Discussion Topic- Subacute care

CHAPTER FIVE: SUBACUTE AND POSTACUTE CARE

CHAPTER HIGHLIGHTS

What is Postacute Care?

· Services to patients needing additional support to assist them to recuperate following discharge from an acute hospital.

What is Subacute Care?

· Comprehensive, cost-effective inpatient level of care for patients who have had an acute event.

What is the Difference between Postacute Care and Subacute Care?

Subacute Care Post-Acute Care

- May be either after or in place of acute care - Is after acute care

- Provides in-patient services - Provides outpatient services

- Provides medical and nursing care - Provides nursing and/or

non-medical care

Postacute Care

· Provided by:

· Inpatient Rehabilitation Facilities

· Long-Term Care Hospitals (LTCH)

· Skilled Nursing Facilities

· Home Health Agencies

· Use of Postacute Care

· About one-third of hospital patients go on to use postacute care. The most common, single, postacute care destination for beneficiaries discharged from acute inpatient care hospitals is a skilled nursing facility.

· Medicare Conditions of Participation - providers must meet different conditions of participation

· Bundled Payments - Like other Medicare-certified providers, post-acute care providers will be impacted by CMS’s Bundled Payments for Care Improvement initiative.

· Readmissions - The Affordable Care Act of 2010 (ACA) reduces payments to hospitals for greater than expected readmissions, decreasing payments for all Medicare discharges in the prior year.

Subacute Care

How did Subacute Care come to be?

· It is one of the fastest growing segments of the health care delivery system.

· Result of pressures to be cost-effective, increased demand for consumer choice, and competition between providers.

Defining Subacute Care

· Comprehensive inpatient care designed for someone who has an acute illness, injury, or exacerbation of a disease process.

· Goal oriented treatment rendered immediately after, or instead of, acute hospitalization to treat one or more specific active complex medical conditions or to administer one or more technically complex treatments.

Philosophy of Care

· Specific care rendered for very specific reasons (conditions or treatments)

Ownership of Subacute Care Units

· Often provided by existing hospitals or free-standing nursing facilities.

Services Provided

· May include:

· Rehabilitation

· Physical and Occupational Therapy

· Respiratory Therapy

· Cardiac Rehabilitation

· Speech Therapy

· Postsurgical Care

· Chemotherapy

· Total Parenteral Nutrition

· Dialysis

· Pain Management

· Complex Medical Care

· Wound Management

· Ventilation Care

· Other Specialty Care

Care Planning

· Involves assessing each individual patient's needs, developing a care plan to meet those needs, and constantly reviewing the care plan and adjusting it as needed.

Measuring Quality of Care

· There are numerous excellent tools available for measuring outcomes-based effectiveness.

· QAPI is the merger of two complementary approaches to quality, Quality Assurance (QA) and Performance Improvement (PI). Both involve seeking and using information, but they differ in key ways

Case Management

· Its primary goal is the cost-effectiveness of the care given.

Consumers Served

· Patients needing a high level of skilled care, generally with a defined treatment plan and timetable for discharge or transfer to another type of care.

· They need rehabilitation, monitoring, or other specialized treatment.

Market Forces Impacting Subacute Care

· Cost Saving Efforts – the primary impetus for subacute care.

· Managed Care – A key promoter of subacute care.

· Choice - The rising demand by health care consumers for more choice in their care is important.

Regulations

· Subject to most of the same regulations as other providers, but is still an immature provider form.

Accreditation

· Joint Commission – Joint Commission on Accreditation of Healthcare Organizations

· CARF International – Commission on Accreditation of Rehabilitation Facilities

· NCQA – National Committee on Quality Assurance

Financing Subacute Care

· No single payer for subacute services, nor any standardized payment mechanism.

· Most reimbursement comes from Medicare, Medicaid, and managed care organizations.

· Managed care influence is growing, even for public payers.

Staffing/Human Resource Issues

· Interdisciplinary team consisting of:

· Program Administrator

· Physicians

· Nursing

· Other Professional Staff

· Non-Licensed Staff

· Recruitment

Legal/Ethical Issues

· Fall into two general categories:

· Meeting licensure and reimbursement regulations

· Professional liability

Management

Management Qualifications

· Subacute care administrators need the same skills as administrators of other health care organizations.

Management Challenges and Opportunities

· Changing the Culture of the Organization – may be part of a hospital or skilled nursing facility with different culture

· Balancing Cost and Quality – similar to other providers.

· Coordination, Competition with Other Facilities, Organizations – need to work with others to survive.

· Physical Facility Considerations – may have to adapt from another provider type.

Significant Trends and Their Impact on Subacute Care

· Managed Care – a growing influence.

· Changes in Acuity Levels – accepting patients from acute care – or instead of acute care presents certain problems.

· Emphasis on Outcomes – more emphasis than other provider types since patients are there for specific treatments.