Subacute care: evolution in search of value

The postacute continuum of nonhospital-based services has experienced rapid growth over the past decade because of a variety of economic factors. Medicare's prospective payment system for inpatient hospital stays combined with the diagnostic requirements of patients in acute medical rehabilitation and the growth of managed care have all reinforced the development of alternative levels and venues of care. Market forces are leading to consolidation and integrated health delivery systems offering both acute and postacute service options. The cost-effectiveness of these new models indicates promise for increased value measured by comparing resource utilization with outcomes. Reimbursement of the developing continuum, however, offers little incentive for efficiency. This article discusses the present dynamics of postacute growth and examines the issues that should be evaluated to determine its relevance in the spectrum of care.