, 8 and 9 (Kindred – Central, North, Lakeshore, Northlake and Sycamore, RML Specialty Hospital, Holy Family Medical Center and Advocate Bethany)

992


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Rules Redevelopment


Accessibility One hour travel time

Occupancy Target 85%

Need Determination Minimum Use Rate – 60% of State Experienced Use Rate – Base Year Apply Minimum or Experienced, whichever is

higher Population projections


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Rules Redevelopment


Authorized Bed Capacity

No Long-Term (Acute) Care Hospital category of service shall be established without approval by the HFPB. Beds in long-term (acute) care hospitals certified by CMS, shall be reclassified by the HFPB in its inventory.


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Rules Redevelopment

LTCH Category of Service Review - Draft Facility Size

An applicant must document that the project will result in a facility capacity of at least 50 Long-Term (Acute) Care beds.

Continuity of Care An applicant proposing to establish a Long-Term (Acute) Care

Hospital category of service shall provide a signed, written transfer agreement with an acute care hospital. Documentation shall consist of copies of all such agreements.

Conversion of Existing Acute Care Beds Address Section 1110.130 for discontinuation of categories of

service. Identify modifications in scope of services or elimination of clinical

service areas, not covered in Section 1110.130 (e.g. Emergency Department classification, Surgical Services, Outpatient Services, etc.).

Document that changes in clinical service areas will not have an adverse impact upon the health care delivery system.


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Rules Redevelopment

LTCH Category of Service Review - Draft

Assurances Achieve occupancy target by second year of

operation; Certify intent to be Medicare-classified as a long-

term (acute) care hospital within twelve (12) months from the date of project completion; and

Certify that the proposed facility will meet all requirements of the Illinois Hospital Licensing Act.

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