Care that produces the best clinical outcome for the patient in the least amount of time with the lowest risk. Triad Healthcare, Inc. manages care by condition severity and patient outcomes.

The treatment necessary to establish a stationary status of the patient at maximum therapeutic benefit. That phase of therapeutic care necessary for re-education or functional restoration of an injured body system or part. It includes treatment that relieves an exacerbation, but there must be continuing documented subjective and objective signs of improvement. Guidelines for the management of therapeutic/rehabilitative care are integrated into the TRIAD Severity Index Matrix, except where noted within this document. Therapeutic care must produce minimal improvement in patient comfort and function of at least 30% within any thirty day period to be considered medically necessary.

Care that is rendered to a patient whom is asymptomatic. Care is determined to be for wellness or preventive to maintain good health with no symptoms.

Supportive and/or Sub-Acute Care is defined as treatment / care for patients having reached maximum therapeutic benefit, where periodic trials of therapeutic withdrawal fail to sustain previous therapeutic gains that would otherwise progressively deteriorate. Supportive and/or Sub-Acute care follows appropriate application of active and passive elements including lifestyle modifications. It is appropriate when rehabilitative and/or functional restorative and alternative care options, including home-based self-care and lifestyle modifications, have been considered and attempted. Supportive and/or Sub-Acute care may be inappropriate when the risk of Supportive and/or Sub-Acute care outweighs its benefits, i.e. physician dependence, somatization, illness behavior or secondary gain.

Supportive and/or Sub-Acute Care for chronic painful conditions of the musculoskeletal system recognizes that the underlying condition is either permanent in nature or has a long natural course during which the patient is at risk for painful, debilitating episodes that can be minimized or eliminated by Supportive and/or Sub-Acute care. Therefore, the goals of Supportive and/or Sub-Acute care are:

1. Establish a credible, practical diagnosis, prognosis and set of patient expectations.
2. Maintain baseline, pain and function with minimal deviation.
3. Provide the safest form of care possible.
4. Provide as little passive care as possible.
5. Educate and counsel the patient to use as much appropriate self-directed, active care as possible.

Supportive and/or Sub-Acute care should be requested only after a patient has reached maximum therapeutic benefit, has been fully educated on appropriate self care modifications to daily activities and work activities and has reported increased pain and/or functional loss after a period of withdrawal from care.

The use of CMT, active physical procedures and patient education is appropriate in providing Supportive care. The expected frequency and intensity of care should be much less than is typically required for therapeutic care. The expected duration of care is much longer.

Supportive and/or Sub-Acute care must be requested using an Extension of Care form. This form is completed similarly to when you are requesting continued therapeutic care, except you must check "Supportive and/or Sub-Acute Care" in type of care field as well as checking the appropriate box for the desired duration of care. Unlike therapeutic care, Supportive and/or Sub-Acute care requests will be approved for periods exceeding thirty days. Periods of up to 180 days will be approved before another Extension of Care is required.