Chapter 5Subacute andPostacute CareLearning .docx
Chapter 5 Subacute and Postacute Care Learning Objectives Define and describe subacute and postacute care Identify where subacute care fits in the continuum of care Identify sources of financing for subacute care Learning Objectives (continued) Identify and describe regulations affecting subacute care Identify and discuss ethical issues affecting subacute care Identify trends affecting subacute care for the near future and the impact of those trends What is Postacute Care? Postacute care: Improves transition from hospital to the community Provides services to patients needing additional support following discharge from the hospital Postacute Care Providers Include: Inpatient rehabilitation facilities Long-term care hospitals Skilled nursing facilities Home health agencies What is Subacute Care? Comprehensive inpatient care Comes after, or instead of, acute care Between acute and long-term care Usually for a defined period of time Developed largely for cost savings Philosophy of Care Four types: Transitional General Chronic Long-term transitional Ownership of Subacute Facilities Mostly freestanding SNFs (two-thirds) Rehabilitation focus Hospital-based Medical focus Many owned by corporate chains Services Provided • Rehabilitation • Chemotherapy • Physical therapy • Parenteral nutrition • Occupational therapy • Dialysis • Respiratory therapy • Pain management • Cardiac rehabilitation • Complex medical care • Speech therapy • Wound management • Postsurgical care • Ventilation care • Other specialty care Care Planning Focus on quality of care and outcomes Initial assessment Interdisciplinary team Weekly team conferences Ongoing evaluation Case Management Focus on efficiency, cost-effectiveness Manage resources to optimize outcomes at lowest cost Case managers may be: “External” – hired by payer “Internal” – hired by provider Consumers of Subacute Care Post hip-replacement surgery Spinal cord or brain injuries Strokes Cancer AIDS Wounds Cardiac recovery Respiratory ventilation I.V. therapy or feedings Market Forces Cost-saving efforts Managed care Choice Regulations Purpose of regulations: Care is safe and of high quality Care is not unnecessarily expensive Services are uniformly accessible Rights of workers are protected Types of Regulations Medicare OBRA Other – similar to other providers Accreditation Joint Commission CARF International NCQA Financing Subacute Care Reimbursement Sources: Medicare – two-thirds Pays as SNF Other third: Managed care Medicaid Private insurance, self-pay, and other Staffing Interdisciplinary team: Program administrator Physicians Nursing Other professional staff Nonlicensed staff Legal and Ethical Issues Meeting regulations Liability issues Management Qualifications Licensed by the states as nursing facility administrators Hospital-based units must find a licensed administrator or get one of the hospital administrators licensed Management Challe.
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Chapter 5Subacute andPostacute CareLearning .docx
- 1. Chapter 5 Subacute and Postacute Care Learning Objectives Define and describe subacute and postacute care Identify where subacute care fits in the continuum of care Identify sources of financing for subacute care Learning Objectives (continued) Identify and describe regulations affecting subacute care Identify and discuss ethical issues affecting subacute care Identify trends affecting subacute care for the near future and the impact of those trends What is Postacute Care? Postacute care: Improves transition from hospital to the community Provides services to patients needing additional support following discharge from the hospital
- 2. Postacute Care Providers Include: Inpatient rehabilitation facilities Long-term care hospitals Skilled nursing facilities Home health agencies What is Subacute Care? Comprehensive inpatient care Comes after, or instead of, acute care Between acute and long-term care Usually for a defined period of time Developed largely for cost savings Philosophy of Care Four types: Transitional General Chronic Long-term transitional Ownership of Subacute Facilities Mostly freestanding SNFs (two-thirds) Rehabilitation focus Hospital-based Medical focus Many owned by corporate chains
- 3. Services Provided • Rehabilitation • Chemotherapy • Physical therapy • Parenteral nutrition • Occupational therapy • Dialysis • Respiratory therapy • Pain management • Cardiac rehabilitation • Complex medical care • Speech therapy • Wound management • Postsurgical care • Ventilation care • Other specialty care Care Planning Focus on quality of care and outcomes Initial assessment Interdisciplinary team Weekly team conferences Ongoing evaluation Case Management Focus on efficiency, cost-effectiveness Manage resources to optimize outcomes at lowest cost Case managers may be: “External” – hired by payer “Internal” – hired by provider Consumers of Subacute Care Post hip-replacement surgery Spinal cord or brain injuries Strokes Cancer AIDS
- 4. Wounds Cardiac recovery Respiratory ventilation I.V. therapy or feedings Market Forces Cost-saving efforts Managed care Choice Regulations Purpose of regulations: Care is safe and of high quality Care is not unnecessarily expensive Services are uniformly accessible Rights of workers are protected Types of Regulations Medicare OBRA Other – similar to other providers Accreditation Joint Commission CARF International NCQA
- 5. Financing Subacute Care Reimbursement Sources: Medicare – two-thirds Pays as SNF Other third: Managed care Medicaid Private insurance, self-pay, and other Staffing Interdisciplinary team: Program administrator Physicians Nursing Other professional staff Nonlicensed staff Legal and Ethical Issues Meeting regulations Liability issues Management Qualifications Licensed by the states as nursing facility administrators Hospital-based units must find a licensed administrator or get one of the hospital administrators licensed Management Challenges
- 6. and Opportunities Changing the culture of the organization Balancing cost and quality Coordination, competition Physical facility considerations Significant Trends Managed care Changes in acuity levels Emphasis on outcomes Summary Subacute care is the newest form of long-term care, falling between acute and long-term care.