Viewpoint: Pharmacist's role in long-term acute care hospitals

February 20, 2006

Having worked as pharmacists at a long-term acute care hospital, we know that the concept of LTACH is widely misunderstood. Long-term acute care hospitals are not skilled-nursing facilities, acute rehab institutions, or short-term acute care hospitals. LTACHs offer different services from those of the other facilities, and clinical pharmacists who practice at LTACHs are required to have a high level of clinical and critical care skills.

Genesis of LTACHs

Many patients are admitted directly from a short-stay hospital intensive care unit to the LTACH and are either disabled by a medically complex condition or are technology-dependent, requiring continuous intensive treatment. LTACHs offer an extended continuum of care without limitations on age, diagnoses, or scope of services. The pharmacist must be able to address the urgent needs of patients while simultaneously planning for long-term goals.

CMS certifies LTACHs as long-term acute care hospitals. Therefore, the inpatient pharmacy must meet all applicable state regulations that define a hospital pharmacy and federal regulations that define conditions of participation for pharmaceutical services.

LTACHs can be accredited by either JCAHO or the Healthcare Facilities Accreditation Program. These two groups are recognized nationally by federal and state governments, managed care organizations, and insurance carriers. Accreditation by either organization is deemed to comply with CMS' published guidelines of Medicare conditions of participation for hospitals.

Payments to LTACHs are made in accordance with the rules established by the Tax, Equity, and Fiscal Responsibility Act of 1982. Currently all LTACH Medicare reimbursements are made under a new prospective payment system (PPS) and diagnosis-related group (DRG) system.

The 2005 reimbursement per-diem rate is approximately $65 for pharmacy services. The patient acuity can vary and may affect the drug therapy needs as well as the daily costs. In general, any patient on multiple high-cost antibiotics or parenteral nutrition will exceed the per-diem rate.

The pharmacist's role

When we practiced as LTACH clinical pharmacists, we were engaged in the following activities:

Pharmacists play a strategic role and consistently interface with an interdisciplinary patient care team to maximize and individualize pharmaceutical care as well as ensure quality treatment and patient satisfaction.

In sum, LTACHs provide a great opportunity for pharmacists to work in an acute care setting, while providing long-term care for patients. If you haven't had a chance to work in this environment, it's one we would highly recommend.

THE AUTHORS, who used to practice in a long-term acute care hospital, now serve as clinical pharmacy writers in Chicago.