CHAPTER SIX analyzes evidence regarding the cost, quality, and effectiveness of subacute care. What is the effect of subacute care on the total cost of the episode of care? In part, this may be a function of the presence of more aggressive managed care arrangements in Los Angeles, compared to other market areas. A person’s functioning may relate to their whole body or a body part, the whole person, or the whole person in a social context, and to impairment of a body function or structure, activity limitation and/or participation restriction. Some providers may not mean to imply anything else by the use of the term than a reference to patients with somewhat higher care needs (both medical and rehabilitative) than the average. A career objective is used to clearly document the job target. Respondents raised questions about staffing qualifications, the role of managed care in HHAs, access issues for lower-income patients, the perception of a "no care zone" for patients with lower acuity, and the fact that Medicare reimbursement for home infusion therapy remains a barrier to appropriate home infusion therapy as compared to the provision of infusion in an SNF. The acceleration of interest in quality also has increased interest in the ability to compare outcomes within similar types of providers and across different types of settings. Estimates of the current annual volume of subacute care range from 1.2 million to 8.1 million patient days. Regulatory Barriers. In general, the ratio of RN time compared to LPN and CNA time is greater in subacute SNFs than among traditional nursing homes. In Oregon, common examples of QMHPs include: psychiatrist, mental health therapist, social worker, psychologist, psychiatric nurse-practitioners. The primary financial and organizational factors shaping the development of subacute care nationally include the efforts of managed care providers to find more cost-effective types of care, the implementation of new Medicare payment policies applicable to acute and post acute care providers, and changes in patient preferences. During recuperation, patients receive rehabilitation in a skilled nursing facility, where they stay overnight until therapy goals are met. Facility-based (institutional) subacute care providers, particularly skilled nursing facilities, have been a driving factor in the development of the subacute care phenomenon. Build Your Own Now . In the future, the growth of managed care might foster the development of more subacute care as managed care providers seek less costly alternatives to hospital acute care. For example, a hospital may provide high-quality acute care during a cardiac health crisis, but it might not be the best place for cardiac rehabilitation. The value of subacute nursing home care Case studies have shown that the costs of subacute nursing home care are significantly less than hospital or traditional rehabilitation centers. In the second study, rehabilitation patients treated in the subacute SNF had significantly higher death rates and emergency rehospitalizations than patients treated in the hospital when controlling for age. These traditional HHAs are said to receive substantial numbers of discharges from subacute facilities, but we were unable to verify this reported trend. This group of patients includes those with cardiovascular diagnoses, cancer, ventilator care, wounds, and IV therapy. Supervised and administered care to hospice patients with acute conditions and exacerbation of terminal illness requiring in-patient acute level care. The questionable assumptions concern length of stay and use, estimates of SNF costs, and bed availability. As is now widely understood, without some changes made to the current system, Medicare expenditures for post-acute care and for acute care are expected to rise substantially as both the number and proportion of persons over age 65 grows. Setting-specific barriers differentially affect the ability of providers to develop subacute programs. Nevertheless, it is our subjective conclusion that activity and apparent quantity of subacute care are greatest in Los Angeles, followed by Miami, Boston, and Columbus, in that order. In response to the growing potential for substitution of home health care for facility-based subacute care, many informants expressed additional quality concerns regarding HHAs. Medicare coverage and payment policies present barriers unique to provider type. The average length of stay (ALOS) varies among subacute patients. Subacute care; waiver from state and federal rules and regulations. Ideal subacute care encompasses a set of techniques thought essential to achieving stated goals. Supervised care team consisting of the RN (myself), an LPN and CNA's. However, long-term hospitals and rehabilitation hospitals have readmission rates that are similar to each other and appear somewhat lower than those of the SNFs. In long-term and rehabilitation hospitals, physician participation in patient care appeared to be slightly greater. Of the providers who do collect outcome data, the data measure most often used is limited to rehabilitation subacute and it does not adjust for medical severity. Some providers are successfully applying key elements of the subacute care concept in their programs. Ohio has recently changed its CON, and it is unclear what the impact will be on the development of subacute care. Although the new subacute care is evolving through both practice and debate, we believe that at the time of this writing (September, 1995) the core elements of this idealized, prototypical subacute care include those highlighted below. The development and use of accreditation standards are influencing the subacute care industry through the establishment of minimum standards and broadly defined quality guidelines. The lower number may be a reasonable estimate of subacute care in the first sense of "higher acuity" patients, but both figures substantially overcount the actual volume of subacute care under the second definition. Medicare is the dominant payor of subacute care. This section provides examples of the benefits of subacute care … This estimate excludes rehabilitation hospital and units, long-term hospitals and home health agencies from the definition of subacute care providers. Assistant Secretary for Planning and Evaluation, Room 415F, U.S. Department of Health & Human Services, National Council on Vital and Health Statistics, Behavioral Health, Disability, and Aging Policy, Patient-Centered Outcomes Research Trust Fund (PCORTF), Public Health Emergency Declaration – PRA Waivers, Social Determinants of Health and Medicare’s Value-Based Purchasing Programs. Examples of Subacute care in a sentence Sub-acute care lasts for a limited time or until a condition is stabilized or a predetermined treatment course is completed. Speech-language pathologists working in subacute units provide the same range of services seen in inpatient rehabilitation and skilled nursing facilities, including speech, language, cognitive-communication, and swallowing treatment. Subacute: Rather recent onset or somewhat rapid change. While all researchers face difficult challenges, we believe that in this case the difficulties we encountered both in finding subacute providers in reportedly better developed markets and in obtaining data on subacute patients are an important part of our findings. In our market area study, we did not visit different facilities owned by the same corporation. Hudson View has staff specifically trained in subacute care and an environment geared toward progress in rehabilitation. To this end, there is a critical need for carefully evaluated demonstrations designed to assess the likely impact of ideas related to increased use of subacute care. The four institutional provider types or "platforms" we studied were nursing facilities (freestanding and hospital-based), rehabilitation hospitals, distinct-part rehabilitation units, and long-term hospitals. For example, the American Health Care Association includes "efficient and effective utilization of health care resources" in its short definition of subacute care. SERVICES, SETTINGS, AND PROVIDERS A. Accreditation is likely to be of growing importance in the development of subacute care, but current standards appear to allow a wide range of quality and services under the "accredited" stamp of approval. If the person cannot tolerate this much therapy or no longer requires therapy at this intensive a level, they may be better served at the subacute level. For example, in Los Angeles, the lack of CON requirements has encouraged the development of subacute care. In addition, publicly-traded growth companies need to continue to grow profits to maintain their stock prices.. WHAT DO PEOPLE MEAN WHEN THEY REFER TO SUBACUTE CARE? To a large extent, these are the same patients who in the not-very-distant past, were called "Medicare high-end skilled," or simply, "heavy care skilled" patients. Finally, public and private payors determined to reduce health care spending should ideally know the likely impact of specific changes before they are implemented. The development and use of outcomes measures are influencing the market for subacute services by becoming an increasingly important component of subacute care programs. Despite the recognized importance of greater involvement of better-trained staff (especially physicians and nurses) to the new subacute care concept and product, we found among the freestanding SNFs we visited (with a few notable exceptions): Little physician involvement beyond that required by existing Medicare/ Medicaid certification standards. We believe that we were privileged to see examples of facilities in this segment that are indeed striving to and in many ways achieving many of the goals of the new subacute care movement. Examples include charting and scheduling. 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