The chart illustrates consensus that care to ventilator dependent patients, brain or head injury patients, or patients requiring orthopedic or cardiac rehabilitation are considered potential subacute care patients. Sub acute rehab (SAR) centers are usually most appropriate for people who need less than three hours of therapy a day, thus the label of "sub acute," which technically means under or less than acute rehab. Staff. As of October 10, 1994, AHCA and JCAHO each agreed to adopt JCAHO's current definition in order to eliminate minor differences between the organizations' previous definitions (Ukens, 1994). Rehabilitation Institute of Chicago. This consulting group sampled hospital-based long-term care units and freestanding nursing facilities (N=94) that they characterized as providing subacute care. Health Care Strategic Management. Establishes a system to provide services to people who have suffered a traumatic brain injury. Subacute/transitional care in hospitals. This study is discussed in more detail later in this paper. It is possible, however, that a transfer to a subacute unit may increase total length of stay, thereby reducing (and possibly eliminating) estimated cost savings. Falcone, D., Bolda, E., & Leak, S.C. (1991, August). Some people can only tolerate about 30 minutes a day at first, depending on their condition. A case study of four hospital-based units participating in this congressionally mandated study and a larger outcomes study. An analysis of Medicare costs, however, would reflect a net savings to Medicare. ", "Care rendered immediately after, or instead of acute hospitalization...given in a discrete unit of a hospital or facility, or a freestanding facility, as part of a specifically designed program...at a level of service generally more intensive than a nursing facility but less intensive than an acute care facility. Leiter, P. (1994, Spring). Unpublished manuscript. Defines traumatic brain injury. The objective of the resolution is to increase access and contain costs. American Association of Retired Persons. Sub acute rehab (also called subacute rehabilitation or SAR) is complete inpatient care for someone suffering from an illness or injury. Among other things, this study found that “only a small portion of Medicare discharges from hospitals spent one or more days as an identified subacute patient [in an acute care bed]” (Manard, et al., 1988). Despite the diversity of settings in which the literature presents subacute care as being provided, most of the available literature focuses on care provided in skilled nursing homes, primarily free-standing facilities. Contemporary Long Term Care, pp.55, 57, 59. (d) Medi-Cal beneficiaries at the subacute level of care in the facility shall be visited by their attending physician as provided for in the Manual of Criteria for Medi-Cal Authorization -Subacute Level of Care Criteria, referenced in Title 22, California Code of Regulations, Section 51003(e). MacLean, D. (1994, August 30, September 27). Typically, your most valuable resource will be recommendations from loved ones or friends who have already been through this process. A third key issue to consider when reviewing previous studies of the costs and potential cost savings of subacute care is the type of subacute unit examined. The Emergence of Subacute Care. Washington, DC: Manard, B.B., Gong, J.A., Blewett, L.A., Roenigk, L.A., Lewin, L.S., Derzon, R.A. Molis, D.B. (PB Report No. The objectives and goals of subacute care is the cost-effective and creative use of healthcare resources to achieve maximal outcomes. The Commission will develop recommendations regarding the most effective means of improving the quality and scope of rehabilitation services for head injured persons. If you have time, it can also be helpful to stop by a few different facilities and ask for a tour. Provider, 20(2), 37-38. Hegland, A. There are a variety of payers for subacute care and studies often measure only the costs of a single payer, such as Medicare or a managed care organization, as determined by the study's sponsor or by limitations in data. Comparing the ratings of different facilities can be very helpful. The method used to identify these facilities was not fully explained. Robert Kane has conducted two studies using the same database. Defines traumatic brain injury. Varro, B. The approaches used by the ventilator unit varied in staffing, team philosophy, staff communication, staff turnover, and other distinctions that affect quality of care. San Francisco, CA: Skolnick, S. Saloman Brothers. Centers for Medicare and Medicaid (CMS) provide a 5-star rating system on nursing homes, and many of those facilities provide SAR. Monitoring the changes in use of Medicare posthospital services. A controversy ensued between hospitals and nursing facilities over these newly identified subacute patients. Bethesda, MD: Sherman, D. & Walker, L., Abt Associates Inc. American Health Care Association. Financial coverage and requirements vary, depending on which plan you have chosen. They concluded that traditional nursing homes were ill prepared to care for post-acute patients (Kane, 1994). Based on these analyses, the study concluded that Medicare might save $7-9 billion per year if patients were treated in SNF-based subacute facilities rather than acute care settings. Unpublished manuscript. Duration of care is also an important determinant of subacute care. ", "Subacute care strategy is directed at providing post-acute care at a less costly and more medically intensive way than skilled nursing facilities. Washington, DC: The George Washington University, Intergovernmental Health Policy Project. Hyatt, L. (1994, July-August). (Research Report: Lewin/ICF). The e-mail address is: webmaster.DALTCP@hhs.gov. American Subacute Care Association Quarterly, 1, 1. How are Subacute Care Services Categorized? Services and/or settings were described in twenty-five percent of the definitions. (1993 Congress Annual Meeting Abstracts). Generally, the individual's condition is such that the care does not depend heavily on high technology monitoring or complex diagnostic procedures. Regulatory Update. Using the same estimate that Medicare beneficiaries represent 70 percent of the subacute population, the total potential subacute care population would number 4.1 million. This is sometimes called a "cut letter" or "denial notice," and a copy must be provided to you and kept on file at the facility to prove that you were given notice of this change before it occurred. In the original Post-Acute Study, researchers compared the actual discharge destination to an optimal destination (with a predicted best outcome) and found a lower amount of agreement between the optimal and actual destination for patients discharged to nursing homes. Treatment and/or assessment of the care plan by physician, Nursing Intervention of more than 3 hours per day; and/or, Therapy services (i.e., physical therapy, occupational therapy, speech therapy, respiratory therapy psychosocial); and, The need for ancillary or technological services (i.e., laboratory, pharmacy, nutrition, diagnostic, DME). B. (1994, September) Incidence of death and emergency transfers in acute and subacute rehabilitation [abstract]. Koska, M.T. The law specifies requirements that home intravenous drug therapy providers must meet, including quality control and record-keeping procedures. Hartwell, R. (1994, March). Many of these articles mentioned a wide-range of services that are provided in the subacute setting, such as “brain injury rehabilitation, high intensity stroke and orthopedic programs, ventilator programs, complex wound care, specialized infusion therapy, or post-surgical recovery programs” (Kelly, 1992). (1994, Summer). Third, researchers estimated savings under a variety of scenarios, including those in which Medicare payment policy is changed in order to realize savings for patients discharged earlier from the acute care setting, and in which Medicare is required to reimburse providers for the fixed costs of empty hospital beds. Therapy services provided to SNF patients under Medicare Part B. Isaac Lane Koval / Corbis / VCG / Getty Images. Skilled nursing facility (SNF) care is health care given when you need skilled nursing or therapy staff to treat, manage, observe, and evaluate your care. Health Data Associates, Inc. (1994). subacute, post-acute, step-down or transitional care, typically 20-50% less expensive than similar care in a hospital setting, American Transitional Care reported costs, $270-$400 per day at American Transitional Care, properly equipped subacute unit in freestanding nursing home, self-reported costs of SNF operators and Medicare claims payment data, relative costs not estimated on per diem basis, savings of 50-60% for subacute care in nursing facilities compared to acute care hospitals, Reasonable costs, subject to 112% mean cost for all urban; rural agencies receive a higher limit; cost limits are determined separately by type of service, but are applied in the aggregate. We conclude with some discussion of research in progress.