A Combined Use of Strategy of Multi-Venues of Care
Key Variables a Multi-Venue Strategy

1 CORF= Comprehensive Outpatient Rehabilitation Facility
2 CAM= Center for Alternative Medicine

A Combined Use of Strategy of Multi-Venues of Care

Venue: Acute Hospital
Medicare Method of Payment: DRG Based
Pre-Admission Requirements: Medical necessity at acute level of care
Venue Purpose: Short term episodic diagnostic
Trigger Points: Discharge when medical condition no longer erratic and surgery not imminent
Key Reimbursement Differentials: National capitation by diagnosis Prospective Payment System
ALOS: 3-10 Days
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Venue: Subacute (Hospital-Based or Free Standing)
Medicare Method of Payment: Case mix adjusted per diem on Prospective Payment System
Pre-Admission Requirements: 3 Day Hospitalization
Venue Purpose: Moderate term medical or restorative
Trigger Points: Medically stable in need of 24 hour skilled nursing but not 7 day physician
Key Reimbursement Differentials: MDS based payment system
ALOS: 7-20 Days
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Venue: Inpatient Rehab
Medicare Method of Payment: PPS beginning 1st cost reporting period after January1, 2002 | 1 year phase-in
Pre-Admission Requirements: 10 Diagnostic Categories | Rehab potential
Venue Purpose: Moderate term restorative care
Trigger Points: Focus physical functioning 21 rehab impairment categories
Key Reimbursement Differentials: Prospective payment per patient discharge, 3 hour rule, 75% diagnosis mix, FIM data required in the new patient assessment instrument
ALOS: 10-22 Days
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Venue: Long Term Care Hospital
Medicare Method of Payment: Long Term Care Prospective Payment System for new providers; TEFRA option for existing providers
Pre-Admission Requirements: Medical necessity at acute level of care
Venue Purpose: Long term acute medical and restorative
Trigger Points: Acute medical needs with targeted LOS range of 18-35 days
Key Reimbursement Differentials: New DRG system for LTACH
Aggregate 25 days ALOS
ALOS: 18-35 days
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Venue: CORF(1)
Medicare Method of Payment: Medicare | 20% copayment | Fee Schedule
Pre-Admission Requirements: Rehab potential. No visit or LOS limit
Venue Purpose: Short moderate term restorative
Trigger Points: No need for 24 hour nursing but can provide intensive medical/therapy services
Key Reimbursement Differentials: Reimburses PT/OT/speech, pysch, nursing, drugs and biologicals, DME, respiratory therapy, medical and social services.
ALOS: 2-10 Weeks
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Venue: Home Care
Medicare Method of Payment: Predetermined base payment | Payment will be adjusted for the health condition and care needs of the beneficiary | 60-day episode payment
Pre-Admission Requirements: Homebound and in need of intermittent skilled nursing care, PT or speech
Venue Purpose: Skilled nursing and therapy provided in the home setting
Trigger Points: Need for intermittent nursing services and patient is homebound
Key Reimbursement Differentials: Does not cover respiratory therapy, drugs/biologicals or DME. Does cover nursing, aides, PT, OT, speech, medical and social services.
ALOS: 1-6 Months
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Venue: CAM(2)
Medicare Method of Payment: Select services
Pre-Admission Requirements: Medical or psychosocial need
Venue Purpose: Prevention and restorative care
Trigger Points: Alternative to traditional Western medicine
Key Reimbursement Differentials: Private pay and commercial or managed care.
ALOS: 6-30 Visits
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1 CORF= Comprehensive Outpatient Rehabilitation Facility
2 CAM= Center for Alternative Medicine

Key Variables a Multi-Venue Strategy

ICU
Avg. 19 direct nursing hours per patient/day
Daily (or more as needed) physician and consult specialist contact
Patient's condition may change by minutes
Patient in crisis
ALOS 1-4 days
Average per diem $1800
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ACUTE
Avg. 8 direct nursing hours per patient/day
Daily physician contact
Patient's condition may change by day
Possibility for crisis
ALOS 3-5 days
Average per diem $1200
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LONG TERM ACUTE CARE
Avg. 8 direct nursing hours per patient/day
Daily physician contact
Patient's condition may change by week
Possibility for crisis
ALOS 18-35 days
Average per diem $1300
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REHAB UNIT
Avg. 5.5 direct nursing hours per patient/day
Daily physician contact, avg. 5 days per week
Patient's condition may change by week
Possibility for crisis
ALOS 10-22 days
Average per diem $650
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SUB-ACUTE
Avg. 4-5 direct nursing hours per patient/day
Intermittent physician contact, avg. 3 days per week
Patient's condition may change by week
Condition newly stable
ALOS 7-20 days
Average per diem $300
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MEDICAL DAY HOSPITAL
Avg. 1.5 nursing hours per patient/day
Intermittent physician contact, less than 1 day per week
Patient medically stable
Medical condition stable
ALOS 2wks-10wks
Average per diem $350
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