Leader Blues

Tuesday, September 04, 2007

TOP STORY >>Medicare cuts hurt therapy at hospitals

Leader staff writer

St. Vincent Rehabilitation Hospital in Sherwood is hopeful a visit from Cong. Vic Snyder, D-Little Rock, might bring about some congressional revisions to the Medicare policy changes, which would result in a drastic decrease in the number of patients receiving in-patient care.

The major federal Centers for Medicare and Medicaid Services’ change St. Vincent Rehab is concerned with is the 75 Percent Rule, which will require that percentage of patients in inpatient rehabilitation facilities to be there for one of 13 medical conditions in order for hospitals to continue to be reimbursed by Medicare.

Rebsamen Medical Center in Jacksonville closed its inpatient rehabilitation unit July 31 after Medicare reimbursement changes significantly reduced the number of patients eligible for admission.

During the past year, Rebsamen’s 20-bed rehab unit had a daily occupancy rate of about eight patients. Rebsamen now redirects those in need of therapy to their outpatient rehab either in Jacksonville or Cabot, or to a skilled nursing facility.

Starting Saturday, 65 percent of St. Vincent’s rehab patients, as well as all other inpatient rehab-facility patients, must fall into Medicare’s 13 categories, which means a drastic change in the patient numbers for hospitals.

According to Debbie Taylor, director of marketing, the categories are “pretty stringent” – stroke, brain injuries, spinal cord injuries, major debilitory illnesses.

“Sometimes we will be able to admit a patient for knee-replacement therapy, but only 35 percent of the time. The others have to go home for home-health therapy or to a nursing home,” Taylor said.

That percentage will increase to 75 percent in two years. Once it is reached Taylor said they hope they will have 20 patients in their 60-bed hospital; the others will have to go to a nursing home.

Ninety-five percent of St. Vincent’s rehab patients use Medicare.

The percentage has been at 60 percent for the last two years with St. Vincent running at a 50 percent occupancy rate.
Taylor explained the change using a typical 70-year-old widow that had a hip replaced.

“Medicare guidelines now don’t consider rehab for a hip replacement as needing in-patient care,” she said. “It makes the patient have to go to a nursing home, where they will stay as long as 30 days and get one hour of therapy a day, and Medicare pay for the costs, compared to a 10-day stay at a rehab hospital where they would receive three hours of therapy a day.”

Taylor said 80 percent of rehab patients are able to return home after therapy because they return to a functioning level of independence.

“The statistics aren’t that high for those that go to a nursing home,” she said. “A short stay here (at St. Vincent Rehab) can make all the difference in the world,” she added.

Medical director Dr. Sean Foley said patients are suffering in Medicare’s attempt to save money. “The patients are not reaching their full potential,” he said.

Lee Frazier, St. Vincent Rehab’s chief executive officer, invited Snyder to tour the hospital’s facilities in order to thank him for his past support and to introduce him to the new technology in use for therapy, like their new AutoAmbulator, an advanced therapeutic walking device the hospital got in late June and the only one in central Arkansas.

“As a physician, he understands and is always supportive of the hospitals and the delivery of care,” Frazier said. “It was nice to reacquaint him with the new technology and what’s available,” he said.