The administrator's edge: ACHCA's subacute care credentialing initiative.

Opportunities for administrators and other health care management professionals continue to look good in subacute care, as more providers and payers utilize it as a strategy for success in today's competitive, cost-sensitive marketplace. More and more hospitals are converting excess acute beds to skilled nursing beds. Meanwhile, nursing homes have invested millions in physical plant changes to accommodate the subacute patient, and are now marketing these changes as a differentiating competitive factor.

Still, there is an unmet need for subacute providers to demonstrate their ability to deliver high-quality subacute care. Outcome measures allowing comparison of subacute providers are still developing and require more time before they become truly useful. The Commission on Accreditation of Rehabilitation Facilities (CARF) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have developed accreditation criteria, but there are no nationally accepted ways of measuring outcomes specific to subacute care.

According to Eli Pick, Governor Region VI of the American College of Health Care Administrators (ACHCA) and Executive Director at Ballard: A Healthcare Residence, what has come into question again and again in this rapidly expanding field is the ability of the provider to effectively meet the needs of subacute clients. "Many companies are offering measurement tools, but without any recognized standards of measure, these tools are more valuable for marketing than anything else."

In particular, Pick believes it is essential to develop a tool to demonstrate professional management competence -- a tool that will complement current facility accreditation programs and related licensure programs. This is the premise upon which the ACHCA has formed a task group and advisory council to spearhead the development of a subacute certification for administrators. Pick, who chairs the ACHCA Subacute Task Group, explains it this way:

"It is our responsibility to evaluate and offer opportunities to enhance the knowledge of administrators who manage subacute services. The certification of an administrator will validate that this individual has demonstrated the knowledge and skills necessary to properly manage subacute services. While JCAHO and CARF can evaluate whether an institution has the systems and infrastructure to provide quality subacute programs, the certification exam will focus on the abilities of the individual responsible for managing these programs. This certification program will offer an additional dimension for evaluating quality."

He adds that, for those pursuing careers in subacute care management, completing the certification program will provide them with a competitive edge in climbing to the top of their career ladders.

ACHCA's interest in formulation of a certification exam began with the recognition of a lack of any consensus on who is qualified to manage the delivery of subacute services. ACHCA initiated a preliminary review of this area and, based on the results, concluded that both consumers and professionals would welcome the development of a certification program. Included in this group are managed care organizations (MCOs), which are increasingly interested in efforts to document quality. More and more MCOS require accreditation as a prerequisite for contracting. In turn, these organizations are embracing their own form of accreditation by groups such as the National Commission on Quality Assurance (NCQA) and JCAHO. For an MCO, NCQA or a comparable accreditation is, in many instances, a competitive advantage in securing large commercial contracts and becoming more desirable to enrollees. As part of this accreditation process, MCOs are encouraged to credential their providers. Clearly, a subacute certification program for administrators would be of value here.

ACHCA formed an advisory council of professionals that comprises an array of disciplines involved in subacute care. The council's purpose was to lay the groundwork for the development of an exam. The council includes: John Anderson, FACHCE, Vice President, Fairview Foundation; Maureen Barry, Case Management Consultant; Kevin Cornish, Manager, Post Acute Care Consulting, Ernst & Young; Mark T. Gibson, Vice President, Professional Development, Lifecare Centers of America; Laura Hyatt, President, Hyatt & Associates, Janice Knebl, DO, University of North Texas Health Science Center; Christine McDonnell, Director, Medical Rehab Programs, CARF; Eli Pick, Executive Director, Ballard: A Healthcare Residence; John Quinn, Haber & Quinn Public Relations & Marketing; Ruth Rothstein, Chief Executive Officer, Cook County Hospital; Joel Shalowitz, MD, Professor, Director, Health Services Management Program, Northwestern University; and Mary Tellis-Nayak, Director, Long Term Care Accreditation Services, JCAHO.

The council began by discussing the selection of a vendor to develop an exam and identifying criteria for the exam. The criteria will recognize the existing professional licenses and certifications of other disciplines. This is a crucial element in the subacute certification process. Establishment of a mechanism that recognizes the achievement of professional certification in one's own discipline and its relevance to subacute care is a core component to this exam. The exam is in the development phase and is anticipated to be completed in May, 1997.

This certification will be available to a varied group of qualifying professionals, including skilled nursing facility and hospital administrators, physicians, registered nurses, and respiratory, physical, occupational and speech therapists. According to Eli Pick, "The certification exam will be a rite of passage for administrators as well as allied health management professionals who are involved in the delivery of subacute services and are seeking to enhance their skills."

This has created a unique opportunity for providers of subacute products and services to become sponsors of the certification program. They would include a wide variety of companies and organizations seeking to enhance their presence in the subacute care field: manufacturers, distributors, contract service providers, professional service providers, temporary staff agencies, and medical suppliers.

Subacute certification will be available to subacute program administrators and managers throughout the United States. With the support of influential, well-respected professional organizations such as ACHCA, trade organizations and involvement of a number of high-level individuals representing a broad array of health care professions, this partnership opportunity offers extensive benefits for everyone concerned.

In short, long-term care is going through a metamorphosis. During these difficult times, organizations need to take action to provide clarity, not more confusion, and to work toward collaboration instead of competition. This certification process is a step toward a cooperative effort that will serve to further define and enhance the post-acute care industry.

To take advantage of this opportunity, interested parties can contact the American College of Health Care Administrators (ACHCA) toll-free at [phone].

Laura Hyatt is president of Hyatt & Associates in Los Angeles, California, and a national expert on health care strategic planning. She is the author of Subacute Care: Redefining Healthcare. John Quinn, a principal in the Miami public relations firm Haber & Quinn, has more than 10 years of experience in health care, including long-term care and subacute care services. Both Hyatt and Quinn are members of ACHCA's Subacute Credentialing Advisory Council.