Explain not admitting an ORIF patient.

[Aeg1075]

Just a basic scenario:

Why would you not admit this patient for a few days and discharge to rehab?

65-70 year old female

prior hx: pacemaker insertion (with known post op complications), high BMI, diabetes type 2.

patient dx: bimalleolar fracture of the right foot.

Patient had foot set in ED incorrectly and was pressure wrapped and sent home with followup to orthopedic surgery within several days

Orthopedic surgery states it was set wrong and resets ankle. Surgery scheduled for 6 days later.

ORIF done outpatient. Pt sent home from recovery with pain meds.

Pt requests muscle relaxer while home. Decreased LOC, ED visit, conclusion is combo of pain meds and muscle relaxer are cause. D/C muscle relaxer.

Post op visit 2 weeks after surgery reveals side ways screw and additional fracture. Pt scheduled to re-do surgery tomorrow. Again, outpatient.

Why outpatient? Patient has terrible environment and not enough support to adequately heal and rest.

[morte, LPN, LVN]

follow the money

[NurseCard, ADN]

Yeah, insurance likely will not pay for an overnight stay for a fractured foot.

That's why.

[Been there,done that, ASN, RN]

An ankle ORIF is not an inpatient surgery. The facility will receive payment for a 48 hour observation. If further discharge planning is needed, that is up to the facility.

Insurance will not cover rest and rehabilitation at 5 thousand dollars a day.

I had an ankle ORIF, with a redo. Never even got to stay overnight... booted from PACU soon as I could breath on my own. An observation stay, would have felt like a vacation, compared to that.

[Been there,done that, ASN, RN]

Yeah, insurance likely will not pay for an overnight stay for a fractured foot.

That's why.

Insurance will pay for 1- 2 overnight stays for an ankle ORIF, just not payment for a full DRG.

[roser13, ASN, RN]

In my experience, it's because the surgeon has a vested interest in the ambulatory surgery center. I have seen so many of these circumstances and they never benefit the patient.

Most egregious example that I can remember: Patient was inpatient x 2 days for fem-pop bypass. Also needed ortho procedure to foot, emergently. Investor-surgeon transferred patient to ASC for procedure. The catch? Patient lived alone in a third floor walk-up apartment, with no family in the area. He had already achieved 2/3 of required Medicare hospital days to qualify for rehab placement post-op, but we robbed him of that placement by transferring him to ambulatory care.

I've never been so disgusted.

[Aeg1075]

There's Medicaid available. I would think she could get an overnight and rehab considering the complications of this injury, lack of assistance in evaluating mobility and the lack of at home care available to her.

I do pediatrics and and in my "world", up to grown bigger size adolescents, we admit our ORIF patients of any broken bone for at least 24 hrs to make sure pain is well managed and they can get up and walk.

Those have been this patients biggest issues....pain control and mobility.