Wednesday, August 19, 2009

Medicare ins & outs

Mom is doing better now and has been moved from hospital to a rehabilitation center where she will learn how to maneuver with her full right leg brace in place. She's gutsy and will do fine. I'll head back to Chicago again this weekend to help out. Glad I am only a 2 hour flight away.

In the Medicare system, as in all govt bureaucracies, I suppose, words have a precise meaning for purposes of classification and the transfer of money from the US Treasury. But, often, government-ese has no relationship to reality.

Take, for example, the notion of hospital-centered "observation" vs. "treatment", which came into play during mom's recent hospital stay. In the old system, a patient who arrives at the emergency room is placed in observation so that doctors/nurses can determine whether to admit, so that treatment can begin.

Under new rules, the line blurs between observation and treatment. Now you can be an in-patient under observation, which is what mom was--as they were cat-scanning, x-raying, medicating, and otherwise stabilizing her. They even put a thigh-to-toe leg brace on her while she was in 'observation'.

This matters because different money streams (and rules for hospital and staff compensation) will be used, depending on whether you as patient are under observation or in treatment. From the patient perspective, classification also matters because of follow-up treatments, such as rehab. The Medicare rules stipulate that you must remain in the hospital in treatment for at least 3 (or 4??) consecutive days in order for your post-hospital rehabilitation to be covered by Medicare. So, without divulging personal family details, guess how many days mom was in hospital in 'treatment'? (Hint: a number greater than 2 and less than 5.)

Her care was excellent, and we are very grateful that she is on the road to recovery. She, in fact, needed to be in the hospital for all the time she spent there (well...almost....).

But makes ya think---does it make sense for Medicare to require lengthier (and costlier) hospital stays in orer to qualify patients for critical post-hospital care?

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