I currently have been working on a Nursing Home. I have learned that Medicare people have 100 days coverage for inpatient nursing home rehab therapy (PT, OT, ST). This coverage also differs on the needs of each patient as determined by their RUG levels. The higher rehab therapy needs means more reimbursement from Medicare to the Nursing Home. Higher RUG levels also means more rehab coverage in every 7 day period. Highest RUG level requires that the patient must complete 720 minutes of skilled rehab therapy. The number of minutes lower to 500 then to 320 to 150 and to 45 minutes at the lowest level. Although ideally the rehab professionals determine which RUG level each patient falls under, almost always the Nursing Home administration pressures the rehab professionals to put all patient on the highest RUG level for better reimbursement even though they are not appropriate or unable to tolerate or participate in therapy that will insure that they complete 720 minutes of therapy in 7 days. Not only are the rehab professional pressured to put every patient at the highest RUG level, often the rehab therapist are also pressured to continue to give each patient therapy till their 100 days of Medicare coverage are used up even though the patient can be discharge before that. This clearly illustrate that the factor from which how much therapy a patient gets depends on the reimbursement their insurance is able to pay.
It should be also mentioned that a patient who have used up his/her 100 days of Medicare coverage can be reinstated for another 100 days after they have been hospitalized for 3 nights or more. So it is SOP in the Nursing home that every Medicare patient who qualifies for another 100 days gets to have therapy again even though they are not appropriate. While those therapy appropriate patients who does not have Medicare coverage does not get therapy.
So often about 25% of our patient loads in the Nursing Homes are not appropriate for therapy and about 30% are not at the appropriate RUG level.
It should be also mentioned that a patient who have used up his/her 100 days of Medicare coverage can be reinstated for another 100 days after they have been hospitalized for 3 nights or more. So it is SOP in the Nursing home that every Medicare patient who qualifies for another 100 days gets to have therapy again even though they are not appropriate. While those therapy appropriate patients who does not have Medicare coverage does not get therapy.
So often about 25% of our patient loads in the Nursing Homes are not appropriate for therapy and about 30% are not at the appropriate RUG level.
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