75% rule!!!!

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

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..... :)

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.

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.

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

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.

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!!

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!!!!

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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

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.