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Toni Talks about PT Today

My Patients Are Sicker Than Ever

Published June 10, 2015 3:12 PM by Toni Patt

We're all well aware of the fattening of our patients. Years ago facilities rented bariatric equipment. Now they own it. Obesity compounds other medical problems as well as interfering with mobilization, and the trend continues. I've noticed another trend that doesn't seem to be getting attention. Our patients are sicker than they've ever been.

My facility has always been known for accepting critically ill patients. But the ones we get now are more dead than alive. It isn't that they're acutely ill. Acuity doesn't always correlate with severity of illness. Some of them have been chronically ill for years. The severity of how ill they are has changed.

Even our "better" patients are in bad shape. Our liaisons aren't going out of their way to find these patients. This is what is in our hospitals. This is what is being discharged. The less severely ill are being sent home.

Nursing homes are also feeling it. I've heard several complaints on the weekends of how the admissions aren't as good as they used to be. Trach patients are much more common.

We can blame our reimbursement structure for some of this problem. In an LTAC, the sicker the patient is, the higher the reimbursement for care we receive. The same is true of DRGs. On the flip side, payers limit the length of stay so the less sick are sent home to be cared for by home health.

The other piece of this puzzle is that patients are living longer and developing more chronic diseases. Combinations of DM, HTN, renal failure and CHF pack quite a wallop, especially if they're not well controlled. I can't remember the last evaluation I did that didn't list something in the past medical history as out of control.

It isn't going to get better. It is the way things are now.

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"On the flip side, payers limit the length of stay so the less sick are sent home to be cared for by home health."

And as a result of this statement, we PTs in home health are seeing sicker and sicker patients, which leads to higher chance of hospital readmission, for which we ultimately get dinged. And so it goes......

Healthcare is a disaster in this country!

Bryce Williams July 9, 2015 8:51 PM

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July 1, 2015 11:17 AM

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