The face of health care is changing…hospitals stays are shortened, patients are going home sicker or in need of additional health care services, the population is aging and living longer — which increases the need for additional health care. Health care consumers and providers are looking for quality, cost-effective alternatives to acute care hospital stays.
One of the reasons for this change in the health care environment is the revisions in Medicare rules enforced by Con-gress in 2004 which established new boundaries on the mix of care rehabilitation hospitals can provide and be paid for.
The revision is known as the “75 Percent Rule” and requires 75 percent of a rehabilitation hospital’s patients to have one of 13 qualifying medical conditions. These conditions include severe cases such as brain injuries, neurological disorders, burns and spinal cord injury. The change came about in part for financial reasons. Skilled nursing facilities currently are providing the same quality of intensive rehabilitation services as inpatient rehabilitation hospitals, but at an average cost to Medicare of $500 less per patient per day. The savings to Medicare and the American taxpayer really adds up.
The 13 medical conditions that are used to determine an inpatient rehabilitation hospital’s compliance to the rule include: Stroke, spinal cord injury, congenital deformity, amputation, major multiple trauma, fracture of femur (hip), brain injury, neurological disorders, burns, active polyarticular rheumatoid arthritis resulting in significant functional impairment, systemic vasculidities with joint inflammation, severe or advanced osteoarthritis involving two or more joints, knee or hip replacement, or both.
To meet the demand of where else to place these patients, skilled nursing and rehabilitation centers are changing to offer outcome-focused skilled nursing and rehabilitation services in a homelike setting at a more economical price than an acute care setting.
With this Medicare change, hospitals and skilled nursing facilities are working together to help patients receive the critical rehabilitation services in the most appropriate setting to meet their needs — and in ways that assure coverage by Medicare.
Skilled nursing centers are no longer just traditional long term care settings for the elderly. Patients are younger, with goals of rehabbing back to home. The environment and services are changing to accommodate their needs.
What should patients, families, physicians, hospital
discharge planners or insurers look for when choosing
a skilled nursing center for post hospital care? Many providers can offer well appointed rooms, a variety of services or a pleasing atmosphere. However, when a patient needs short-term rehabilitation to recover from a stroke, heart surgery or a hip replacement, they need to decide on what matters most.
The single most important criteria for selecting post acute medical rehabilitation should be the expertise of the clinical team. Ultimately, it is the physicians, therapists and nurses who will help patients achieve their recovery goals. This selection of a clinical team to guide a patient’s rehabilitation is a critical decision at a critical time. Therefore, before choosing a post-acute provider, consumers should examine the evidence of that provider’s clinical success and its commitment to clinical excellence.
Some points to consider:
• What percentage of patients return successfully to the community?
• How much rehabilitation progress do patients make?
• To what extent are treatment targets achieved?
• When patients are discharged home, to what extent do they feel prepared to manage their care at home?
Outcomes are the true measure of success. Skilled nursing centers and rehabilitation hospitals need to take a comprehensive approach to measuring outcomes in as many areas of post-acute care.
Though many skilled nursing centers exist, consumers must do their research and find a center that is committed to helping patients, referrers and insurers make better post-acute care decisions based on evidence of successful patient outcomes.
In short, like selecting the right physician and deciding on which recommended procedure is best for the patient, ultimately selecting the right fit in aftercare and rehabilitation facilities can greatly affect the outcome for the patient.
This report was prepared for our readers by BCMS Circle of Friends member HCR•ManorCare.
The majority of their centers are branded under the name Heartland Health Care Center or ManorCare Health Services.
They can be reached at 1-800-736-4427.
