A 23-bed "sub-acute" unit for patients too ill to go home may open within Howard County General Hospital under a proposed joint venture between the hospital and the management firm of Lorien Nursing & Convalescent Home.
If the venture is approved by county and state health officials, it would allow the hospital to offer a transitional level of care for patients who don't need acute care but who are not well enough to go home.
"We really feel this fills the gap," said Steven Cohen, executive vice president and chief operating officer of Howard County General Hospital.
Maryland Health Enterprises, which oversees the Lorien nursing home on Cedar Lane in Columbia, wants to transfer 23 comprehensive care beds to a second-floor unit at Howard County General Hospital. The beds would be owned and operated by the hospital.
The proposed unit would serve "medically stable" patients who need rehabilitation for problems such as fractured hips, joint replacements or strokes. Patients could stay up to 60 days, but organizers expect the average patient to stay about a month.
Patients now leave the hospital within days of an operation to return home or a skilled nursing facility. Some have insurance for a home health aide.
With the proposed unit, doctors would place medically fragile patients in the hospital's sub-acute care facility while referring healthier patients to Lorien's 38-bed unit.
"We see the two units working in tandem," said Louis Grimmel, chief executive officer of Maryland Health Enterprises. He added: "Howard County will become a model for other communities."
Thirteen hospitals in the state offer sub-acute care.
In Howard County, only Lorien nursing home offers that care.
As health insurers limit the number of days patients may stay in hospitals, health care providers are searching for ways to deliver high-quality care in a lower-cost setting. Sub-acute care is one alternative.
"The simple fact is, a lot of these efforts are driven economically," said Mr. Cohen, adding, "There's going to be increasing pressure to place patients directly into sub-acute care."
Insurance reimbursement rates for sub-acute beds would be at least 20 percent cheaper a day than acute-care beds, Mr. Cohen said.
He also said that the proposed unit would benefit doctors and patients. Doctors would be more willing to discharge patients to the unit -- as opposed to outside facilities -- because they could trust its standards of care and they could conduct follow-up visits more easily, he said.
For patients, the unit would allow them to stay in the same hospital and deal with the same doctors.
Sub-acute care exemplifies the radical changes the health-care field is undergoing, industry experts said.
"The evolution is how health care is being delivered," said Nancy Fiedler, spokeswoman for the Maryland Hospital Association. "Hospitals are becoming less acute-care facilities. They're providing a full spectrum of services an individual might need."
Before the hospital can open the wing, it must be approved by the county Board of Health and the Maryland Health Resources Planning Commission, a 14-member regulatory agency that governs health care services in Maryland.