In part, this may be a function of the presence of more aggressive managed care arrangements in Los Angeles, compared to other market areas. Subacute care in hospitals. Related Flashcards. There is no single, agreed-upon definition of subacute care, although several health care associations and key accreditation organizations have developed formal definitions, discussed in the report. High tech home health care firms differ from SNFs in some of their staffing and patient characteristics. 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. Subacute Facilities' Search for More and Better-Paying Markets. The average length of stay (ALOS) varies among subacute patients. In general, the ratio of RN time compared to LPN and CNA time is greater in subacute SNFs than among traditional nursing homes. Patients have similar etiologies, as well, including stroke, head injury, dementia, and complex medical conditions. Concerns from those in the community (i.e., hospital discharge planners and health plans) about inadequately-trained staff at subacute providers. However, the majority of nursing associations with which we spoke had concerns about the whether SNFs were staffed appropriately for the acuity of patients being referred and the quality of care provided. Examples of how to use “subacute” in a sentence from the Cambridge Dictionary Labs The cost-saving arguments are based principally on the fact that per diem costs in a subacute care setting may be as much as 40 to 60 percent less than hospital acute care, but there are many other considerations involved in realizing savings discussed in the study. Physicians' attitudes about nursing homes may make it more difficult for SNFs to develop subacute programs relative to other post-acute providers. But, we also found substantial evidence of a movement to create a new type of program to service those patients, a new approach to care, different from traditional Medicare "high-end" skilled care. Some key examples of the undeveloped product include the following: None of the hospital-based SNFs and only a few of the freestanding SNFs we visited are actually using even those clinical outcomes measures (i.e., the FIM) that are currently available; Few of the state-of-the-art facilities we visited could easily produce minimal data (e.g., length-of-stay by patient characteristic or program type) for the patients they called subacute. One patient may need labs drawn, an IV placed for fluids, and an assessment every hour, while another patient is coding and needing CPR with a rapid response team to bring them back to life. And, more vividly, what’s the Buxbaum (2009) conceptualization? I. What is subacute care? NFs in Los Angeles have the lowest occupancy of the four market areas, and California Medicaid NF reimbursement is the only one of the four applicable systems that provides no additional Medicaid dollars to facilities that take patients with heavier care needs, except for technology-dependent patients. 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. We had assumed that we would find low hospital use rates in areas with high managed care penetration, but we found that three out of the four market areas have hospital use rates close to the national average and much higher than the managed care "ideal." This study found that direct care resource consumption for rehabilitation facility stroke patients was appreciably higher than for SNF patients in licensed nurse time, therapy time, and physician visits, but that differences in total patient care costs were less than 20 percent. Our Location. These physiological responses may reach gr… Subacute facilities vary in contracting out versus providing in-house therapies and physician services. Special resources to achieve those goals include more and better trained staff (than in a "traditional" SNF), especially physicians and nurses. The Functional Independence Measure (FIM) is the best known measure for assessing outcomes for rehabilitation patients and is being used to measure subacute rehabilitation outcomes. However, providers tend to disagree on a common set of subacute care patient characteristics. Subacute units tend to be housed in skilled nursing facilities or on skilled nursing units. The higher intensity of direct nursing care, therapy care, and physician care suggests that quality of rehabilitation care may be higher in hospitals than in SNFs. 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. This group of patients includes those with cardiovascular diagnoses, cancer, ventilator care, wounds, and IV therapy. 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. CHAPTER FIVE discusses variations in subacute care across four market areas (Los Angeles, Miami, Boston, and Columbus) and focuses on the factors in these markets that affect the local development of subacute care. Few facilities currently are collecting data on quality or clinical outcomes. Information on prices paid by managed care plans is closely guarded by individual facilities. As we discussed in Chapter Two, prototypical subacute care is an organized program intensely focused on achieving specified measurable outcomes in an efficient and cost-effective manner. We acknowledged the following developments: Two accreditation organizations have established subacute care standards. While true, subacute programs in the ideal stress an intensity of focus on outcomes, as well as achieving outcomes in a particularly efficient and lower cost manner. Three of these similarly conclude that outcomes were better for those treated in hospitals. Subchronic systemic toxicity is defined as adverse effects occurring after the repeated or continuous administration of a test sample for up to 90 days or not exceeding 10% of the animal's lifespan. Love this resume? There are, however, daily visits from nurses and other staff to stay on top of the patient’s situation in case there are any changes that need a quick response. 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. Subacute may sometimes be found in rehabilitation hospitals, although this is less common. In general, providers tend to distinguish between "rehabilitation subacute" patients, which include conditions such as hip replacement, spinal cord injuries, and brain injuries. Emergency interventions and services should be integrated with primary care and public health measures to complete and strengthen health systems. What is the effect of subacute care on long-term outcomes for patients? Regulatory Barriers. Subacute care provides a specialized level of care to medically fragile patients, though often with a longer length of stay than acute care. Organizations that provide care for persons with AIDS or cancer typ ically adopt this model. Subacute systemic toxicity is defined as adverse effects occurring after multiple or continuous exposure between 24 h and 28 days. Subacute Care Model Organizations that follow the subacute care model serve patients who need moderate- to low-level subacute services such as orthopedic rehabilitation. It was not uncommon to find, for example, state-of-the-art providers who called a portion of a Medicare and/or dually-certified unit the "subacute care" wing or unit, but whose routine data systems did not distinguish those patients from others. Medicare's payment systems for acute care have led to increased demand for post-acute care services for higher acuity patients. Nursing homes respond to changing patient preferences. Estimates of the current annual volume of subacute care range from 1.2 million to 8.1 million patient days. 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