Illinois takes subacute care on test drive

Quality, cost-effective health care to be evaluated

The Land of Lincoln is taking the lead in quantifying the role subacute care plays in the overall health care delivery system. But unlike most health care reform efforts driven by employer groups urging managed care, the driving force behind this effort is the state legislature.

Although the legislation was passed earlier this decade, the first facility did not gain licensure for the project until June 1996, says Patricia Heidenreich, chief of the division of administrative rules and procedures at the Springfield-based Illinois Department of Public Health.

"As far as we know, this is the first state- sponsored program to look at subacute care specifically. California has an exceptional care program where individual evaluations are allowed for cases exceeding the Medical rates, but this is the first program involving licensing," says Heidenreich.

The project is called the Subacute Care Demonstration Program (SCDP). SCDP is coordinated by the state’s public health department — the Office of Health Care Regulation — and is responsible for choosing and licensing the 13 facilities participating in the program. One of the conditions of participating in the program is that the participants be willing to dedicate a unit of the facility to the SCDP.

Illinois’ program is the result of a piece of legislation called the Alternative Health Care Delivery Act, which mandates the state board of health to establish demonstration models for alternative, cost-effective health care delivery models. Subacute care was the first one the agency focused on, notes Heidenreich.

Transitional Hospitals Corp. (THC) North Shore is the sole subacute hospital participant, while the remaining 12 participants are skilled nursing facility- (SNF) based programs. Heidenreich’s department has licensed eight participants in the project so far.

Getting SCDP up and running proved to be a new challenge for state regulators, recalls Heidenreich. Part of SCDP’s implementation required the creation of a separate set of licensing requirements and standards.

"It took us until 1996 because the competition proved to be tough for participants wanting to be selected, and our regulators weren’t used to selecting facilities for licensing. And there was a lot of controversy over the licensing and standards as well," she adds.

Subacute, acute regs combined

The difficult aspect of creating the standards was combining the stringent regulations associated with skilled nursing care with those of hospitals.

"In Illinois, [liability] actions taken against hospitals amount to less than 1% a year because regulatory actions are handled largely through the Joint Commission [on Accreditation of Health Care Organizations], but SNFs on the other hand, have extensive federal regulations to keep up with," adds Heidenreich.

Despite the confusion over which standards and requirements to include in the new regulations, the hospital and SNF participants are learning from each other, says Heidenreich. THC North Shore, for example, learned how to develop and implement policies and procedures to reflect a residents’ rights program.

Additionally, the state’s Medicaid reimbursement standards are being rewritten for participants in SCDP, says Heidenreich. The state’s reimbursement standards are not yet completed for participants, however.

"There’s one participating facility with a large Medicare population, and they are getting some level of cooperation for those patients as well," she adds.

Data collection begins

Existing participating facilities report that their demonstration units are full and operating well, notes Heidenreich.

"Now it’s time to start evaluating what we’re doing. Hopefully, we can start collecting data as early as this month," she adds.

Participating facilities met in December to discuss how to best collect data, says Heidenreich. "We asked them what they currently collect in terms of data, and we’d like to maybe be copied on that information so there’s no duplication," she explains.

Heidenreich hopes to gather enough evidence during a one-year collection period to make recommendations to the Illinois Legislature. The state board of health’s goal is to make those recommendations within a two-year period, she adds.

Data gathered from the SCDP will be shared, adds Heidenreich. "If there’s something that is of national interest, we’ll share it with other states."