HOSPITAL WITHIN A HOSPITAL’

Long-Term Acute Care Addressed By CareOne

(Reprinted from Amboy Beacon, Feb. 9, 2011)

PERTH AMBOY — It has been called “a hospital within a hospital,” but it is

more than that.

Operating on the second-floor of Raritan Bay Medical Center’s Perth Amboy

Division, New Brunswick Avenue, the CareOne LTACH (Long-Term Acute Care

Hospital) is part of Raritan Bay physically but totally-separate

administratively, right down to having its own housekeeping staff.

It also has been called “the wave of the future.”

“Our specialty is critical patients whose stay is longer than 20 days,

especially those who’ve been put on a ventilator,” CareOne Business Development

Manager Michael Fancher explained. “The average hospital stay is four days.

After a regular hospital stay of 15 days, a hospital loses money. It costs

$5,000-a-day to keep someone in an ICU (Intensive Care Unit) in New Jersey,

and as much as $8,500-a-day in New York City.”

Using economies-of-scale, a LTACH is able to bring those costs down

dramatically, although Fancher had no “average” number because each case is

so-different.

“We’re paid under a different scale under Medicare or Medicaid,” he said.

“The average stay here is 25 days, and we have 26 beds total.”

There are 160 credentialed doctors from about a half-dozen hospitals

affiliated with CareOne at Raritan Bay. “We provide an opportunity for

pulmonologists to practice pulmonology,” he said.

Each nurse at CareOne has special certification, and is not part of the

RBMC staff. The only service that CareOne contracts-with Raritan Bay is food

service.

“Every nurse carries a caseload of five acute patients, not nine as is

common in the normal hospital setting,” Fancher said. “The average subacute

caseload can be as high as 15 to 17 patients.”

The CareOne LTACH at Raritan Bay is the first one to open in the area, and

most of its patients are not from Raritan Bay, but from Robert Wood Johnson

University Hospital in New Brunswick.

A regional LTACH facility, CareOne at Raritan Bay receives between 300 and

400 referrals each year, according to CEO Michael Burns.

“We help area hospitals reduce their average Medicare length-of-stay,” he

said. “There are 400 facilities like ours across the country, and they’ve

been-around since the 1970s.

“New Jersey has seven, and we started in 2003,” Burns noted. “We’re all

still here, the original people.”

Many of the patients at CareOne were longtime smokers or have had chronic

pneumonia.

“They’ve been put on a ventilator, and our job is to wean them off of it,”

Fancher said. “Patients who have suffered a stroke, were in a car accident

or had extensive surgery are sent to us from other hospitals to do this.

“When they wake-up, especially if they’re elderly, they can’t get-off the

ventilator,” he explained. “It’s common to have a 30-day stay. We have

someone who’s been here for 100 days, and they’re starting to make-progress.”

Patients at the CareOne LTACH at Raritan Bay are on ventilators

24-hours-a-day, seven-days-a-week, and “wean-trials” are conducted frequently. A

normal hospital has one respiratory team to handle all of its patients on

ventilators, and attempts to wean them off ventilators are infrequent.

CareOne patients range from Age 19 to 93. Some of them suffer from COPD

(Chronic Obstructive Pulmonary Disease), which presents special problems of its

own.

But Fancher said the CareOne staff accepts all challenges. “We believe that

we can wean anyone off a ventilator, but some just take-longer than

others,” he said.

“Our patients belong in a hospital, not in rehab,” Fancher said. “Our

hospital is specifically-built for this.”

When they leave the CareOne LTACH at Raritan Bay, patients are discharged

to their homes, subacute hospitals or nursing homes “as far-away as Moscow.”

“Patients on ventilators have a 27-percent death-rate nationally,” Burns

noted. “It’s nine-percent here.”