A hospital within a hospital

--------------------------------------------------------------------------------
By Peggy Kreimer
Post staff reporter

Northern Kentucky hospital patients who need longer care than their insurance will allow used to face going to specialty hospitals in Cincinnati or to nursing homes before they were medically ready.
That will change in December, when Cardinal Hill of Northern Kentucky opens Northern Kentucky's first long term acute care hospital on the third floor of St. Luke Hospital East in Fort Thomas.

The Cardinal Hill Specialty Hospital will be a 33-bed independent hospital owned and managed by Cardinal Hill, with its own doctors, nurses and staff. The new hospital will lease space and 20 acute care bed licenses from St. Luke, said Cardinal Hill director Cynthia Williams, who will direct the new hospital.

The specialty hospital will have its own ventilators and other equipment but will purchase lab, x-ray and other services from St. Luke. St. Luke doctors are expected to apply for medical privileges at the new hospital, which would allow doctors to continue treating patients who move out of St. Luke's acute care and into the new long-term acute care facility.

The average hospital stay is less than five days, said St. Luke Vice President Nancy Kremer. But patients with complex medical problems, brain or spinal injury, or chronic pulmonary needs can require extended intense care. Medicare and most private insurance cover that type of care, but it falls into a category that most hospitals do not fit, she said.

About five years ago, specialty hospitals within larger hospitals started opening across the country to offer that extended acute care. There are close to 270 long-term, acute care hospitals nationally now.

Federal regulations require a hospital within a hospital to have a separate governing body, administration and medical staff, so the hospital had to partner with another organization. In Cincinnati, Drake Center rehabilitation hospital runs the Drake Pavilion long-term acute care hospital within Christ Hospital. The national Select Medical Corp. operates the Select Specialty Hospital in Cincinnati's Good Samaritan Hospital.

Kremer said St. Luke started considering opening a long-term acute care hospital a year ago. Cardinal Hill, which has provided speech and hearing services to St. Luke for 12 years, was a perfect fit, Kremer said.

Cardinal Hill of Northern Kentucky is an arm of Cardinal Hill of Kentucky, the Easter Seal agency that specializes in rehabilitation and therapy programs for children and adults. The state organization runs Cardinal Hill Rehabilitation Hospital in Lexington, specializing in treating spinal cord injury, brain injury, stroke, multiple sclerosis and other disabling conditions.

Cardinal Hill of Northern Kentucky has specialized in speech and hearing therapy and adult day care for decades. It opened its Center for Rehabilitative Medicine outpatient rehabilitation hospital in Florence in 2000.

The average stay at a long term acute care hospitals is around 25 days, but patients could stay 90 days or longer, said Williams. "People stay until they are able to be released to a rehabilitation hospital or nursing home or back to their own home," she said.

Typical patients could include those with massive stroke, head injury or heart surgery with complications.

One of the benefits of a specialty hospital is the ability to couple rehabilitation therapy with medical services.

"To go to a rehabilitation hospital, you must be able to tolerate three hours of therapy a day," Williams said. People who have not made sufficient medical progress end up foregoing rehabilitation therapy until their medical condition improves. Long-term acute care hospitals can offer physical therapy in conjunction with intensive medical care. "When you're doing both at the same time, it's been proven people bounce back quicker," Williams said.

Typical needs would include care for lung diseases that could require ventilators; serious wound care including burns, ulcers, amputation and diseases involving tissue loss; brain and spinal injury; massive stroke; and complex medical problems that require more than routine care, including infectious disease, some cancers, congestive heart failure, HIV/AIDS and renal failure.

The Cardinal Hill Specialty Hospital will be open to the public. Patients won't have to receive care at St. Luke to move on to the Cardinal Hill hospital. But the two hospitals plan to synchronize their admissions processes to assure patients moving from St. Luke to Cardinal Hill will have an almost seamless transition, Kremer said.

The lease arrangement means St. Luke will have 305 acute care beds available rather than 338. "That won't present any hardship," Kremer said. She said the hospital has not had waiting lists for acute care beds, but it has had to deal with patients needing the beds for longer periods. "People who come to hospitals these days are coming in with more problems," she said.

She said hospitals must provide a continuum of care for patients, but that can cause difficulties when patients' insurance or other reimbursement plans do not match their needs.

The initial cost to equip the new hospital will be about $250,000, Williams said. Cardinal Hill of Kentucky is providing the start-up funds. Williams plans to start hiring staff next month, including a medical director and nursing director.


http://www.kypost.com/2003/08/26/cardin082603.html


Publication Date: 08-26-2003
Email this story to a friend