Spotty Track Record Found at Long-Term Care Hospitals

This is one of our editors' picks from our ongoing roundup of Investigations Elsewhere.

The New York Times is keeping hospitals in the hot seat: On the heels of its series on radiation errors comes an investigation into long-term care facilities. Such hospitals, designed to treat patients with chronic health problems, have proliferated in recent years, but the Times found that they operate with little scrutiny and have a spotty record of care.

Financial incentive, reports the Times, has driven this boom: Hospitals that treat patients for more than 25 days on average earn high Medicare payouts, whereas traditional hospitals often lose money on such patients. This year, the government is expected to spend about $4.8 billion on patients at long-term care hospitals, most of which are owned by for-profit companies.

Meanwhile, the Times reports, “Medicare has never closely examined their care. Unlike traditional hospitals, Medicare does not penalize them financially if they fail to submit quality data.”

When the Times dug into inspection records and lawsuits, it found “a troubling picture of the care” offered at such hospitals, and at those operated by one company in particular: Select Medical Corporation. For instance:

In 2007 and 2008, Select’s hospitals were cited at a rate almost four times that of regular hospitals for serious violations of Medicare rules, according to an analysis by The New York Times. Other long-term care hospitals were cited at a rate about twice that of regular hospitals.

Few long-term care facilities actually employ doctors on their staffs. But their proponents say that they fill a necessary gap anyway, treating “patients who are too sick for nursing homes but are not improving at traditional hospitals.” Select said that its hospitals always have doctors on call and that patients are seen by doctors at least once a day. “In 13 years of operating hospitals, we have a demonstrated record of regulatory compliance and quality patient care,” the company said in a statement. "Unfortunately, we cannot prevent our staff, as well trained as they are, from making mistakes on rare occasions.”