EVALUATION OF THE POST-ACUTE CARE PATIENT Taylor Bailey, NP-C Jessica Reed, NP-C AGENDA What is Post-Acute Care? Why Post-Acute Care? Post-Acute Care: Who Belongs Where? Overview of Post-Acute Care inpatient facilities and criteria needed for acceptance. Barriers of Post-Acute Care facility placement. 1
WHAT IS POST-ACUTE CARE (PAC)? PAC refers to health care that includes rehabilitation or palliative services that a patient receives after, or in some instances instead of, an acute care hospital admission. PAC services operate on a continuum of care, involving various levels of intensity that are provided in numerous settings including: inpatient facilities, outpatient facilities, and patients homes. WHY POST-ACUTE CARE? Demographics and demand for PAC services are growing Patient satisfaction Improve quality and patient outcomes Decrease hospital length of stay Reduce hospital readmissions INCREASE Patient satisfaction Quality care Patient outcomes Hospital length of stay Hospital readmissions DECREASE 2
POST-ACUTE CARE: WHO BELONGS WHERE? Things to consider: Clinical picture/medical status Hospital course Prior level of function Current functional status Cognitive status Nutritional status Psychosocial factors Environmental factors Family/care giver support/burden Goal of care POST-ACUTE CARE: INPATIENT FACILITIES Inpatient Rehabilitation Facility (IRF) Skilled Nursing Facility (SNF) Long-Term Acute Care Hospital (LTACH) 3
INPATIENT REHABILITATION FACILITY (IRF) Freestanding rehab hospital or rehab unit within an acute care hospital that provides intensive rehabilitation services using an interdisciplinary team approach within a hospital environment. INPATIENT REHABILITATION FACILITY Criteria for Admission Medically stable patient with nursing, medical management, and rehabilitative needs Patient must be able to tolerate and be willing to participate in 3 hours of therapy per day at least 5 days per week or in some cases, at least 15 hours of therapy within 7 days Patient requires active and ongoing intervention of at least 2 therapy disciplines: Physical Therapy (PT), Occupational Therapy (OT), Speech-Language Pathology (SLP) Goal of Care Provide an interdisciplinary team approach that results in measurable progress in patient function Restoration of a disabled person to self-sufficiency or maximal possible functional independence Common Medical Conditions Treated Stroke, Brain Injury, Spinal Cord Injury, Congenital Deformity, Multiple Sclerosis, Parkinson s Disease, Amputation, Major Multiple Trauma, Burns, Hip Fracture, Bilateral hip or knee replacements Most frequent condition is stroke 4
SKILLED NURSING FACILITY (SNF) Hospital-based or freestanding facility that is licensed, certified or otherwise authorized to provide skilled nursing and rehabilitation services needed to transition the patient to the home setting. SKILLED NURSING FACILITY (SNF) Criteria for Admission Patients with conditions requiring skilled nursing or rehabilitation (PT, OT, SLP) services on a daily basis due to condition that was treated during acute hospital admission Patient with a minimum 3 consecutive day admission in acute hospital Goal of Care Reduce the length of stay in acute care hospitals by providing 24-hour intermittent skilled nursing or therapy necessary to transition the patient to the home setting Improve or maintain patient s condition Common Medical Conditions Treated Heart failure and shock, septicemia, pneumonia, hip/femur procedures, joint replacement, kidney and urinary tract infections 5
LONG-TERM ACUTE CARE HOSPITAL (LTACH) Freestanding hospital or unit within acute care hospital that is designed to provide extended medical and rehabilitative services to medically complex patients with multi-system problems that require intense, special treatment for an extended period of time. LONG-TERM ACUTE CARE HOSPITAL (LTACH) Criteria for Admission Require acute care services and daily physician intervention to manage multiple acute complex conditions Cannot be effectively managed at a lower level of care Average length of stay is greater than 25 days Goal of Care Comprehensive, individualized approach to treat complex medical conditions, while providing more cost-effective care then if patient remained in acute care hospital Efficiently transition patients to the next step of treatment plan to regain independence through specialized transitional care Common Medical Conditions Treated Prolonged ventilator use or weaning, ongoing dialysis for chronic kidney failure, intensive respiratory care, multiple IV medications or transfusions, complex wound care/burn care Simultaneous chronic conditions or multi-system organ failure with significant loss of independence 6
POST-ACUTE CARE INPATIENT FACILITIES Criteria for Admission Goal of Care Common Medical Conditions Treated Therapy Requirements IRF SNF LTACH Medically stable patient with nursing, medical management, and rehabilitative needs, who is required to participate in 3 hours of therapy per day at least 5 days per week. Provide an interdisciplinary team approach that results in restoration of a disabled person to self-sufficiency or maximal possible functional independence. Stroke, Brain Injury SpinalCord Injury Lower extremityfracture, amputation, bilateral joint replacement Neurologicaldisorders Debility Patient withmedical conditions requiring skilled nursing orrehabilitation services for the short term on a daily basis in an inpatient setting after an inpatient stay of 3 or more days. Reduce the length of stay in acute care hospitals by providing 24-hour intermittent skilled nursing or therapy necessary to transition the patient to the home setting. Joint replacement Kidney and urinary tract infections Hip and femur procedures Heart failure and shock Pneumonia 3 hours 1-1.5 hours N/A Average LOS 13.1 days 27 days 26.6 days Require acute care services and daily physician intervention to manage multiple acute complex conditionsthat cannot be effectively managed at a lower level of carewith average admission of greater than 25 days. Comprehensiveapproach to treat complex medical conditionswith the goaltoefficiently transition patients to the next step of treatment to regain independence through specialized transitional care. Prolongedmechanical ventilation Pulmonary edema and respiratory failure Severe septicemia or sepsis Respiratory infection or inflammations Skin ulcers with complications/comorbidities Number of PAC facilities 1,188 15,293 427 BARRIERS OF POST-ACUTE PLACEMENT Insurance coverage Social issues Patient's ability to go home Staffing Lack of communication Lack of team effort Lack of clear definable discharge criteria Inadequate documentation Lack of early mobility during hospitalization 7
REFERENCES Burke, R. E., Carl, L., & Juarez-Colunga, E. (2015). Rise of Post-Acute Care Facilities as a Discharge Destination of US Hospitalizations. JAMA Intern Med, 175(2):295-296. doi:10.1001/jamainternmed.2014.6383 Coberly, S. & Linehan, K. (2015). Medicare s Post-Acute Care Payment: An Updated Review of the Issues and Policy Proposals. National Health Policy Forum, 847. Retrieved from http://www.nhpf.org/library/issue-briefs/ib847_postacutecare_10-05-15.pdf Cornelius, E. S. & Helbing, C. (1992). Chapter 5: Skilled Nursing Facilities. Health Care Financing Review, Annual Supplement. Retrieved from https://www.cms.gov/research-statistics- Data-and-Systems/Research/HealthCareFinancingReview/Downloads/CMS1191229dl.pdf Department of Health and Human Services. (2012). Inpatient Rehabilitation Therapy Services: Complying with Documentation Requirements. Centers for Medicare & Medicaid Services, ICN905643. Retrieved from https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/inpatient_rehab_fact_sheet_icn905643.pdf Medpac (2017). Inpatient Rehabilitation Facilities Payment System. Paymentbasics. Retrieved from http://www.medpac.gov/docs/default-source/paymentbasics/medpac_payment_basics_17_irf_final93a311adfa9c665e80adff00009edf9c.pdf?sfvrsn=0 Stefanacci, R. G. (2015). Admission Criteria for Facility-Based Post-Acute Services. Annals of Long-Term Care: Clinical Care and Aging, 23 (11): 18-20. Retrieved from https://www.managedhealthcareconnect.com/article/admission-criteria-facility-based-post-acute-services-0 THANK YOU! Questions? 8