We had an inservice today on how the Medicare changes to the cap and the new threshold will affect our computer documentation and billing, and how it may affect us as a facility. I hadn’t thought that with the new rule of fining hospitals for re-admissions, hospitals will have an incentive to keep a person there under observation status if there is nothing seriously wrong, which means if they can’t go home our TCU/SNF will receive the person with only MedB benefits (so they would be paying privately for the room and board, vs having a 3-day qualifying hospital stay for MedA). On the face of it, there only seems to be losers in this new set-up, and I can think of many patients in the past three years that would probably be under observational status and come for rehab under MedB.
With the limitations in funds for MedB, as well as the manual review if we reach the threshold, there will be likely be renewed pressure from management in many facilities, as well as pressure from the patient/ family to get home to reduce their out of pocket cost. However while in the training, a thought occurred to me. Maybe with this new situation there will be an incentive not only to document better, but also to improve our practice for all of geriatrics (SNF/TCU and outpatient) for better outcomes, and for researchers to help deepen the pool of literature out there for issues facing this population.
One of the reasons I chose to do the residency is that I saw changes would be coming, not just the population shift but also in Medicare. I wanted to deepen my understanding of geriatric PT and improve my practice, because I knew the game would change on many levels and I wanted to be ready. I don’t think the changes to Medicare are finished, no matter who wins in November. But I think we have an opportunity to step up our knowledge, improve our practice, and sell ourselves and outcomes (not our nifty gadgets, although the NeuroCom is pretty cool). If I ever have to tour rehab facilities for temporary placement of a family member, I’d rather pay for a one that is knowledgeable about geriatrics and seeks to improve themselves and their practice. I’d rather practice there too.