NALTHNews

NALTH wishes to acknowledge our members this Holiday Season -wishing you, your hospitals and your families the best for the Holiday Season and New Year. For the past several months NALTH has been diligently working on your behalf. We have been introducing our organization to the new CMS leadership. We havebeen visiting MedPAC’s new team, the new team at CMS (both inAcute Care and also in Managed Medicare), and members of both the House Committee on Ways and Means plus the SenateCommittee on Finance. We also have been meeting and contacting

many of our legislators.

This Fall, we had our NA LTH Member’s Leadership Conference in Phoenix, Arizona. Wehad a panel discussion regarding the Pathway for SGR Reform Act with keynote speakers: Al Dobson of Dobson & Devazzo and Lane Koenig, KNG Consulting and NALTH’s Directorof Policy. Both have done extensive research on post -acute care, including LTCH’s and reimbursement. Dr. Dobson shared with the group that when the LTCH Criteria was published by CMS, that Wall Street responded by increasing the financial value of LTCH’s.Discussion was also held regarding Bundling, ACO’s, medical homes etc.

My personal “take away” is that acute, long term care hospitals will have to show value for the care they provide and realize that they will be competing against other post-acutecare providers for the same patient in the future. Developing referral patterns, including incontracts and being a recognized part of the continuum care in your region is very beneficialand should be your 2015 focus. Dr. Dobson also said he believed that most LTCH’s will“make it” into the future as a care provider, but will have to show that they are the bestprovider for complex patients and be prepared to demonstrate measureable patient outcome data.

As we approach 2015, please join NALTH by being a strong participant and advocate for LTCHs. We will need everyone’s support in our efforts to get wound care cases and complex Multi-System Failure patients included as appropriate for LTCH reimbursement. We will need legislative action to achieve this important outcome and it has to come fromthe members. You have your Board, Lane Koenig and Jon Sheiner available to guide you.Please let us know you will be beside us as we move forward with our goal to get the LTCHcriteria revised to include a few more classifications of LTCH appropriate cases.

Please mark your calendars for our Annual Meeting in Washington, DC and our Fall Leadership Forum in San Antonio. Your attendance is very important to us so that we can work as a team to get things accomplished for our members.

My best to all of you for this new upcoming year.

Cherri Burzynski, MSN, RN, BC-NENALTH PresidentMcLaren-Bay Special Care, President

THIS ISSUE...President’s Message..................................1

Advocacy.......................................................... 2

Research Summary .................................. 3

Policy & Research ...................................... 4

Leadership & Committees ...................... 6

Annual Meeting ............................................ 7

Registration Form ...................................... 8

Call for Submissions .................................. 9

NALTH encourages the submission of articles for publication. For more

information, please contact

Association Resources, NALTH’s Administrator

342 North Main Street, Suite 301West Hartford, CT 06117-2507

860.586.7579info@nalth.org

CALENDARNALTH 2015 Annual MeetingThursday, April 30 – Friday, May 1, 2015The Dupont Circle HotelWashington, DCThe Hotel reservation deadline is Friday, April 3, 2015.

NALTH Goldberg Innovation AwardNALTH Quality Achievement AwardSubmit call for submissions to: kira.carter@sparrowspecialty.org

Question & Answer Information CallTuesday, February 3, 2015 1pm EasternAwards - Question & Answer Information:Call 800-832-0736 | Code = 1177922(press *, enter code 1177922, then press #)

Award Submission DeadlineTuesday March 10, 2015 by 5pm ET

PRESIDENT’S MESSAGE

www.nalth.org Winter 2015

Copyright ©2015 by NALTH. ALL RIGHTS RESERVED. No part of this document may be reproduced in any form without prior written

permission from an Officer or the General Counsel of NALTH.

2NATIONAL ASSOCIATION OF LONG TERM HOSPITALS WINTER 2015 Copyright ©2015 by NALTH. ALL RIGHTS RESERVED.

ADVOCACY

Legislative Action Alert

NALTH Members,

Many NALTH members are confronted with a serious financialand operating threat. It is the loss of LTCH level reimbursementfor wound cases that are not coincident with a previous threeday stay in an ICU or 72 hours of ventilator care. For someNALTH members it is an existential threat.

To resolve this threat is a great political and legislative challenge.How can NALTH members influence Congress to reinstateLTCH level reimbursement for wound cases?

Because of the passage of the Pathway for SGR reform in December 2013, in a rather rushed and truncated process theopportunity to substantively review Congressional product andexpress politically the need for changes was denied.

The failure to include wound cases among the cases reimbursedat the LTCH level has left a potential gaping hole in the abilityof LTCHs to effectively care for a significant segment of patients.NALTH members know that these are patients with severe anddifficult wounds that do not quickly or easily heal. These arewounds that need special and long term care to achieve effective results.

The best opportunity for changing the current law to allowLTCH level reimbursement for wound cases will come in Marchduring the effort to extend the SGR relief or finally pass a longterm solution.

NALTH has developed a proposal that the Board believes is equitable and justified both medically and fiscally:

NALTH Legislative Proposal(December 10, 2014)

1. PAYMENT FOR LONG-TERM CARE HOSPITAL SERVICES

a. The Secretary of Health and Human Services shall not apply, for cost reporting periods prior to October 1, 2017, 42 U.S.C. 1395ww(m)(6) to a long-term care hospital (LTCH), as identified by the amendment made by section 4417(a) of the Balanced Budget Act of 1997 (Public Law 105-33), for severe wound cases that meet one of the following criteria:

A. Patient is discharged from a subsection(d) hospital to an LTCH, and

a. Has a diagnosis of non-healing surgical wound, infected wound, wound with morbid obesity, fistula, osteomyelitis, stage 3 or stage 4 wound, or unstageable wound as coded in LTCH, and

b. Has one of the following:

i. Patient has at least 1 major system organ failure (lung, liver, kidney, or heart) as coded in immediately prior STCH stay, or

ii. Patient receives an excisional debridement or TPN in the LTCH.

B. Patient is discharged from a grandfathered LTCH, as described in the Pathway for SGR Reform Act, and has either non-healing surgical wound, infected wound, wound with morbid obesity, fistula, osteomyelitis, stage 3 or stage 4 wound, or unstageable wound as coded in LTCH.

2. STUDY AND REPORT

a. The Secretary of the Department of Health and Human Services shall, in consultation with stakeholders, conduct an investigation and issue a report to Congress no later than October 1, 2016, which identifies the treatment needs and associated cost of treating severe wound cases in rural and urban markets. The report will include an assessment of access to appropriate levels of care for these cases, the potential impact of 42 U.S.C. 1295ww(m)(6) on access, quality and the cost of care for Medicare beneficiaries requiring specialized wound care, and recommendations for paying for their care in the Medicare program.

If this attempt to amend the Medicare title is to be successful, it will need a great deal of political support to overcome the reluctance to amend the law at possibly a significant cost to the Medicare trust fund.

You are urged to contact your Members of Congress. Youshould consider:

• Writing or Emailing their offices. (Emailing or attaching a letter by email is better because of the increased security over mailed items;

• Calling the Member or their legislative staff responsible for health issues;

• Asking for a meeting with the Member either in Washington or at home. We can help with Washington meetings; and

• Inviting the Member to your hospital.

Thank you for your support of NALTH.

3NATIONAL ASSOCIATION OF LONG TERM HOSPITALS WINTER 2015

POLICY & RESEARCH

Copyright ©2015 by NALTH. ALL RIGHTS RESERVED.

Caring for Medicare Patients with Severe Wounds: The Comparative Effectiveness of LTCHs

By Lane Koenig, PhD

In the Pathway for SGR Reform Act of 2013, Congress establishedcriteria for a case to receive full payment under the long term carehospital (LTCH) prospective payment system (PPS). Under thenew criteria, an LTCH will receive full payment for the case if thepatient spent 3 or more days in an intensive or cardiac care unit(ICU/CCU) at an acute care hospital paid under the Medicare inpatient prospective payment system immediately prior to admission to the LTCH or if the patient received mechanical ventilation of 96 or more hours during the LTCH stay. Roughly53% of LTCH cases in 2013 would have met these new criteria.Once the criteria are fully implemented in 2018, Medicare pay-ments for non-qualifying cases (47% of cases in 2013) would fall by over 50 percent.

NALTH members identified the omission of severe wound cases from the long-term care hospital criteria established by the Pathway for SGR Reform Act of 2013 as a key area of concern. Many wound cases do not require stays in an intensive or cardiac care units, or prolonged mechanical ventilation. Amongthe approximately 47,000 LTCH discharges with a stage III or IVpressure ulcer, osteomyelitis, infected wound or non-healing surgical wound, 57% would not qualify for full payment using the new criteria.

NALTH commissioned KNG Health to assist in developing criteria to identify severe wound cases that could be incorporatedinto the current LTCH criteria. To do this, we first defined LTCH-appropriate severe wound cases. We then examined resource use,outlier status, and margins for these cases. Finally, we estimatedthe effects of receiving LTCH care on patient mortality, hospitalreadmissions, and Medicare payments.

Severe Wound Definition

Using the NALTH wound admission criteria as a basis, restrictingthe criteria to factors observable in claims, and incorporating positive findings with respect to LTCH care for patients with multiple organ failure, we defined severe wound cases as follows:

1. A patient must have one of the following: Non-healing surgical wound, infected wound, wound with morbid obesity, fistula, osteomyelitis, stage III, stage IV or unstageable pressure ulcer; AND

2. a patient must have one of the following: a major system organ failure (lung, liver, kidney, or heart), excisional debridement, or total parenteral nutrition.

Characteristics of Severe Wound Cases

Using data from 2013, we found that the average length of stay is about 5 days longer for severe wound cases compared to othercases in both LCTHs (30 vs. 25 days) and short term acute carehospitals (10 vs. 5 days). From a financial perspective, patientswith severe wounds differ significantly from other cases treated in short term acute hospitals and LTCHs. The analysis showed that severe wound cases were almost 3 times more likely to be ahigh-cost outlier as other cases in short term acute care hospitals (9 % vs. 3 %), and 1.5 times more likely to be a high-cost outlier in LTCHs (20 % vs. 13%). In addition, margins are lower for severe wound cases in both settings. In acute care hospitals, average margins for a severe wound case are -11.6 percent, which is almost twice the average margin for other acute care hospital cases. In LTCHs, margins for severe wound cases aver-aged -1.5 percent, which is 3.6 percentage points lower than theaverage margin for other cases. These finding suggest a discrep-ancy between resource utilization rates and higher costs relative to Medicare payments among the severe wounds population captured by our definition.

Comparative Effectiveness

We then assessed the effects of receiving care in an LTCH for severe wound patients immediately following discharge from ashort term acute care hospital as compared to receiving care insome other setting following discharge over a 180-day episode ofcare. The analysis found that receiving care for severe wounds inan LTCH as compared to other settings leads to:

• Lower mortality in 9 out of 11 condition categories studied.

• Lower probability of hospital readmissions in all condition categories studied.

• Lower or similar Medicare payments in 8 of the 11 condition categories.

The study findings indicate that our definition of severe wound patients identifies a population with higher resource utilization and higher cost relative to payments compared to cases not meeting our definition. In addition, the study demonstrates thatLTCH care is more effective compared to other settings in terms of lower mortality and hospital readmissions for most of the condition categories studied.

NALTH will be advocating for changes to the LTCH criteria early in 2015. NALTH is seeking a two-year reprieve from the Pathway for SGR Reform, for the Department of Health andHuman Services to conduct a study to assess the effects of the new LTCH criteria on access to appropriate levels of care for severe wound cases, and for the development of appropriate payment policies for this population of Medicare beneficiaries.

4NATIONAL ASSOCIATION OF LONG TERM HOSPITALS WINTER 2015

POLICY & RESEARCH

Copyright ©2015 by NALTH. ALL RIGHTS RESERVED.

...continued on page 5

Medicare Advantage Plans’ Exclusion of Long Term Care HospitalsBy Rochelle H. Zapol, NALTH General Counsel

Approximately thirty per cent of Medicare beneficiaries enroll in Medicare Advantage (MA) plans. In September the Centersfor Medicare & Medicaid Services (CMS) reported that MA enrollment was at an all-time high and projected that it wouldcontinue to increase.

This past spring NALTH conducted a survey of its members related to their experience with MA plans. A significant percentof NALTH member hospitals reported serious problems withMA Plans, specifically, that a large number of MA plans (1) have a pattern and practice of excluding long-term care hospitals (LTCHs) from their provider networks and (2) issue a high number of denials of admissions to LTCHs. NALTH identified the following issues which need to be addressed byCMS to ensure that LTCHs are able to provide services to beneficiaries enrolled in MA plans:

Issues Identified by NALTH

1. MA plans have refused to contract with LTCHs or to allow LTCHs to participate in their MA provider networks.

2. The exclusion of LTCHs from MA contracts deprives Medicare beneficiaries who have elected MA plans the opportunity to access the same services that are covered under Medicare Parts A and B.

3. By systematically excluding LTCHs from their networks MA plans discriminate against the special medical needs of the disabled, elderly populations suffering from chronic diseases that are served by LTCHs.

4. The website s of some MA plans are deceptive and misleading to beneficiaries and their families. For example, United Healthcare’s website states its MA plans “cover all the benefits of Medical Part A, including hospital stays, skilled nursing care and home health care, but not hospice care (which is still covered by your Part A benefit).” A beneficiary or a member of his/her family would have no way of knowing that in many States, United Healthcare does not contract with LTCHs and that, consequently, coverage is not provided for LTCH services.

5. A MA private fee for service plan is required to permit enrollees freedom of choice to obtain services from any provider that is authorized to provide services under Medicare Parts A and B and agrees to provide services under the terms of the plan. Therefore, even if an LTCH is not part of a MA private fee for service plan network, a beneficiary should be allowed to obtain services from the LTCH provided the LTCH agrees to provide services under the terms of the plan.

6. The MA statute and regulations contain providerantidiscrimination provisions which prohibit a MA organization from discriminating against a provider with regard to participation, if the provider is acting within the scope of its license or certification under applicable State law, “solely on the basis of such license or certification.” See Section 1852(b)(2) of the Social Security Act and 42 C.F.R. § 422.205(a). Many MA plans are arbitrarily excluding LTCHs from their providernetworks solely on the basis of their certification as LTCHs under Section 1886(d)(1)(B)(iv) of the Social Security Act.

7. A MA plan is required to comply with general coverage guidelines in original Medicare manuals and instructions unless they are superseded by MA regulations or related instructions. A number of MA plans apply criteria, which are inconsistent with general Medicare coverage guidelines, to deny approval for admission to LTCHs. For example:

a. In Ohio, United Healthcare refuses to pre-certify admissions to LTCHs, and Anthem Senior Care will not allow the admission of a ventilator dependent patient unless the patient has been hospitalized for at least 21 days in a short-term acute care hospital prior to the admission.

b. In Georgia, AARP Medicare, Care Improvement Plus, Humana Gold Choice, Secure Horizons, UHC, and Wellcare will not allow the admission of a ventilator dependent patient unless the patient has been hospitalized for at least 21 days in a short-term acute care hospital prior to the admission, has been on a traecheostomy for at least 7 days, and has failed at least 2 ventilator weaning attempts.

c. In South Carolina, Humana Gold Choice and Care Improvement deny almost 100 percent of the requests for admission to LTCHs. They also require that a ventilator patient be hospitalized in a short-term acute care hospital for at least 21 days prior to the patient’s admission to an LTCH.

8. There are no criteria in Medicare manuals and instructions or MA regulations which require that a ventilator patient be hospitalized for at least 21 days in a short-term acute care hospital for an admission to an LTCH to be medically necessary. The fact that such criteria are not consistent with general coverage guidelines and instructions for the Medicare program

5NATIONAL ASSOCIATION OF LONG TERM HOSPITALS WINTER 2015 Copyright ©2015 by NALTH. ALL RIGHTS RESERVED.

Medicare Advantage Plans’ Exclusion of Long Term Care Hospitals...continued from page 4

is further evidenced by the fact that Congress recently adopted ventilator criterion for LTCHs effective for discharges in cost reporting periods beginning on or after October 1, 2015. The ventilator criterion adopted by Congress does not require a 21 day stay in a short-term acute care hospital prior to the admission to an LTCH or that the patient has failed at least 2 or 3 ventilator weaning attempts.

9. A number of MA plans refuse to authorize or fail to timely respond to requests to authorize admissions to LTCHs. For example:

a. In Ohio, United Healthcare refuses to pre-certify admissions to LTCHs.

b. In Washington, Group Health Cooperative Med Advantage is not timely in its response to short-term acute care hospitals’ requests for authorizations to admit patients to LTCHs, while United Med Advantage is extremely slow in processing authorizations for admissions to LTCHs which are not in its network.

10. Sending the patient’s clinical record to a MA plan for review is futile as it invariably results in a denial. Pursuing the administrative appeals process is also futile.

A physician to physician discussion between the LTCH physician and the MA physician invariably results in a denial.

NALTH Meeting with Representatives of the Medicare Advantage Program

During the summer, NALTH wrote a letter to the Director of the Medicare Advantage program at CMS detailing the above issues, citing legal authority to support NALTH’s position, and requesting that CMS conduct an investigation to ensure thatMedicare beneficiaries who elect MA Plans are afforded access to LTCH services. In early October, NALTH received a letter fromCMS stating that it would be investigating the issues raised byNALTH and that, “if necessary,” it would “provide guidance toMA plans to insure that enrollees have access to LTCH servicesconsistent with the requirements to cover all medically necessaryPart A and Part B services.”

On October 22, 2014, NALTH representatives met with the Acting Director of the Medicare Drug & Health Plan Contract Administration Group and other CMS representatives in Baltimore to discuss NALTH’s concerns regarding MA. CMS representatives again stated that CMS would conduct an investigation. NALTH intends to continue to pursue these issues and will keep members informed of its progress.

Recent Regulatory Developments

There have been a number of recent regulatory developments af-fecting the Medicare program that may be of interest to NALTHmember hospitals, including:

1. Proposed Rule on Changes to the Medicare Shared Savings Program for Accountable Care Organizations

2. Final Rule on the Hospital Outpatient Prospective Payment System for CY 2015

3. Final Rule Implementing Medicare Provider Enrollment Requirements

4. Centers for Medicare and Medicaid Services (CMS) Transmittal Requiring MACs to Support their Medical Review Decisions through the ALJ Level of Appeal

5. CMS Letter Issued to State Survey Agencies on EMTALA Requirements and Ebola

These developments are discussed in a NALTH Advisory datedDecember 11, 2014.

POLICY & RESEARCH

6NATIONAL ASSOCIATION OF LONG TERM HOSPITALS WINTER 2015 Copyright ©2015 by NALTH. ALL RIGHTS RESERVED.

LEADERSHIP & COMMITTEES

Elizabeth (Libby) Mitchell, MSNThe Specialty Hospital of Meridian, Meridian, Mississippilibby.mitchell@rushhealth.com

Linda O’Neil, RN, BSN, BC, MSHCAHospital for Extended Recovery, Norfolk, Virginialboneil@sentara.com

Jim PristerRML Specialty Hospital, Hinsdale, Illinoisjprister@rmlsh.org

Kay BowlingCentra Specialty HospitalLynchburg, VA

Kira Carter-Robertson, MHA, FACHESparrow Specialty Hospital, Lansing, Michigankira.carter@sparrowspecialty.org

Margaret Crane, MSNBarlow Respiratory Hospital, Los Angeles, Californiamcrane@barlow2000.org

Paul Dongilli, Jr., PhD, FACHE, Immediate Past President Madonna Rehabilitation Hospital, Lincoln, Nebraskapdongilli@madonna.org

Troy Felix, MSNA, BSRN, RRT, WCCDubuis Health SystemBeaumont, Texas

Eddie HowardEast Texas Specialty Hospital, Tyler, Texasehoward@etmc.org

Lawrence Hotes, MD, FACE, FACPNew England Sinai Hospital, Stoughton, Massachusettslhotes@nesinai.org

Denise KannErnest Health, Albuquerque, New Mexicodenisekann@ernesthealth.com

Arthur Maples, MSEBaptist Memorial Restorative Care Hospital, Memphis, Tennesseearthur.maples@bmhcc.org

DIRECTORS

GENERAL COUNSEL

Rochelle H. ZapolPrince Lobel Tye LLPBoston, MA617 456-8036rzapol@PrinceLobel.com

DIRECTOR - POLICY & RESEARCH

Lane Koenig, PhDKNG Health ConsultingRockville, MD240 403-0154lane.koenig@knghealth.com

LEGISLATIVE CONSULTANT

Jon Sheiner703 298-3138jon.sheiner@verizon.net

ADMINISTRATIVE DIRECTOR

Ryan Drydenrdryden@nalth.org

MEETING PLANNER

Valerie Sandbachvsandbach@nalth.org

ADMINISTRATIVE ASSISTANT

Catriona Horstmannchorstmann@nalth.org

OFFICERS

Cheryl (Cherri) Burzynski, MSN, RN, NE-BC, PresidentMcLaren Bay Special Care Hospital, Bay City, Michigancheryl.burzynski@mclaren.org

John Votto, DO, Vice PresidentHospital for Special Care, New Britain, Connecticut jvotto@hfsc.org

James Blanton, TreasurerEast Texas Specialty Hospital, Tyler, Texas

NALTH BOARD OF DIRECTORS

PROFESSIONAL STAFF

LEADERSHIP & COMMITTEES

7NATIONAL ASSOCIATION OF LONG TERM HOSPITALS WINTER 2015 Copyright ©2015 by NALTH. ALL RIGHTS RESERVED.

NALTH COMMITTEES & WORKGROUPS

COMMUNICATIONS & INNOVATIONS COMMITTEEArthur Maples, MSE (Chair), Cherri Burzynski, MSN, RN, NE-BC,Troy Felix, MSNA, BSRN, RRT, WCC, Libby Mitchell

EDUCATION COMMITTEEPaul Dongilli, Jr., PhD, FACHE (Chair), Pam Bell, James Blanton, Kay Bowling, Kira Carte Robertson, MHA FACHE, MSN, Margaret Crane, MSN, Arthur Maples, MSE, Linda O’Neil, RN, BSN, BCMS, HCA

FINANCIAL OVERSIGHT COMMITTEE James Blanton (Chair), Eddie Howard, Jim Prister

MEMBERSHIP COMMITTEELibby Mitchell (Chair), Kay Bowling

NALTH CRITERIA REVIEW COMMITTEEJohn Votto, DO (Chair)

NOMINATING AND BYLAWS COMMITTEEJim Prister (Chair), Kira Carter-Robertson, MHA, FACHE, Eddie Howard

RESEARCH & QUALITY COMMITTEEMargaret Crane MSN & Larry Hotes MD FACE FACP (Co-Chairs), Pam Bell RN, BSN, MBA, Dottie Leighton APRN,Troy Felix MSNA, BSRN, RRT, WCC, Cynthia Miller BSN, RN,CWOCN, Libby Mitchell MSN, Linda O'Neil RN, BSN, BC,MSHCA, Cynthia Tew MSN John Votto, DO

WORKGROUPS

CFO Policy Analysis WorkgroupPolicy & Advocacy Advisory WorkgroupCommittees – Expanded Lists

KEYNOTE SESSIONS • The ACO and Bundling Primer:

Preparing for Payment & Delivery System Change Allen Dobson, PhD — President, Dobson | DaVanzo and Associates

• Wound Care in LTCHs – Clinical Innovations, Documentation,Payment Indication, & Policy Implications

Other current session topics include:• The Evolving Role of LTCHs in the US Continuum of Care• Policy and Advocacy Update• MedPAC Recommendations• Award Presentations: Goldberg Innovation Award & Quality

Achievement Award (Call for submissions coming soon)• The New Business of LTCHs: Strategies for Managed Care,

Increasing Volume while Identifying Appropriate Cases, and Showing Value

• Changing Post Acute Payment Policies• Networking Reception

(with poster presentations)Program is subject to change.

Plan now to attend the NALTH Annual Meeting in order to put long term care policy challenges and solutions into perspective. Leaders and experts will highlight industry changes and effects on hospitals, systems and patients.

SAVE THE

DATE!

NALTH 2015 ANNUAL MEETING

The LTCH Evolution: Critical Part of the Continuum of Care

Long Term Care Hospital (LTCH) Policy and Clinical Update

Thursday, April 30–Friday, May 1, 2015

The Dupont Circle Hotel Washington, DC

www.NALTH.org

Who should attend:

n LTCH Leaders including CEOs/Administrators, Financial Officers, Directors of Quality, Directors of Utilization Review, & others

n Clinical Staff & Case Managers

NALTH - the National Association of Long Term Hospitals – is the premier association representing long term acute care hospitals and associated professional staff committed to advancing the health, well-being and quality of care for medically complex patients who require prolonged hospital stays. Included in the care are specialized programs to achieve medical stability and maximum function.

Hotel InformationThe Dupont Circle Hotel, 1500 New Hampshire Ave NW, Was hington, DC 20036

The Dupont Circle Hotel has a special NALTH room rate of $269 per night,single/double occupancy, plus applicable taxes. The reservation deadline is Friday, April 3, 2015.

Reserve your room online at www.doylecollection.com/dupontcircle. Type in your Room Block Code “NALTH2015” under “More Options.” Or call the hotel directly at 202-483-6000 and reference the NALTH 2015 Annual Meeting.

Note: Only those registered for the meeting or special guest recognized by NALTH will be eligible for hotel rooms at the special meeting rate.

For sponsorship and exhibit opportunities, please contact:Telephone: 860.586.7579 | Email: info@nalth.org | 342 North Main Street | Suite 301 | West Hartford, CT 06117-2507

REGISTRATION FORMInstructions1. Use a separate form for each registration. Payment must accompany each

registration. Registrations will not be confirmed until payment is received.2. Three ways to register:

a. Register and pay securely online with a credit card at www.NALTH.orgb. Fax the form using a credit card to 860.586.7550

c. Mail the form with a check or credit card information to Association Resources, NALTH’s Administrator, 342 North Main St., Suite 301, West Hartford CT 06117-2507.

3. Confirmations are only sent via email (within 2 weeks of receipt) – pleaseinclude a valid email address.

4. For more information or questions, please call 860.586.7579 or emailinfo@nalth.org.

Use a separate form for each individual’s registration.

First Name: ____________________________________ Last Name: ________________________ Designation: __________________

Badge Name: __________________________________________________________________________________________________

Title:__________________________________ Hospitals/System/Organization: ______________________________________________

Mailing Address:________________________________________________________________________________________________

City: __________________________________________ State:__________________________ Zip Code: ____________________

Phone: ______________________ Fax: ______________________ Email (required for confirmation):______________________________

Emergency Contact: __________________________________________ Emergency Contact Phone: ______________________________

r Please check here and describe below any special accommodations you need to participate fully in this conference. NALTH fully complies with thelegal requirements of the ADA, and the rules and regulations thereof.

______________________________________________________________________________________________

Registration FeesFees include meeting sessions, continental breakfast (Thursday and Friday), lunch (Thursday) and reception (Thursday).

Early Registration ends February 20, 2015 Standard Registration: February 21-April 20, 2015Member r $400 r $500Nonmember (Includes Allied Industry/Non Profit) r $800 r $1,000State Association Representative r $225 r $225

Hotel InformationThe Dupont Circle Hotel, Washington, DC

Special NALTH room rate of $269 per night, single/double occupancy, plus applicable taxes. The reservation deadline is Friday, April 3, 2015.

Reserve your room online at www.doylecollection.com/dupontcircle. Type in your Room Block Code “NALTH2015” under “More Options.” Or call the hotel directly at 202-483-6000 and reference the NALTH 2015 Annual Meeting.

PaymentAll fees must be paid in full before registration can be confirmed. Registration is only confirmed by e-mail.r Check enclosed payable to NALTH. Amount $ ______________________

Credit Card Information: r VISA r MasterCard r American Express

Card Number:_______________________________________________________ Security Code:_______ Exp. Date: ________________

Name on Card: __________________________________________ Signature: ____________________________________________

Billing Address: _______________________________________________________________________________________________

Cancellation PolicyAll cancellations up to Monday April 6, 2015 at 11:59pm ET will be subject to a $50 cancellation fee. All cancellations from April 7 through April 24 are subject to a50% cancellation fee. There will be no refunds after April 24, 2015. All cancellations must be received in writing (email notice accepted).

NALTH • Association Resources, NALTH’s Administrator • 342 North Main Street, Suite 301 • West Hartford, CT 06117-2507Fax: 860.586.7550; Phone: 860.586.7579; E-mail: info@nalth.org

NALTH 2015 ANNUAL MEETINGThe LTCH Evolution: Being a Critical Part of the Continuum of Care

April 30–May 1, 2015The Dupont Circle Hotel n Washington, DC

9NATIONAL ASSOCIATION OF LONG TERM HOSPITALS WINTER 2015 Copyright ©2015 by NALTH. ALL RIGHTS RESERVED.

GOLDBERG INNOVATION AWARD & QUALITY ACHIEVEMENT AWARDPresented in conjunction with

NALTH 2015 Annual MeetingThe LTCH Evolution: Critical Part of the Continuum of Care

Thursday, April 30 – Friday, May 1, 2015The Dupont Circle Hotel - Washington, DC

Submission Deadline: Tuesday, March 10, 2015 by 5pm EasternSubmissions to: Kira.Carter@SparrowSpecialty.org

Chair of Awards Subcommittee: Kira Carter-Robertson, Sparrow Specialty Hospital, Lansing, MIQuestion & Answer Informational Call, Tuesday, February 3, 2015 at 1pm Eastern 800-832-0736 Code = 1177922 (press *, code 1177922, then press#)

NALTH GOLDBERG INNOVATION AWARDThe AwardThe Goldberg Innovation Award shall be given in recognition of an innovative process or technology that supports long term acute care hospitals. The overarching principle in the review process is Innovation in anLTACH setting.EligibilityAll employees and professional staff associated with NALTH member facilities in good standing are eligible tosubmit entries.CriteriaThe overarching principle in the review process is innovation. The following criteria will be used to assess thecompleteness of each award submission and how fully each award submission meets the expected qualities of an innovation. You may find it helpful to refer to the following criteria when preparing your submission:

1. Identify an innovative process or technology that was undertaken by your facility with exceptional results.

2. The process or technology is considered innovative if it is not commonly found in LTAC hospital operations. It could be a system or process or technology commonly used in a different level of care or different industry but is not common in LTACs.

3. The submission could benefit quality of patient care and/or operational efficiencies.4. The submission clearly describes the innovation implemented.5. The measurement indicators are clearly defined and are appropriate for this type of program or

process – and the measurement indicators demonstrate that the innovation was successful and yielded the desired result.

6. The financial indicators are clearly defined and are appropriate for this type of program or process – and the financial indicators demonstrate that the innovation was successful and yielded the desired financial result. If the innovation generated a net cost (rather than savings), then the net cost was acceptable to the facility given other favorable results of the innovation.

7. Resources required to implement the innovation were such that other hospitals would be able to duplicate the innovation.

8. The submission clearly describes how this innovation provides value under Prospective Payment System (PPS).

Submission GuidelinesAll submissions must adhere to the following guidelines or they will not be accepted. The review panel will haveno affiliation to any of the submissions.Submissions must be:

1. Single-spaced, left justified, using 12 point font size with 1” margins.2. No more than three 8 ½ x 11” text pages EXCLUDING the Submission Form, graphs and charts.

Graphs and Charts depicting data are highly encouraged and will not be counted in the overall 3 page maximum.

3. Should be copyrighted. If you have questions about copyright, please contact NALTH.4. Displayed as a poster during the NALTH Annual Meeting if award is received. Award recipients will

be recognized during the NALTH Annual Meeting and two authors will receive complimentary meeting registrations. Runners up may also be invited to display a poster. NALTH Annual Meeting;

May 1 – 2, 2014; The Dupont Circle Hotel; Washington, DCSubmission FormatSubmissions must be formatted with sections as follows:SECTION 1: Cover SheetThis must be a separate page – make this the first page of your submission and do not include any other sections on this page. Begin Section 2 on your page 2.Include the following information on the Cover Sheet:

1. Award Submission Type: GOLDBERG INNOVATION AWARD2. Name of facility3. Submission title4. Primary contact – name, email and phone number5. Names of individuals contributing to the submission

SECTION 2: Description of the Program or ProcessInclude a clear and concise description of the innovative process or technology that you implemented. Describethe setting specifically and include the rationale for pursuing the innovation. The process or technology is considered innovative if it is not commonly found in LTAC hospital operations. It could be a system or process or technology commonly used in a different level of care or different industry but is not common in LTACs.SECTION 3: UniquenessDescribe why the program or technology is so unique and why it should be considered to be an innovation.SECTION 4: Measurement IndicatorsWhat criteria did you use to measure the effectiveness of your innovation? Clearly define what is included in the measurement. Clearly state pre- and post- innovation measurements.SECTION 5: Financial ImpactInclude financial impacts of the innovation. What was the cost of implementation as well as the cost/benefits following the implementation? This would include the cost of any new equipment or technology, the training of staff, etc.SECTION 6: Lessons LearnedInclude in this section what your facility learned from the process. Highlight any suggestions or future initiativesyou may make following this experience.

NALTH QUALITY ACHIEVEMENT AWARDThe AwardThe Quality Award shall be given in recognition of a process or technology that supports and achieves a higherlevel of quality in long term acute care hospitals. The overarching principle in the review process is qualityachievement in an LTACH setting.EligibilityAll employees and professional staff associated with NALTH member facilities in good standing are eligible tosubmit entries.CriteriaThe overarching principle in the review process is quality achievement. The following criteria will be used to assess the completeness of each award submission and how fully each award submission meets the expectedqualities of a successful performance improvement (PI) initiative. You may find it helpful to refer to the followingcriteria when preparing your submission:

1. Identify a PI initiative that was undertaken by your facility with exceptional quality results.2. The submission should benefit quality of patient care and may also improve operational efficiencies.3. The submission clearly describes the PI initiative implemented.4. The measurement indicators are clearly defined and are appropriate for this type of program or

process – and the measurement indicators demonstrate that the PI initiative was successful and yielded the desired result.

5. The financial indicators are clearly defined and are appropriate for this type of program or process – and the financial indicators demonstrate that the PI initiative was successful and yielded the desired financial result. If the PI initiative generated a net cost (rather than savings), then the net cost was acceptable to the facility given other favorable results of the PI initiative.

6. Resources required to implement the PI initiative innovation were such that other hospitals would be able to duplicate the innovation.

Submission GuidelinesAll submissions must adhere to the following guidelines or they will not be accepted. The review panel will haveno affiliation to any of the submissions.Submissions must be:

1. Single-spaced, left justified, using 12 point font size with 1” margins.2. No more than three 8 ½ x 11” text pages EXCLUDING the Submission Form, graphs and charts.

Graphs and Charts depicting data are highly encouraged and will not be counted in the overall3 page maximum.

3. Should be copyrighted. If you have questions about copyright, please contact NALTH.4. Displayed as a poster during the NALTH Annual Meeting if award is received. Award recipients will

be recognized during the NALTH Education Conference and two authors will receive complimentary meeting registrations. Runners up may also be invited to display a poster.

Submission FormatSubmissions must be formatted with sections as follows:SECTION 1: Cover SheetThis must be a separate page – make this the first page of your submission and do not include any othersections on this page. Begin Section 2 on your page 2..Include the following information on the Cover Sheet:

1. Award Submission Type: QUALITY ACHIEVEMENT AWARD2. Name of facility3. Submission title4. Primary contact – name, email and phone number5. Names of individuals contributing to the submission

SECTION 2: Description of the Performance Improvement (PI) InitiativeInclude a clear and concise description of the PI Initiative that you implemented. Describe the setting specificallyand include the rationale for pursuing the PI Initiative. Be sure to provide a high level overview of all specializedmaterials and general procedures so that methods can be utilized in another facility to produce similar results.SECTION 3: Results and Measurement IndicatorsWhat criteria did you use to measure the effectiveness of your PI initiative? Clearly define what is included in the measurement. Clearly state pre- and post- initiative measurements. The measurement indicators shoulddemonstrate that the PI initiative was successful and yielded improvements in quality outcomes.SECTION 4: Financial ImpactInclude financial impacts of the PI initiative. What was the cost of implementation as well as the cost/benefits following the implementation? This would include the cost of any new equipment or technology, the training of staff, etc.SECTION 5: Lessons LearnedInclude in this section what your facility learned from the process. Highlight any suggestions or future initiativesyou may make following this experience.

2015 CALL FOR SUBMISSIONS

Submission Deadline: Tuesday, March 10, 2015 by 5pm EasternSubmissions to: Kira.Carter@SparrowSpecialty.org

Chair of Awards Subcommittee: Kira Carter-Robertson, Sparrow Specialty Hospital, Lansing, MIQuestion & Answer Informational Call - Tuesday, February 3, 2015 at 1pm Eastern

800-832-0736 Code = 1177922 (* then code then #)

10NATIONAL ASSOCIATION OF LONG TERM HOSPITALS WINTER 2015 Copyright ©2015 by NALTH. ALL RIGHTS RESERVED.

NALTH: ADVOCATING FOR LONG TERM CARE HOSPITALS For the past 25 years, the NationalAssociation of Long Term Hospitals(NALTH) has been at the forefront ofpolicy and healthcare qualitydiscussions related to the long termcare hospital (LTCH) industry. Withrecent legislative changes and anincreased focus on value, LTCHs mustadapt to the evolving healthcareenvironment and demonstrate theirrole in the continuum of care.

As the only national associationadvocating exclusively on behalf ofLTCHs, NALTH is engaged on manyfronts to support its members. Theseefforts range from effectivelycommunicating the value of LTCHservices to policy makers, payers andto advocating for sensible regulationsrecognizing the important servicesLTCHs provide to the most critically

complex patients. NALTH has alsoestablished a committee on qualityand research to focus on issues usingempirical research to drive soundpolicy decision making, such asdetermining appropriate criteria forwound cases requiring LTCH care.

In addition, NALTH, whose membersinclude both for profit and not forprofit LTCHs, will continue to be avital resource to its members in thecoming years. NALTH provides arange of services, includingdeveloping resources to help informmembers of legislative proposals andregulatory issues, conductinghospital specific financial impactanalyses, and organizing educationalconferences for clinicians and hospitalleaders.

RESEARCH AND RESOURCES

As a member driven organization,NALTH has been responsive tomembers’ needs with respect toadvocacy, education, and research. Inparticular, NALTH has:

Assessed the impact of thePathway for SGR Reform Act andprovided detailed impact analysisto members.

Designed a Payment Calculator toassist members in determiningfuture payments under thePathway for SGR Reform Act.

Demonstrated LTCH valuethrough a study on outcomes,utilization, and payments forMedicare beneficiaries in LTCHs.The study shows that, for certaintypes of patients, LTCH careresults in savings to the Medicareprogram, as well as improved

outcomes in the form of lowermortality and reducedreadmission rates (2013 14).

Created tools to assist membersin navigating the 25 PercentThreshold Rule and LTCH qualitymeasure submission andreporting deadlines.

Commissioned the onlycomprehensive, multi site studyof ventilator weaning outcomesin LTCHs, with results publishedin Chest, The Cardiopulmonaryand Critical Care Journal (2007).

Developed and refined LTCHinpatient medical necessityscreening criteria for admission,continued stay, and dischargethat are utilized by LTCHs acrossthe nation.

WWW.NALTH.ORG | INFO@NALTH.ORG

RECENT LEGISLATIVE

ACHIEVEMENTS

Successfully advocated for certainprovisions in the Pathway for SGRReform Act, including: The exclusion of Medicare

Advantage cases and those notmeeting the new LTCH criteriafrom the 25 day average lengthof stay requirement for existingLTCHs.

For grandfathered LTCHs,permanent exclusion from the25 Percent Threshold Rule.

Moving Congress away fromthe more stringent CMS orMedPAC proposed criteria

Other recent legislativeachievements include: Extension of the partial relief

from the 25 Percent ThresholdRule provided under theMedicare, Medicaid, and SCHIPExtension Act of 2007, asamended by the AmericanRecovery and Reinvestment Actof 2009 and the PatientProtection and Affordable CareAct of 2010.

JOIN US! To continue its work on behalf of theLTCH industry, NALTH depends on itsmembers. Join the only associationdedicated exclusively to representingLTCHs in improving care and ensuringcontinued access to our hospitals.

NALTH is pleased to thank our valued Partners and Supporters:

RevenueCycle

EMR

Financial

Mobile

Insight

HCS is focused on providing tailored solutionsfor long-term acute care hospitals, such as ourintegrated platform of clinical, financial and embedded CARE Data Set modules.

Clinical. Financial. Integrated.

Proud NALTH Advocate Partner

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11NATIONAL ASSOCIATION OF LONG TERM HOSPITALS WINTER 2015 Copyright ©2015 by NALTH. ALL RIGHTS RESERVED.

NALTH is pleased to thank our valued Partners and Supporters:

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LTRAX has the largest database of LTCH CARE data, patient satisfaction with HCAHPS, and pre-admission screenings. LTRAX reports have real-time comparisons with over 300 LTACHs.

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Please contact us at qualityhospitals@jointcommission.org for a free resource guide for LTACH hospitals and/or a copy of the new Patient Safety Systems Chapter.

12 Copyright ©2015 by NALTH. ALL RIGHTS RESERVED.NATIONAL ASSOCIATION OF LONG TERM HOSPITALS WINTER 2015

13NATIONAL ASSOCIATION OF LONG TERM HOSPITALS WINTER 2015 Copyright ©2015 by NALTH. ALL RIGHTS RESERVED.