This blog post is hidden because you have chosen to ignore GailL1. Show Details
This blog post is hidden because you have submitted an abuse report against it. Show Details
My mother had a stroke on a Monday. She is deaf and she became unable to speak or read and she was disoriented to some degree. I took her to the emergency room and after test was diagnosed with a stroke - she was admitted to the hospital at 6:30 pm on Monday.
The hospital/doctor wanted to transfer her to a SNF for rehab on Thursday but I told them I know about the 3-day (72 hour Medicare rule) and she would not have that time in until Thursday evening at 6:30 pm - plus the Medicare book says they do not count the day of discharge. Because of this Medicare (CMS) rule - my mother had to stay that extra (at least) one day in order for Medicare to cover the SNF Rehab.
They told me there was no clinical reason for her to stay that extra day - I told them, last I looked ( at 6:00 pm on Thrusday) she still had an IV going with B complex vitamins and a catheter in. They finally said they would just leave her til Friday - she finally got transferred about 3:00 pm on Friday.
I thought I would do some research and sure enough I found this 2005 letter to Medicare from the LCOG concerning this very subject. I'm reprinting it below in bold italics since I had a round about way of finding the PDF file.
I am offering this as how this interference between doctor and patient by Medicare increases the cost for all of us. WHY ? ! I can tell you that if the doctor and patient were more in charge and / or if it was partly the patient's nickel, stuff like this would be corrected .
It is STILL in the 2012 Medicare Rules - hey, sorry to cost you taxpayers this money but HEY, IT IS THE MEDICARE RULES !!!
Also, it pays to know the RULES backwards and forwards -
April 28, 2005
Dr. Mark McClellan, Administrator
Centers for Medicare and Medicaid Services
7500 Security Blvd.
Baltimore, MD 21244-1850
RE: Medicare’s Three-Day Prior Hospital Stay Rule
Dear Dr. McClellan:
On behalf of the Board of Directors of Lane Council of Governments (LCOG), the policy body for the Area Agency on Aging for Lane County, Oregon, I write to urge the Centers for Medicare and Medicaid Services (CMS) to amend Medicare’s three-day prior hospital stay rule. This rule, which establishes one of the
conditions upon which Medicare payment for skilled nursing facility (SNF) care hinges, is out of date. It was designed for a different era; health care procedures and technologies have advanced significantly over the past 40 years. Payment methods for medical care, including hospital care, are different, as well. As a result of these advances and changes, lengths of stays in hospitals have dropped significantly. Unfortunately, the three-day prior stay rule has remained unchanged,
making it progressively more difficult for Medicare beneficiaries to gain access to Medicare coverage to pay for needed skilled nursing facility care.
A hospital inpatient admission is no longer the sole marker of a significant decline in health status. An example of a condition that in the past would have resulted in an extended hospitalization is a stroke. At the time that Medicare was enacted, stroke victims would likely have remained hospitalized for at least four days, and
perhaps many more. Now, patients may be released from the emergency room after a stroke. But, these patients still need rehabilitation. We believe that patients whose conditions warrant skilled nursing care should have the option of a Medicare-paid stay at a SNF even if, and perhaps especially if, medical advances
have shortened their need for acute hospitalization. For these reasons, we urge CMS to drop Medicare’s antiquated three-day prior hospital stay rule and, in its place, use the following criterion to trigger Medicare payment for skilled care in a nursing facility: that the patient has experienced a significant change in condition which requires sub-acute skilled nursing care.
As I am sure you are aware, in 1989 the Health Care Financing Administration and Congress concluded that the three-day prior stay rule should be eliminated. Several months later, the Omnibus Medicare law that ended the rule was rescinded
due to protests about unrelated changes in Medicare premiums. Although the wisdom of eliminating the three-day rule was not questioned, the issue has not been revisited. LCOG urges CMS and Congress to, once again, study this issue and embrace the solution we propose above.
We wish to thank you in advance for your willingness to address this issue.
Gary Williams, Chairperson
LCOG Board of Directors"