LTACHs vs. SNFs: Key Differences in Patient Care & Recovery

Every referral decision impacts patient outcomes, hospital partnerships, and your facility’s bottom line. But when a hospital discharge coordinator sends a complex case your way, how do you determine whether a long-term acute care hospital (LTACH) or a skilled nursing facility (SNF) is the right fit?

The differences between these settings aren’t always obvious — but getting it wrong can mean denied reimbursements, longer hospital stays, or readmission risks.

In this article, we’ll break down:

• The key differences of LTACHs vs. SNFs

• How care models and patient needs dictate the best setting

• Cost, reimbursement, and regulatory considerations for both

Understanding LTACHs and SNFs

Long-term acute care isn’t one-size-fits-all. When a patient no longer needs hospital-level care but still requires medical support, they often transition to either a long-term acute care hospital (LTACH) or a skilled nursing facility (SNF).

These two settings serve different types of patients with distinct medical needs, but the differences aren’t always obvious at a glance.

Let’s break down what each setting offers and who they serve.

What is an LTACH?

A long-term acute care hospital (LTACH) is designed for patients who are critically ill but stable enough to leave a traditional hospital. These facilities provide hospital-level care for an extended period, often acting as a step-down option for patients who still need complex medical treatment.

Typical patient profiles

LTACHs typically admit patients who:

• Require prolonged ventilator support or respiratory therapy

• Have complex wounds that need intensive wound care

• Need daily physician oversight and specialized treatments

• Are recovering from severe infections, multi-organ failure, or other life-threatening conditions

Average length of stay

Unlike traditional hospitals, where patients stay for just a few days, LTACH patients typically remain for 25 days or longer. The goal is to stabilize patients and transition them to a lower level of care when they no longer need intensive medical support.

Purpose of stay

LTACHs focus on ongoing acute care, meaning they provide hospital-level treatment for extended periods. These facilities help patients recover from serious illnesses or injuries while reducing hospital readmissions.

What is an SNF?

A skilled nursing facility (SNF) provides short-term rehabilitative care and long-term nursing support for patients who don’t require hospital-level treatment but still need medical supervision.

Typical patient profiles

SNFs primarily admit patients who:

• Are recovering from surgery, strokes, or orthopedic injuries

• Need physical, occupational, or speech therapy to regain mobility and function

• Require ongoing medical monitoring for chronic conditions but not daily physician oversight

• Need assistance with daily living activities like bathing, dressing, and medication management

Average length of stay

SNF stays vary based on patient needs, but most short-term rehabilitation patients stay for 20-30 days, while long-term residents may remain indefinitely.

Purpose of stay

The main goal of an SNF stay is rehabilitation and recovery. Patients receive therapy and nursing care to help them regain independence and transition back home or to a lower level of care, such as assisted living.

For long-term residents, SNFs provide ongoing nursing care for chronic conditions and age-related health concerns.

Key differences between LTACHs and SNFs

Choosing between an LTACH and an SNF comes down to the level of care a patient needs. LTACHs function more like hospitals, providing extended acute care for medically complex patients, while SNFs focus on rehabilitation and long-term nursing care.

Here’s a quick comparison:

|       Feature       |                          LTACH                          |                            SNF                           |
|:-------------------:|:-------------------------------------------------------:|:--------------------------------------------------------:|
|      Care level     |   Hospital-level care, including ICU-level monitoring   |    Sub-acute care, focusing on rehab and daily support   |
|    Patient needs    |   Critically ill patients requiring ongoing acute care  |      Patients needing rehabilitation or nursing care     |
|    Length of stay   |                   25+ days on average                   |       20-30 days for rehab, long-term for residents      |
|       Staffing      | Daily physician visits, specialists, ICU-trained nurses |  Nurses, therapists, and aides with physician oversight  |
|    Reimbursement    |      Primarily Medicare Part A, DRG-based payments      |   Medicare, Medicaid, private insurance, per-diem rates  |
| Cost considerations |       Higher due to specialized care and equipment      | Lower, but varies based on care level and length of stay

When to choose an LTACH vs. an SNF

Choosing the right care setting depends on the patient’s medical needs, the intensity of treatment required, and reimbursement considerations. Here’s when each setting makes the most sense.

Scenarios for choosing an LTACH

LTACHs are best for patients who still need hospital-level care but no longer require a traditional hospital stay. These patients often have complex conditions that require intensive monitoring and specialized treatments. Consider an LTACH if the patient:

• Requires prolonged ventilator support: Patients dependent on a ventilator or needing respiratory therapy benefit from LTACHs’ critical care capabilities.
  
  

• Has complex medical conditions: Cases like multi-organ failure, severe infections, or post-surgical complications need daily physician oversight and ongoing hospital-level treatments.
  
  

• Needs ongoing intensive monitoring: Patients requiring frequent lab work, dialysis, or advanced wound care are better suited for LTACHs than SNFs.
  
  

• Has been discharged from the ICU but still requires acute care: LTACHs serve as a step-down option for critically ill patients who are stable but not ready for rehabilitation.

Scenarios for choosing an SNF

SNFs provide rehabilitation and nursing care for patients who need medical support but do not require hospital-level treatment. Consider an SNF if the patient:

• Is recovering from surgery or an illness: Many SNF patients need short-term rehab after hip replacements, strokes, or cardiac events before returning home.
  
  

• Requires therapy but not daily physician oversight: SNFs offer physical, occupational, and speech therapy, but they do not provide continuous acute medical care.
  
  

• Needs help with daily activities: Patients requiring assistance with mobility, dressing, medication management, or wound care but who don’t need intensive medical intervention are best suited for SNFs.
  
  

• Is a long-term care resident: Some patients stay in SNFs permanently due to chronic conditions like dementia, Parkinson’s, or advanced age-related illnesses.

Cost, reimbursement, and regulatory differences

Post-acute care facilities must balance patient needs with financial and regulatory realities. Understanding reimbursement models and compliance requirements helps avoid denied claims and operational inefficiencies.

LTACHs

• Higher costs: LTACHs provide advanced care, requiring specialized equipment, ICU-trained staff, and intensive monitoring, making them more expensive than SNFs.
  
  

• Medicare reimbursement: LTACHs primarily bill Medicare Part A under the Long-Term Care Hospital Prospective Payment System (LTCH PPS), which reimburses based on Diagnosis-Related Groups (DRGs) similar to hospitals.
  
  

• Reimbursement risks: Medicare and private insurers require strict medical necessity criteria for LTACH stays. Patients must typically have spent at least three days in a hospital and be transferred there directly from a hospital before qualifying for LTACH Medicare coverage.

SNFs

• Lower costs: SNFs operate on a more cost-effective model, but expenses vary based on staffing levels, therapy needs, and patient acuity.
  
  

• Medicare and Medicaid reimbursement: SNFs are reimbursed under Medicare’s Patient-Driven Payment Model (PDPM) and Medicaid for long-term residents. Payments are based on patient conditions rather than therapy volume.
  
  

• Billing and compliance risks: SNFs must document medical necessity, therapy use, and skilled nursing needs to avoid claim denials or reduced reimbursement.

Regulatory compliance

Both LTACHs and SNFs must meet federal and state regulations, but the requirements differ based on the level of care provided.

LTACHs

• Medicare length-of-stay requirement: LTACHs must maintain an average length of stay of 25+ days to qualify for their Medicare payment structure.
  
  

• Acute care compliance: LTACHs follow hospital-level regulations for infection control, staffing ratios, and emergency preparedness.
  
  

• Denial risks: Failure to justify medical necessity can result in denied claims and financial penalties.

SNFs

• CMS and state regulations: SNFs must meet federal and state licensing requirements, covering patient care, safety, and staffing.
  
  

• PDPM documentation requirements: Proper coding, therapy tracking, and care planning are critical for Medicare compliance.
  
  

• Routine audits and surveys: SNFs face regular inspections and compliance audits, with deficiencies leading to fines or reimbursement cuts.

How ExaCare supports LTACHs and SNFs

Managing admissions for an LTACH or SNF is a high-stakes process. Hospitals expect quick responses, administrators must balance clinical and financial considerations, and reimbursement depends on accurate documentation.

Delays, errors, or incomplete information can mean lost referrals, denied claims, or strained hospital relationships.

ExaCare streamlines this process using AI-powered tools that help facilities evaluate referrals faster, reduce administrative burdens, and improve decision-making.

Here’s how it supports both LTACHs and SNFs.

1. Faster, smarter admissions decisions

LTACH and SNF admissions teams often receive hundreds of pages of referral documents — sorting through them manually is time-consuming and prone to errors. ExaCare’s AI-driven screening extracts key clinical and financial details like medications, diagnoses, and insurance coverage, summarizing them into actionable insights.

This means faster referral decisions — critical when hospital discharge planners expect responses in under seven minutes.

2. Centralized referral management

Instead of juggling multiple referral portals (EPIC Link, etc.), ExaCare unifies all incoming referrals into one interface.

Staff can review and accept referrals directly within ExaCare, eliminating the need to switch between platforms. With all referral data in one place, facilities can track response times, referral sources, and denial reasons — helping them optimize their hospital relationships.

3. Financial and clinical decision support

LTACHs and SNFs must carefully evaluate whether they can take on a patient — not just clinically, but also financially. ExaCare flags high-cost medications, reimbursement risks, and potential gaps in coverage, helping facilities make informed acceptance decisions that align with their financial goals.

Built-in reimbursement estimates ensure that facilities are prepared for billing and revenue cycle challenges upfront.

4. Improved hospital collaboration

Hospitals prioritize fast, reliable post-acute partners — facilities that can respond quickly and take on complex cases efficiently. ExaCare helps streamline communication with hospital case managers and discharge planners, making it easier to secure referrals and strengthen partnerships.

5. Compliance and documentation support

Both LTACHs and SNFs must meet strict regulatory requirements to maintain reimbursements and avoid penalties.

ExaCare helps to ensure accurate, complete documentation for CMS audits, PDPM compliance (for SNFs), and LTACH admission criteria. Automated tools track staff training, documentation status, and reporting needs, reducing the risk of compliance issues.

Frequently asked questions

Which patients are best suited for LTACH care?

LTACHs are ideal for patients who are stable enough to leave a traditional hospital but still require hospital-level care for an extended period.

This includes individuals who need prolonged ventilator support, intensive wound care, daily physician oversight, or treatment for complex conditions like multi-organ failure or severe infections. Patients at high risk of readmission without continued acute care also benefit from LTACH placement.

Can an SNF handle ventilator-dependent patients?

Most SNFs are not equipped to manage ventilator-dependent patients long-term. While some specialized SNFs offer respiratory therapy, their primary goal is to wean patients off ventilators rather than provide ongoing support.

Patients who need continuous ventilator management, frequent respiratory interventions, or ICU-level monitoring are better suited for an LTACH or a dedicated ventilator care unit.

Are LTACHs more expensive than SNFs?

Yes, LTACHs are more expensive than SNFs because they provide hospital-level care, including daily physician involvement, ICU-trained staff, and advanced medical treatments. LTACHs are reimbursed under Medicare’s Long-Term Care Hospital Prospective Payment System (LTCH PPS), which is based on Diagnosis-Related Groups (DRGs), similar to hospital payments.

In contrast, SNFs follow Medicare’s Patient-Driven Payment Model (PDPM), which adjusts payments based on patient conditions and therapy needs. While LTACHs have higher costs, they are necessary for patients with ongoing acute medical needs who are not ready for step-down care in an SNF.

How long can a patient stay in an LTACH or an SNF?

The average length of stay in an LTACH is 25 days or more. Some patients stay longer, depending on their medical complexity and progress.

In an SNF, length of stay varies — short-term rehabilitation patients usually stay for 20 to 30 days, while long-term residents may remain indefinitely if they require ongoing skilled nursing care and qualify for Medicaid. The duration of care in both settings ultimately depends on medical necessity, insurance coverage, and the patient’s recovery trajectory.

Is your facility ready to manage referrals?

Winning referrals is one thing — processing them quickly and accurately is another. Many LTACHs and SNFs still juggle multiple referral platforms, manually sift through lengthy documents, and struggle to make timely decisions.

Slow response times can mean lost referrals, denied reimbursements, and strained hospital relationships.

ExaCare streamlines the admissions process, helping facilities review referrals faster, reduce manual work, and improve decision-making.

With AI-powered screening, centralized referral management, and automated financial insights, your team can focus on accepting the right patients — without the administrative headache.

Faster decisions mean more referrals, stronger hospital partnerships, and better financial outcomes. Schedule a demo today to see how ExaCare can help.

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