Chapter 5: Subacute and Postacute Care – Flashcards
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Postacute Care
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-(Comes after acute care) Improves transition from the hospital to the community -Provides services to patients needing additional support following discharge from a hospital +Recuperation +Rehabilitation +Nursing
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Subacute Care
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Comprehensive, cost-effective inpatient level of care for a person with an acute illness, injury, or exacerbation of a disease process. Provides services to patients who require frequent assessments and/or procedures to manage their condition Between acute and long-term care
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Postacute vs. Subacute Care
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Postacute -After acute care -Can be inpatient or outpatient -Nursing and/or nonmedical care Subacute -After or in place of acute care -Inpatient only -Medical and nursing care
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Postacute Care Providers
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-Provider Types: +Skilled nursing facilities +Home health agencies +Inpatient rehabilitation facilities +Long-term care hospitals -Providers must meet different conditions of participation under Medicare
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inpatient rehabilitation facilities
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Provide intensive rehab therapies to maintain the patient at the maximal functional level Usually provided by specialized hospitals or hospital units Medicare requires 75% of admissions to fall in 1 of 13 diagnoses
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LTC Hospitals
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Provide extended medical and rehab to clinically complex patients Can be freestanding or within hospitals Most expensive and least frequently used postacute setting Medicare requires certification as an acute care hospital with an ALOS of 25+ days
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Use of Postacute Care
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About 1/3 of hospital patients use postacute care The most common setting for postacute care is a skilled nursing facility Constitutes 11% of Medicare's total spending
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Development of Subacute Care
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One of the newest and fastest growing segments of the health care system Result of pressures to be cost-effective, demand for consumer choice, and competition between providers
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Ownership of Subacute Care Units
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-SNF 67% -Hospital 21% -Other 12% -Many are owned by corporate chains and increasingly becoming part of integrated health networks
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Typical reasons for Subacute Care include:
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-Cardiac Recovery -Cancer/oncology recovery -Pulmonary conditions -Orthopedic rehab -Neurological disorders/stroke -Complex wound management -Conditions requiring IV therapy or tube feedings
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Subacute Care Services include:
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-Therapy -Cardiac rehab -Post surgical care -Chemotherapy -Dialysis -Complex wound care -Wound management -Ventilation care -Total parenteral nutrition (tube feeding)
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Care Planning
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-Assessing individual needs, developing a care plan, and reviewing/adjusting the care plan +Focuses on care goals with clearly defined outcomes +Done by an interdisciplinary care team
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Care Planning is Important because:
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You need specific goals and detailed information on how to achieve them. Inter coordinated teams across all services.
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Case Management
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-Parallels the care planning process but focused on efficiency or cost-effectiveness -Manages resources to optimize outcomes at the lowest cost -Can have external or internal case managers
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Staffing: Interdisciplinary team of:
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-Administrator -Medical director/physicians -Nursing -Other professional staff -Paraprofessional staff -Ancillary staff
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Management
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Overall responsibility for quality of care, staffing, and future planning Many are licensed as nursing home administrators, but hospital administrators are not licensed
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Management Challenges
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Changing the culture Balancing cost and quality Coordination and competition Physical facility considerations
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Financing Subacute Care
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No standardized payment mechanism -Medicare: PPS -Managed care: discounted fees, capitation, per diem -Bundled payments: ACOs will pay contracted providers -Medicare: 68% -Private Insurance: 22% -Medicaid: 10% -Other: 8%
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Significant Trends
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Increased influence of managed care, with pressure to improve quality and reduce costs The acuity level of patients will likely increase Payers will continue to emphasize outcome measures (e.g., NCQA)
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Conclusion
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Both postacute and subacute care are substitutes to more costly acute care There is room for innovation and creativity as subacute care is still ill defined and poorly regulated
