U.S. Department of Health and Human Services
Subacute Care: Policy Synthesis and Market Area Analysis
Proponents of subacute care claim that subacute care is a cost-effective alternative to acute care services, that is, it can be provided in lower cost settings with no diminution of quality.
The Office of the Assistant Secretary for Planning and Evaluation commissioned Lewin-VHI, Inc. to conduct a study of the concept of subacute care and related issues. The purposes of the study were to: (1) identify and understand the definitions of subacute care; (2) examine the provision of subacute care in select market areas by a variety of provider types including hospital-based and freestanding skilled nursing facilities, rehabilitation and long-term care hospitals, and home health agencies; (3) evaluate a myriad of policy relevant issues including identifying who receives, provides, and pays for subacute care; and (4) assess the cost, quality, and cost-effectiveness of this type of care.
Based on a review of the literature, site visits and discussions with key stakeholders in four market areas, the study found that the concept of subacute care is often used to refer to patients traditionally considered to be high-end, Medicare skilled patients. Increasingly, however, subacute care appears to be emerging as a concept referring to an organized program for which there is growing consensus about its elements. Further, the report concludes that while subacute care per diem costs may be less than acute care per diem costs, such comparisons fail to consider the impact of subacute care on episodes of care and the associated costs. The report concludes that more information is needed on the impact of subacute care on costs and quality of care before any conclusions can be reached concerning the cost-effectiveness of this type of care.
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Ms. Jennie Harvell was the Project Officer for this study. You may contact her by e-mail at Jennie.Harvell@hhs.gov, or write to her at HHS/ASPE/Office of Disability, Aging and Long-Term Care Policy, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201.