75% rule!!!!

sonsonly · Jul 5, 2005

Jack, Hi, my name is Laura Jones. I am a RN pursuing my BSN through University of South Alabama. I am working on one of my final projects for my degree and would appreciate your help. I am to have a discussion with a nurse that is working in the area I completed my practicum (which was rehab). It has to be in another region of the country. (I see you live in Pennsylvania) Would you please share with me who you are, where you work and what the current protocols for fall precautions are at your facility. Does your hospital use bed alarms, wheelchair alarms, vail beds, something else? Do you use hip protectors at your facility, if so, on which patients? Please provide any other information concerning fall precautions that you think I might like to know. Thank you so very much for your help! It is greatly appreciated! Laura

Also, when doing my practicum at two different rehab hospitals, both were already attempting to comply with the 75% rule. They discussed the diagnoses of the possible new admits and elected not to take some, because they felt Medicare would not deem them appropriate.

One of the conditions -routine total knee and routine hip- must fail outpatient therapy before being eligible under the 75% rule. I think orthopedic surgeons in our area will be ordering more outpatient therapy, then when the patient fails and has to have surgery they will meet the guidelines. Unfortunately, this will probably cost Medicare more in the long run. I know this rule is a very big concern for the Rehab docs in Baton Rouge.

rncrrncws · Feb 2, 2006

75% rule /CMS-13 will be the death of may rehab hospitals. Still a great deal of politics and trying to get the ruling changed, if it isn't changed many of the Rehab Hospitals will be forced to close. That is sad.

PooterPT · Sep 16, 2006

The 75% rule certainly does make things tense at times. I am PPS nurse at rehab hospital and these new regs keep me hopping. Our census has been up and down at times as we try to stay above the 60% mark. We are hoping they will extend the time where we can do 60% rather than 75%. As we get used to the new criteria we will become more adept at looking for patients who fit the CMS and also at the comorbidities that help to make them fit.

Wellness RN · Nov 6, 2006

I've got a quick question. Does anyone know specifically which 13 diagnoses medicare will count towards the 75%? Can't seem to find them. Thanks! Sue

bewell · Nov 6, 2006

I am a rehab nurse in Missouri. We too have been hit by the cuts-hard!! We have a 20 bed unit, and since May `06 average 4-5 patients. We have become the new float pool at my hospital. It is really sad for patients that could benefit from our services-but dont "qualify". We are also getting patients that shock us to be on a rehab floor. Scary times:uhoh3:

kcisofnursing · Nov 10, 2006

I work in acute rehab facility. Everyone is being hit hard but to date we have maintained census but patients are very sick coming to us. PIC Lines, codes, etc. I predict allied health will be at bedside in ICU and inpatient rehab will vanish.

Rehab is not a hotel for sure...we would expect more from hotel. Reimbursement policies make it impossible to service appropriately.

oramar · Nov 20, 2006

You know what saved my rehab unit, bilateral knees! Our ortho unit has had a doubling or trippeling of the number of bilat. knee surgeries, which by in large come to rehab. They qualify automatically for admission to rehab unit where as single knees really have to fight to get admitted. That is the situation for time being. I would not be surprised in the future if bilat. knee situation reimbursement rules changed. How in heck all these people in late 70s and early 80s could go straight home after 3-5day acute inpatient stay is beyond me considering they can hardly move.

But I would not be surprised if medicare and other insurances suddenly announced bilat knees do not qualifty.