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View Diary: Hospital "Observation" Stays Being Used to Deny Medicare Patients Reimbursement Benefits (18 comments)

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  •  As I've posted before on my mom (14+ / 0-)

    They also try to evict them after surgery before they reach 3 days so they don't qualify for the 3 weeks in rehab.  When you've had a joint replacement over the age of 85, 2 days and no rehab is not enough.

    •  Not really (2+ / 0-)
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      FloridaSNMOM, Neuroptimalian

      a hospital has no interest in keeping somebody from qualifying for nursing home rehabilitation. If the patient goes to an outside nursing home, it doesn't touch the hospital's bottom line. If the patient goes to a nursing home affiliated with the hospital, it would actually be in its best interest for the patient to qualify for Medicare, which pays far more than Medicaid, and even more than patients who can't pay their bills.

      The economic factor behind releasing patients has nothing to do with nursing homes. Rather, it is related to how hospitals are paid by Medicare for hospital inpatients, the DRG system. They receive the same amount of money whether the patient is there for 2 days or 10. The factors that keeps patients in, rather than out, are several. First, the doctor releases, not the hospital, so the doctor has to consider his actual professional opinion, as well as malpractice risks. The hospital also has malpractice risk. Now, with new quality of care initiatives, hospitals also risk penalties if patients return to the hospital with infections or other complications that could have been avoided with a longer stay. Not only do they have to provide that care (within the "global period) for no additional money, they also risk losing quality bonuses from Medicare, which amount to quite a lot of money.

      In other words, apples and oranges.

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      by dhonig on Wed Sep 04, 2013 at 12:59:33 PM PDT

      [ Parent ]

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