The Joint Commission on Accreditation of Healthcare Organizations has notched its first accreditation in the subacute-care field and is preparing decisions on five other organizations surveyed in January.
Administered by the commission's long-term-care division, the subacute-care program was inaugurated last month after a development period dating back to May 1993, when the commission board decided to enter the subacute field.
At the time, subacute care was catching on as a middle level of institutional care for acutely ill but stabilized patients. Those patients didn't need the full complement of costly acute care but required more than nursing homes were typically staffed to provide.
But HCFA has resisted industry efforts to create a payment category for subacute care, defining it as a component of long-term care even though it's characterized by short stays.
As a consequence, HCFA hasn't written specific regulations, and the JCAHO sees that as an opportunity for it to define the care requirements.
"The question is, what is the standard for subacute care?" said Mary Tellis-Nayak, director of long-term-care accreditation services. "There is no standard, except for what we have."
The JCAHO used HCFA's regulations for nursing homes as a "template" for subacute-care accreditation, Tellis-Nayak said, because subacute care taking place in skilled-nursing units is subject to those regulations.
About a third of the conditions of participation were revised where they did not relate to the subacute patient, she said. The revisions mainly had to do with the generally shorter stays and higher staffing qualifications for subacute care, compared with long-term care.
For example, federal regulations require nursing homes to perform a comprehensive assessment of a resident's condition within 14 days, but subacute patients are likely to be treated and discharged by then, Tellis-Nayak said. The JCAHO's guidelines call for such assessment within 48 hours instead.
The subacute standards also address the more extensive requirements for medical equipment and physical-plant capacity. Two ventilator-dependent patients in one room, for example, would need treatment that requires more machine space and electrical supply than the typical resident room would have, she said.
Subacute units offering intensive rehabilitation would need to arrange for sufficient therapy space. "You can't just do rehab and have them walking up and down the hall," Tellis-Nayak said. "You need a place to put them."
To determine the types of services and patient populations offered by subacute facilities, the JCAHO requires an extensive pre-survey application. Facilities must detail everything from simple demographic profiles to information on lengths of stay, interruption of care while undergoing treatment, and where patients came from and went afterward.
So far, 41 organizations have completed the application, Tellis-Nayak said.
Last week, 38-bed Sub-Acute Saratoga (Calif.) Hospital announced it had become the first to earn JCAHO accreditation.
Since HCFA is not collecting specific data on subacute care, the information from the applications will be used to build a picture of the subacute field, including who's paying for the care, she said.
The data also will give the program's 19 specialized surveyors a good idea of the type of subacute services and patients they'll be evaluating before they arrive for the two-day survey, she added.
The survey costs $2,650 and usually will be done along with an organization's long-term-care or acute-care survey.
However, organizations surveyed during the past two years will be able to schedule the subacute survey by itself if they want to be accredited before the next survey for their main business, she said.