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Thread: Threat to SCI inpatient rehab

  1. #1
    Junior Member
    Join Date
    Sep 2003
    Shickshinny PA USA

    Threat to SCI inpatient rehab

    CMS 75% Rule and Veritus proposed rules

    We are contacting you to update you about the most recent Centers for Medicare and Medicaid (CMS) proposal for acute inpatient rehabilitation facilities like Magee. CMS is threatening to tighten the national rules for administering Medicare funds. These more restrictive rules would limit the availability of acute inpatient rehabilitation for patients who previously would have been served In addition, the local regulators for the distribution of Medicare funds for patient care (Veritus) have proposed a new and highly restrictive set of rules governing their approval of acute rehabilitation. The highly restrictive Veritus rules will place additional restrictions on eligibility for acute rehabilitation.

    For acute rehabilitation hospitals or units, there are now two issues. The first is that CMS (Medicare) proposes to drastically decrease the number of patients who will be allowed treatment in acute rehabilitation hospitals. The new regulations (referred to as the "75% Rule") will phase in this decrease over the next three years, but the overall result is that many patients who currently come to acute rehabilitation hospitals like Magee will be sent home or to nursing homes after their illness, injury or surgery. CMS estimates that they will reduce payments for rehabilitation by $223 million dollars through these limitations to care.

    On August 21st, providers utilizing the Medicare financial intermediary Veritus received an unexpected notice of proposed changes to the Veritus guidelines for acute rehabilitation. (The financial intermediary coordinates approval and payment for care provided to Medicare beneficiaries.) These guidelines propose to deny Medicare payment for acute inpatient rehabilitation for a number of conditions that are currently covered, including joint replacement. Patients with diseases such as multiple sclerosis will not be allowed to return to rehabilitation for strengthening after an acute hospitalization. Similarly, individuals with spinal cord injury will not be allowed to return for additional rehabilitation following illnesses. Individuals with stroke, spinal cord injury, brain injury and other incapacitating injuries will not be allowed access to acute inpatient rehabilitation unless they meet stringent guidelines concerning decreased function. Veritus urges the use of acute care, nursing homes and long term acute care hospitals for the care of many patients who currently come to acute inpatient rehabilitation. One of the differences between these alternative settings and the services provided at facilities like Magee is the number of hours of therapy that patients receive. By definition, acute rehabilitation settings must provide at least 15 hours of therapy to the patient over each 7 day period. Other settings are required to provide only one-third to one-half this number of therapy hours. Acute inpatient rehabilitation facilities (like Magee) provide the highest number of therapy hours per day, and as a result, send patients home sooner and at a higher level of functioning than the proposed alternatives.

    CMS and Veritus are both attempting to reduce Medicare coverage for acute rehabilitation. If these changes are enacted, they will seriously limit access to services provided by acute rehabilitation settings. The timelines for comment are tight: Veritus is inviting comment until November 17th, with a proposed implementation date of December 3, 2003. CMS is inviting comment until November 3, 2003, with an anticipated implementation date of January 1, 2004.
    Your efforts to communicate with Congress, CMS and Veritus are critical!

    PLEASE NOTE: I received this as an e-mail attachment from the Magee Center this morning. Under "medicare" in this forum, Dr Young has a post regarding this issue with the emphasis on the elderly. However, the Magee Center, a regional SCI center in the NE USA, is taking this as a particular threat to SCI survivors and to the livelihood of their center. As per Magee's accompanying explanation:

    "People with SCI will not be allowed to return for additional rehab following illnesses.

    People with SCI, stroke, brain injury, and other incapacitating injuries will not be allowed acute inpatient rehab unless they meet stringent guidelines concerning decreased function.

    People who currently come to Magee for reasons listed above will be forced to go to acute care nursing homes, significantly reducing their amount of therapy time."

    The following is a letter, wording by Magee, to send to the administrator of medicare/medicaid services. My son is hoping to go to Magee for a "tune-up" after his hardware removal surgery, so this could directly effect him.

    October 7, 2003

    Centers for Medicare and Medicaid Services
    Department of Health and Human Services
    Attention: CMS-1262-P
    P.O. Box 8010
    Baltimore, Maryland 21244-8010

    Dear Administrator Scully:

    I am writing to you as a concerned citizen. The Centers for Medicare Services (CMS) has recently said you will begin to use a new interpretation of the "75 % Rule" and aggressively enforce its interpretation. This proposed rule will jeopardize Medicare recipients' and others' access to needed inpatient rehabilitation care. The proposed contingencies for Medicare funding will limit rehabilitation hospitals' ability to deliver healthcare to the most vulnerable people that they serve.

    Rehabilitation hospitals serve this community and are committed to caring for their patients. But with this proposed " 75% Rule", they may no longer be able to provide much-needed inpatient rehab care to our community. I see the role inpatient rehabilitation plays in returning my friends and family members to their homes after illness, surgery or injury. If their doctors recommend it, I strongly urge you to continue to permit patients with joint replacements, as well as those with cardiac and pulmonary issues, the ability to access inpatient acute rehabilitation. Individuals I know and care for are living independently in the community because of the acute inpatient rehabilitation they received. I feel strongly that others should be afforded this same opportunity.

    I would like you to place a moratorium on the implementation of any version of the 75% rule, until the Institute of Medicine has conducted a thorough study of the issue, and provides recommendations concerning appropriate next steps. A moratorium to allow this independent review will be a clear indication that CMS is invested in good outcomes for Medicare beneficiaries.


    [This message was edited by MomDonna on 10-17-03 at 10:49 AM.]

  2. #2
    They're planting a cabbage patch; we're the vegetables. This is a huge waste of potential...

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