75% rule!!!!

CoffeeRTC, BSN, RN · Apr 18, 2005

I give....What is the 75% rule?

jaluck · Apr 18, 2005

In a nutshell...the 75% rule means that 75% of admits have to fall into a group of diagnosis (HICVA 10..think I spelled it right)...for example we won't get any ortho pts. unless they are like> 85 and have co-morbidities...or 2 joints etc..no more basic hips & knees in the future. Right now we only have to be 50% compliant...but its gonna get worse, If we don't comply medicare does not have to pay!!!!!! Do you currently work in an acute rehab???? If so you WILL hear about it if you have not...which would be kinda hard to believe if you haven't...good luck..... :)

labonita271 · Apr 24, 2005

In a nutshell...the 75% rule means that 75% of admits have to fall into a group of diagnosis (HICVA 10..think I spelled it right)...for example we won't get any ortho pts. unless they are like> 85 and have co-morbidities...or 2 joints etc..no more basic hips & knees in the future. Right now we only have to be 50% compliant...but its gonna get worse, If we don't comply medicare does not have to pay!!!!!! Do you currently work in an acute rehab???? If so you WILL hear about it if you have not...which would be kinda hard to believe if you haven't...good luck..... :)

hey there! i'm also working in acute rehab in florida, palm beach county, and we've been hit hard by the new rules. very VERY low census, almost half the hospital closed. there have been rumors that if it keeps up like this we'll go SNF :uhoh21:

and as if the new rules weren't bad enough, soon reimbursment will be based on pt satisfaction. we try our hardest, but not everyone can have therapy whenever they want, have their own room and lobster for dinner. and that is honestly what some people expect! it's a hospital, not a hotel. jeez.

fluffwad · Apr 24, 2005

First I've heard of this too. Is this on your SNF unit? I wonder of the rest of these folks will be shifted to the skilled nursing home units.

cmbull · May 6, 2005

Hi, I work in Georgia @ IRF We are doing okay but very serious about meeting criteria. 2006 will greatly impact us.

cranky · Jun 30, 2005

I work in an acute rehab in Texas, and HICFA has hit us hard. we can hold 40 pts but our average cencus now is 12. We are looking at leasing one hall to a hospice and making some beds SNF beds.It looks like that is the only way to survive. Its kind of scary. I really feel bad for the pts that truely need rehab, but dont qualify.

Home Health Columnist / Guide · Jun 30, 2005

Sorry about the hit to Rehab...but a boon to homecare, my area.

MC estimates it will save ~$5,000/episode by not having patients in rehab, and using homecare; save $~2,500 if they go to a SNF per Home Health line article I read today.

All without a change in outcomes...time will tell.

Hope if my time comes, ruling will be reversed by then.

RNKITTY04 · Jun 30, 2005

My hospital has also been hit hard. The census has been in the toilet lately and all the new admits we are getting are really really sick, not rehab material in my humble opinion.

Of my current 11 pts, a good half of them list dementia as a secondary dx, 5 of them have picc lines, 1 is on continous TPN, its just crazy. Maybe we have already changed over to a SNF and they forgot to tell us employee's!!

cmbull · Jul 1, 2005

I agree it is kinda scary. We are having to pay close attention to our documentation. IRF-PAI(FIMs) Making sure everything is perfect to get the maximum reinbursement. I also agree that rehab as we know it will change. kinda sad, because acute rehab provides such a great service to the community.

I am a rehab nurse from PA...CRRN.....17yrs.exp.....wondering how others are being handling the new rules & regs of Medicare!!!! I am currently working in FL.....our census up & down...kinda scary... wondering how long our beloved rehab as we know it will exist!!!!

marycd · Jul 1, 2005

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renerian, BSN, RN · Jul 2, 2005

I am with you on this.........after all the saving come out of OUR pockets.....lets keep site of that......just a toss out to the group.......

renerian