Medicare
regulations could push rehab facilities to turn away some who need their help |
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Capital Region Seniors Who Have
A Hip Replacement Or Heart Surgery May Be Denied A Bed At A Local
Rehabilitation Hospital Because Of A New Federal Push To Save Money By Restricting
Whom Those Hospitals Can Treat. |
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Medicare Rules That Went Into
Effect Thursday Will Force Rehab Hospitals, Like Sunnyview Hospital In
Schenectady Or The Eddy Cohoes Rehabilitation Center In Cohoes, To Give
Priority To Treatment For Patients Overcoming The Most Serious Conditions, Like
Strokes, Amputations Or Spinal Cord Injuries. |
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The Push To Limit Inpatient
Rehab After Procedures Like Knee Replacements Or Pulmonary Surgeries Could Push
Area Hospitals, Which Currently Don't Meet The Feds' New Targets, To Slash
Services. "We May Have To Cut Beds," Said Eddy Cohoes CEO Jo-Ann
Costantino. "Staff Cuts Are Possible Too." |
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"At Some Point And Time,
We Will Have To Make Decisions About Who Can Qualify For Rehab Services Not
Based On Their Ability To Benefit," Said Robert J. Bylancik, The Ceo Of
Sunnyview, "But Based On Medicare's Conditions." |
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Officials At The Federal
Centers For Medicare And Medicaid Services Didn't Return Phone Calls Seeking
Comment. Previously, However, They Have Said That Intensive Rehab Care, Because
Of Its Cost, Should Be Mostly For The Most Serious Conditions And Injuries. |
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To Be Reimbursed For Providing
Care For Patients On Medicare For The Year That Began July 1, At Least 50
Percent Of The Patients At Rehab Hospitals Will Have To Be Receiving Care For
One Of 13 Serious Medical Conditions, From Brain Injuries To Burns. |
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That Percentage Requirement
Will Increase Gradually Over The Next Few Years Until 2007, When 75 Percent Of
The Hospital's Patient Load Will Have To Fit Those Diagnoses. |
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Most Patients In Rehab
Hospitals Are Seniors, But The Rule Applies To All Patients Regardless Of Age. |
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The Rule Has Actually Been On
The Books For Years. But It Was Rarely Enforced Until April 2003, When The
Agency Announced Its Intention To Start Holding Hospitals To The Standard. |
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Both Eddy Cohoes And Sunnyview
Say They Are Slightly Below 50 Percent Now, But They Think They'll Get There As
The New Rules Kick In. |
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Eddy Cohoes Said It's
Contacting Doctors' Offices And Urging Them To Refer Stroke Patients To Increase
The Number Of Patients They Have With The Right Diagnoses. |
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The Rehab Hospitals Are Turning
To Congress For Help In Pushing Federal Health Officials To Back Off The New
Rules. |
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Eighty-two Senators, Including
Sens. Hillary Rodham Clinton And Charles Schumer, And 241 Members Of The House
Of Representatives, Including John Sweeney Of Clifton Park And Michael J.
McNulty Of Green Island, Have Signed A Letter Calling For A Suspension Of The
Rules Until A Study Determines The Impact They'll Have. |
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Across The Country, About 70
Percent Of Patients At Rehab Hospitals Get Medicare, According To The Federal
Government. |
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The Main Argument That Rehab
Hospitals Make Is That Staying At A Specialized Rehab Hospital Is Better For
Patients Than Regular Outpatient Therapy Visits Or Rehab At A Regular Hospital.
Medicare Would Still Pay For Those Alternatives. |
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Rehab Hospitals "Believe
That They Are Able To Get People With Joint Replacements Back On Their Feet
Faster And More Effectively," Said Jeannie Cross, Spokeswoman For The Healthcare
Association Of New York State, Which Includes Rehab Hospitals Among Its
Members. |
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Bylancik Pointed To The Success
That Sunnyview Has Had Doing Pulmonary Rehabilitation, Getting Patients With
Severe Breathing Problems Off Mechanical Ventilators Much Faster Than
Traditional Hospitals Do. |
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"Eighty Percent Wean
Off," Said Bylancik, "In As Few As Eight Days." |
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Hospital Officials Say That
While They Could And Do Offer Outpatient Rehab Services By Appointment, Such
Therapy Isn't Always Accessible For The Elderly. |
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"How Are They Going To Get
There?" Asked Costantino. "Do They Have A Family Member To Drive Them
There Three, Four Or Five Times A Week?" |
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For Now, The Hospitals Hope
Their Lobbying Works, With Congress Mostly On Their Side. But If Not, Said
Bylancik, They'll Face Tough Choices. |
"It's A Scheme Where In
January, There's A Person You're Able To Help," Said Bylancik. "But
In September, You Might Not Be Able To Care For Them."
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