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Thread: Medicare change could cut down on ability to get rehab

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    Medicare change could cut down on ability to get rehab

    Medicare change could cut down on ability to get rehab
    By ANITA SRIKAMESWARAN
    Pittsburgh Post-Gazette
    October 22, 2003

    - Rehabilitation experts and their patients say a proposed change to a Medicare rule could prevent many seniors from getting the inpatient therapy that helps them return to independence after major medical interventions.

    Patients recovering from heart surgery or hip fractures, for instance, could find it difficult to obtain inpatient rehab services.

    The Centers for Medicare and Medicaid Services, a federal agency known as CMS, proposed the change last month, a modification of what was known as the 75 percent rule. For two decades, Medicare has provided inpatient rehab for patients with 10 qualifying conditions, including stroke, spinal cord injury, amputations, burns and brain injury. Patients with other conditions could receive inpatient rehab only if 75 percent of the other patients in the hospital were admitted with one of the 10 qualifying conditions.

    The rule was inconsistently enforced, however, and CMS suspended its enforcement last year. Now the agency is proposing that 65 percent of a rehab hospital's admissions for inpatient care must fall into one of 12 diagnostic categories, before switching back to the 75 percent standard in two years or so.

    A CMS spokesman said that inpatient rehab centers are reimbursed at higher rates than other kinds of facilities and the agency wants to be sure that patients treated there do indeed require intensive services.

    Although less stringent than the old 75 percent rule, the proposed rule nevertheless is narrow and unrealistic, critics say.

    Whenever a rule change is proposed, "people don't like the eligibility criteria, the amount we're going to pay and so on," a CMS spokesman said. "But we are charged to make sure we get the maximum our of Medicare resources for beneficiaries."

    Rehab industry officials are calling for a moratorium on the proposed rule until a study is conducted and recommendations are made by an independent body, such as the Institute of Medicine.

    Dr. Ross Zafonte, vice president of University of Pittsburgh Medical Center's clinical rehabilitation services, said that the original diagnostic categories were adopted at a long-ago brainstorming meeting and have been dogma ever since.

    "They are not based in science and they have not been updated in over 20 years," he said. They do not include organ transplants, for instance.

    The implication of the proposed rule is that patients with nonqualifying conditions will do just as well with outpatient or less intensive services, but there is little scientific evidence to support that view, Zafonte said. Denying patients inpatient rehabilitation services is akin to forcing a cardiac patient to accept a cheaper, less effective treatment than what has been proven to be the best possible care, he said.

    Richard Nagel of Overbrook, a current patient at UPMC Rehab, said he arrived at the hospital a few weeks ago after back surgery with "floppy legs" that prevented him from walking. Now, the "over 65"-year-old can stroll outside on uneven terrain and can go up and down 10 steps. He expects to regain even more independence with time.

    "To deny that (opportunity) to other people is horrendous," Nagel said. "If I went into a nursing home and (had) not had the good therapists, I wouldn't be where I'm at."

    CMS is accepting public comments on the rehab proposal before a final decision is made. Send one original and two copies of comments to the Centers for Medicare and Medicaid Services, Department of Health and Human Services, attn: CMS-1262-P, P.O. Box 8010, Baltimore, MD 21244-8010. Letters should refer to file code CMS-1262-P and must be received by Nov. 3.


    http://www.knoxstudio.com/shns/story...0-22-03&cat=AN


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    (Distributed by Scripps Howard News Service, http://www.shns.com.

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    Senior Member Max's Avatar
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    Are Medicare's proposed rules for inpatient therapy too narrow?

    Are Medicare's proposed rules for inpatient therapy too narrow?

    By ANITA SRIKAMESWARAN, Pittsburgh Post-Gazette
    October 23, 2003

    Rehabilitation experts and their patients say a proposed change to a Medicare rule could prevent many seniors from getting the inpatient therapy that helps them return to independence after major medical interventions.

    Patients recovering from heart surgery or hip fractures, for instance, could find it difficult to obtain inpatient rehab services.


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    The Centers for Medicare and Medicaid Services, a federal agency known as CMS, proposed the change last month, a modification of what was known as the "75 percent rule." For two decades, Medicare has provided inpatient rehab for patients with 10 qualifying conditions, including stroke, spinal cord injury, amputations, burns and brain injury. Patients with other conditions could receive inpatient rehab only if 75 percent of the other patients in the hospital were admitted with one of the 10 qualifying conditions.

    The rule was inconsistently enforced, however, and CMS suspended its enforcement last year. Now the agency is proposing that 65 percent of a rehab hospital's admissions for inpatient care must fall into one of 12 diagnostic categories, before switching back to the 75 percent standard in two years or so.

    A CMS spokesman said that inpatient rehab centers are reimbursed at higher rates than other kinds of facilities, and the agency wants to be sure that patients treated there do indeed require intensive services.

    Although less stringent than the old 75 percent rule, the proposed rule nevertheless is narrow and unrealistic, critics say.

    Whenever a rule change is proposed, "people don't like the eligibility criteria, the amount we're going to pay and so on," a CMS spokesman said. "But we are charged to make sure we get the maximum our of Medicare resources for beneficiaries."

    Rehab industry officials are calling for a moratorium on the proposed rule until a study is conducted and recommendations are made by an independent body, such as the Institute of Medicine.

    Dr. Ross Zafonte, vice president of University of Pittsburgh Medical Center's clinical rehabilitation services, said that the original diagnostic categories were adopted at a long-ago brainstorming meeting and have been dogma ever since.

    "They are not based in science, and they have not been updated in over 20 years," he said. They do not include organ transplants, for instance.

    The implication of the proposed rule is that patients with nonqualifying conditions will do just as well with outpatient or less intensive services, but there is little scientific evidence to support that view, Zafonte said. Denying patients inpatient rehabilitation services is akin to forcing a cardiac patient to accept a cheaper, less effective treatment than what has been proven to be the best possible care, he said.

    Richard Nagel of Overbrook, a current patient at UPMC Rehab, said he arrived at the hospital a few weeks ago after back surgery with "floppy legs" that prevented him from walking. Now, the "over 65"-year-old can stroll outside on uneven terrain and can go up and down 10 steps. He expects to regain even more independence with time.

    "To deny that (opportunity) to other people is horrendous," Nagel said. "If I went into a nursing home and (had) not had the good therapists, I wouldn't be where I'm at."

    CMS is accepting public comments on the rehab proposal before a final decision is made. Send one original and two copies of comments to the Centers for Medicare and Medicaid Services, Department of Health and Human Services, attn: CMS-1262-P, P.O. Box 8010, Baltimore, MD 21244-8010. Letters should refer to file code CMS-1262-P and must be received by Nov. 3.





    http://www.knoxnews.com/kns/national...368925,00.html

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