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PTA Blog Talk

Discharged Early

Published May 16, 2012 7:59 PM by Jason Marketti

We recently had another patient who seems to have fallen between the cracks in our wonderful health care system. He was initially in therapy for a variety of medical reasons and then a fracture was discovered in the mid-spinal region. Therapy was held per MD request for about two weeks. When therapy requested orders to resume activity, none were given. Then the insurance company decided it was not going to pay for the patient's stay any longer since he was not making progress with therapy.

The patient was not able to walk more than 10 feet with an assistive device due to pain, and with the MD not giving resume-activity orders, he got weak and had to have more assistance with transfers. The day the patient left, he explained to me his home environment. I knew there would be trouble at home if this man left but away he went. It was like sending him home "against therapist advice." (Is there such a thing?)

The patient was upset that therapy was not involved in the decision-making process about going home. He could obviously see the benefits we offered him but apparently the insurance company couldn't care less about the person's function and how he would be able to move around in a home environment. It reminds me of when Medicare Part A refuses to purchase any ADL equipment for the bathrooms, specifically for THA patients who are at a high risk for dislocation.

They would rather have a patient dislocate a recent surgery than provide a high-rise commode and a bath bench. There is a lot I do not understand about our insurance industry, beginning with how in the world someone decided a patient should be in ARDs, RUG categories, COT etc. and not give the patient what he needs to be safely discharged to home? Maybe "Obamacare" has a point; I don't know, but the current system has failed too many of my patients.


I remember that blog and my mouth fell open when I first read it. Two walkers....thats unheard of here and sometimes its a struggle to get insurance to provide one.  And if they need a 4WW then it really becomes a hassle.  And patients ask me alot if I know a contractor who could install rails and bars.  It would be nice to send people home safely with a minimum of worry.

Jason Marketti May 18, 2012 9:17 AM

I agree completely. Mind you, the NHS has its share of cracks to fall through as well.

That being said, I posted well over a year ago how remarkable it was that I could order a downstairs and an upstairs walker for someone who lived in a two storey home. I have a number of people who require bilateral upper extremity support to walk or climb stairs. We can get a second railing installed and a second walker for upstairs use. That is sure a LOT cheaper than keeping someone in a facility longer! The whole Medicare doesn't pay for bathroom equipment and only one assistive device seems penny wise and pound foolish.

Dean Metz May 16, 2012 3:21 PM

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About this Blog

    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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