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PTA Blog Talk

A New Scenario

Published October 31, 2013 10:02 PM by Jason Marketti

Let's suppose a surgeon defines a technique that allows total joint replacements to leave the hospital sooner than three days. The patient will not qualify for Medicare Part A coverage in a SNF, so the patient is sent home. Home health nurses and therapists will suddenly be overextended, as will outpatient facilities. The SNF units will see a significant decrease in residents and loss of revenue while therapists will leave that sector of healthcare and go where the patients are.

One proposal I have read about is to eliminate the CMS rule of the three-day qualifying stay to be eligible for Medicare Part A coverage in a SNF. It has been tried before, but according to CMS there wasn't a significant savings and at the time there were not enough patients using Medicare Part A. Now there are, so maybe a rule change would be a good idea. It could take years before it would go into effect though.

Ultimately it is the MDs who dictate when patients go home from a hospital setting and as more MDs become hospital employees, there may be a push for patients to leave before they could qualify for the three-day stay. This would be a business decision by the hospitals so they would not be penalized for readmissions. But the hospitals already have a way around the penalty, it is called "observation beds." Patients are not re-admitted to the hospital, just observed there. And since the patients are not formally admitted, there would be no decrease in payment for services. There is talk to get rid of the observation bed loophole too.

If a patient has a total knee surgery, stays two days in the hospital and is then discharged to an observation bed for another 48 hours, then discharged to home health, would the hospital be in compliance with the Office of Inspector General? The patient would not qualify for Medicare Part A and would still be assessed appropriately by medical personnel. I wonder if that would be legal under the rules CMS has laid out for us. The hospitals could ultimately open their own transitional care units and keep the profits CMS doles out for therapy services. Either way, hospitals will want to be profitable and will adapt to any rules so they can ensure their doors will remain open. By the way, happy PT Month.

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2 comments

I've seen a lot of patients go to a hospital and not admitted and stay a day or two.  If short term profits are more important than patient care then your scenario may not be all that off base.  I just haven't seen it done, yet.

karen November 3, 2013 11:37 AM

I haven't heard anyone discuss the scenario you propose: 2 days as an admitted patient then 2 days in an observation bed. I don't think one can do that as the observation beds are used when no admission has taken place, not afterward. The NY Times just had this article on this topic this week:

http://newoldage.blogs.nytimes.com/2013/10/29/two-kinds-of-hospital-patients-admitted-and-not/

A timely topic which we all need to be well versed on.

Dean Metz November 1, 2013 12:23 PM

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