The subacute-care industry has admitted its failure to define itself. Now, it's trying to change that perception.
The new efforts follow a Lewin-VHI study late last year which concluded that many "subacute" services aren't new; they're simply within the realm of traditional high-end skilled-nursing care (Jan. 22, p. 34).
The good news for subacute providers is the study also found that subacute programs appear to be in their infancy and have potential for cost-effective treatment of high-acuity patients in a post-acute setting.
At the industry's third annual conference, "Subacute Care '96," earlier this month in Atlanta, industry leaders outlined upcoming efforts to move beyond the Lewin-VHI study. That study, commissioned by HHS, identified a need for reliable, industrywide cost and outcomes measurements.
In an extension of that project, the National Subacute Care Association teamed up last fall with Lewin-VHI to organize a cost and outcomes study.
First, the groups will define the subacute patient population. Next, they will determine the resources used in providing subacute care. Finally, they plan to evaluate the results of subacute care, measured according to clinical outcomes and patient satisfaction.
The aim of the 18-month project is to define the value of subacute care, said Bonnie-Lou Binnig, executive vice president of Olympus Healthcare Group, based in Westborough, Mass. Binnig chairs the NSCA's committee on cost-effective outcomes. The committee and Lewin-VHI currently are working on the study's methodology. They plan to use a questionnaire to survey providers, then issue a report. In addition, the project will identify some providers as "centers of excellence," she said.
Perhaps the single most pressing issue for the industry is the uncertainty of the regulatory environment, according to Arthur Stratton, M.D., chairman and chief executive officer of Mariner Health Group, New London, Conn.
To address that fear through its legislative efforts, the NSCA is designing a post-acute prospective payment system in conjunction with the American Health Care Association. The groups retained Price Waterhouse for the $40,000 project, expected to be completed early next year.
Five top long-term-care executives discussed their industry's future in subacute care during a panel discussion at the Atlanta subacute meeting.
"The devil here will be in the details," said Daniel Kane, president and CEO of Olympus. The first and foremost task for subacute providers, he said, is to get rid of the perception that "the industry is being gamed."
"When we prove that we can provide this service at a much more reasonable cost...then I think we have a future," said David Banks, chairman and CEO of Beverly Enterprises, the nation's largest long-term-care provider, based in Fort Smith, Ark.
Only 22% of the subacute field is
in large chains, according to John Bardis, president and CEO of Atlanta-based TheraTx. Consequently, in many markets a single operator or small chain is the preferred provider.
But in coming years, those smaller providers will find themselves under pressure to join an integrated delivery system, said Mariner's Stratton.
Mariner currently reaps the benefits of being a leading national subacute provider, in terms of information systems and cost-control capabilities.
However, since last fall the company has begun to install local managers in its five regions. "You have to be able to counter the fact that you're a national company," Stratton said.