BOISE – The state’s lone rehabilitation hospital is fighting money-saving measures by the federal government that could force many of its patients into nursing homes rather than allowing them to receive more expensive inpatient hospital care.
By 2008, the agency that oversees Medicare will require that at least 75 percent of patients receiving inpatient rehabilitation at places such as Idaho Elks Rehabilitation Hospital in Boise have one of 13 conditions, including stroke, spinal cord injuries and amputations.
Otherwise, Medicare, the federal health insurance program for the elderly, will slash reimbursements that those hospitals receive to care for patients recovering from other conditions.
Federal officials hope to save $320 million over the next three years by moving many patients from hospitals to nursing homes. Nationwide, Medicare pays an average of $320 per day for rehabilitation services provided in nursing homes compared with an average of $850 per day in rehabilitation hospitals.
Idaho Elks officials say the new rule could deny some patients the extensive rehabilitation they need in a hospital setting. With backing from the Idaho Hospital Association, the Boise hospital is sending officials to Washington, D.C., next week to lobby for a bill that would keep the rule at 50 percent until the issue has been studied further.
“If 75 percent of patients do not meet these criteria, Medicare would cut back the amount it reimburses to the hospital for these services, making it too costly for Idaho Elks to treat those patients,” said Joseph Caroselli, administrator of the Boise hospital.
U.S. Rep. Mike Simpson, R-Idaho, has agreed to support the 50 percent bill. U.S. Sen. Mike Crapo, R-Idaho, is undecided, but he wrote a letter asking the Centers for Medicare and Medicaid Services, the federal agency that administers health care for the elderly, to freeze the rule at 50 percent and study the impact of changing it without Congress passing legislation.
Although other hospitals in Idaho provide inpatient rehabilitation services, hospitals such as Idaho Elks, whose services are dedicated to helping patients recover from surgery, will be most affected by the rule.
Currently, only 53 percent of patients at Idaho Elks meet one of the 13 conditions listed under the 75 percent rule, and Caroselli said the rule will force him to turn people away. Nearly one-third of the patients treated at Idaho Elks last year would have been denied access under the new rule, Caroselli said.
At Idaho Elks, the average patient pays $800 a day. In comparison, it costs between $150 and $450 a day to treat rehabilitation patients at nursing facilities in the area, said Robert Vande Merwe, executive director of the Idaho Health Care Association,
“We want to make sure Medicare directs patients to get the right care in the right setting,” said Laurence Wilson, director of the chronic-care policy group at the Centers for Medicare and Medicaid Services.
Most nursing homes are equipped to rehabilitate patients just as well as hospitals such as Idaho Elks, Wilson said.
The agency set the rule at 75 percent to allow hospitals such as Idaho Elks some flexibility, he said, meaning they won’t have to turn away all patients being rehabilitated after operations such as joint replacements.
The federal agency gradually started enforcing the 75 percent rule last year.
By July, 60 percent of patients at inpatient rehabilitation hospitals will have to meet the criteria, and 75 percent will have to meet the criteria by July 2008.
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