Obamacare affect on LTC

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    I was sent to a training seminar this week. "assessment training". Some of this training was the trainer talking about obamacare and what it means to "us". I am wondering how many other facilities are already taking steps to "deal" with the new issues and exactly what steps are they taking?

    She told us as of Oct 1st the hospitals will have to give free care to anyone we have to send back to them for five specific diagnoses if that diagnosis is what they were there for in the first place and it is within 30 days of their discharge. We are required to be able to maintain these patients or improve them. If we have to send people back the hospitals are not going to keep sending us any patients because we will be costing them money. We are not really LTC anymore even if the people coming to us are not "rehab and send back home" patients.We are more like med surg units now. Yeah med surg with LTC nurse to patient ratios. It is already a nightmare, I can hardly wait for it to get even "better" with NO LTC patients and ALL med surg filling my 25 beds.

    She also said that we are going to be pushing hard and fast to get out of LTC altogether and be strictly rehab because there is a 28% cut to medicare and it will no longer be profitable to take these patients and most likely we will not even be able to break even on them. (Well this explains why we have been cut to the bone on staffing, having people called off, nurses working as aids, not allowed to have any overtime, told to clock out and go finish our work after we clock out crap)

    We are also going to be losing Dr's willing to treat them because they will not make any money either. Without Dr's willing to treat we obviously cannot take those patients in.

    Well where ARE they going to go? She had nothing to say about what will happen to all these medicare patients nor the medical assistance patients that are taking an even bigger cut. She said 50% cut for them! Is there some kind of provision in Obama's plan to deal with millions of medicare patients and no facilities or Dr's willing to treat them?
    lindarn likes this.
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  3. 4 Comments so far...

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    Within Obamacare there is funding provided for education for healthcare professionals. Some of those provisions were already in place before Obamacare. However, people are less likely to want to become a healthcare professional because of the ACA.
    One survey finds that "only 11 percent of doctors are likely to recommend the medical profession to their children or other family members due to health care reform." The Future of Health Care | The Doctors Company
    I don't know of anything in Obamacare that provides for the additional facilities. I could be wrong. Of course, why build more facilities if there is no one to care for the patients in them?
    lindarn likes this.
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    I sincerely hope that Obamacare's changes to LTC reimbursement are coupled with concrete staffing ratios. Med-surg level patients need med-surg level staffing and resources. What kind of med-surg unit has a 1:30 nurse/patient ratio?

    Short staffing and lack of supplies are why many nurses refuse to work LTC. Sane ratios (maybe 1:7-10) would result in better patient care, and would attract more nurses to LTC.
    Susie2310 and lindarn like this.
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    I don't mean a provision to build more LTC facilities. I mean some other kind of provision that would provide incentive for facilities to continue to take medicare patients in or increased funding for families to keep their family members at home with them since there are going to be less and less LTC facilities willing to take medicare patients. WHO is going to take care of all these people is my biggest question? HOW and WHERE next?

    MY facility is CALLED a LTC facility with a Rehab unit. That is not REALLY the type of patients they are bringing in to us! They are coming to me 3-5 days post op for example. The REALITY is these patients are med surg patients not rehab and definitely not LTC! The "rehab" unit has 30 beds in it and my hall "rehab overflow" soon to be all rehab also has 25 beds. I have a mix of patients and I am the only nurse down this hall on 3-11.I currently have an "isolation" room that is used for C-diff, VRE, shingles etc patients. If we need more than one they shift patients so they can put a second isolation patient in my hall. (Like now) I have a shingles in one and VRE in another. They can be hospice, LTC or rehab patients any given week. I have 3 hospice patients right now. I have 6 LTC and the rest are "rehab" Part of the problem is some of my "rehab" patients are still not going to be be able to go home after we "rehab" their current injury/ illness. some of them will still need to be transferred to LTC after they are done with me due to dementia or other underlying problems that are not rehab-able. yes one nurse for all 25 of these patients and I can tell you it is a nightmare.

    More often than not the actual rehab unit also only has one nurse on the 3-11 shift and none of those patients are LTC.
    lindarn likes this.
  7. 3
    After 2011's 11% Medicare cut, SNF's will be getting an 1.8% increase Oct.1st, 2012.

    What every one is bracing for is the Accountable Care Act's penalties for excess readmissions and Quality care initiatives.

    Overall Medicare cuts to beneficiaries are not happening,


    [FAQ: Decoding The $716 Billion In Medicare Reductions

    ...Hospital reimbursements would be reduced by $260 billion from 2013-2022, while federal payments to Medicare Advantage, the private insurance plans in Medicare, would be cut by approximately $156 billion. Other Medicare spending reductions include $39 billion less for skilled nursing services; $66 billion less for home health and $17 billion less for hospice. The law does not make any cuts to the amount of benefits beneficiaries receive and adds some new benefits, including closing the "doughnut hole" gap in Medicare prescription drug coverage, and new preventive services, such as an annual wellness visit with a physician.
    [/h]

    Medicare To Penalize 2,211 Hospitals For Excess Readmissions
    The new penalties are based on data for three health conditions: heart attack, heart failure and pneumonia that have patients readmitted to hospital within 30 days of discharge.

    Hospitals are looking at ways to cut costs. Referring to home care is one option, but 30% patients are readmitted within 30 days. So looking at SNF's to discharge clients to is very attractive. SNF's have to prove themselves with quality care, low transfer rates back to hospitals and improved functional scores.

    SNFs Facing an $800 Million Bludgeoning in Medicare Cuts Under Balanced Budget

    Between FY 2012 and FY 2021, SNFs are expected to absorb at least $3 billion in new cuts thanks to “bad debt” provisions contained in the Middle Class Tax Relief and Job Creation Act of 2012, and overall, the industry is already slated to absorb $48 billion in funding cuts in that same window.

    How Advancing Excellence is Reducing Hospital Readmissions

    Last edit by NRSKarenRN on Aug 20, '12
    Altra, Susie2310, and lindarn like this.


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