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The implications of risk shifting on subacute care providers by payers are enormous. Financially, it will force subacute care providers to strategize on how to deal with capitated arrangements. Strategically, it will provide the impetus for retaining, increasing or losing market share in the health care arena. Philosophically, it will forge a leveling of the playing field among different subacute care sites in terms of average length of stay and pricing.

The key to success in any managed care arrangement is building relationships between the players. Thus, it is imperative that the subacute care provider develop and nurture positive working relationships with MCOs and other sources of referrals. It is no longer enough to have an MCO contract. It is what happens after the contract has been signed that makes a difference on whether or not a subacute care provider can thrive in the managed care environment.

In 1995, subacute care providers focused much attention on program development, marketing, managed care contracting and outcomes measurements. As the move to balance the federal budget continues to occupy center stage in the health care arena, subacute care providers need to rapidly shift gears and develop a blueprint for managing the changing marketplace. Without such a blueprint, subacute care providers may find themselves struggling for survival in the years ahead, instead of strategically positioned to remain competitive.

Accreditation promotes continuous quality improvement of systems that affects the quality of patient care delivered, attains desirable clinical and financial outcomes and strategically positions the subacute care provider in the rapidly changing health care delivery system. Thus, as consumers and purchasers of health care plans continue to demand quality care with the best possible outcomes at significant cost savings, accreditation may become the panacea of the future.

When using an algorithm to make subacute care admission decisions, the staff's uncertainty concerning required resources to meet the patient's needs as well as the anxiety about financial loss are alleviated. A system defining levels of care and scope of practice based on the patient's acuity is described.