Medicare has never taken steps to curb this financially perverse scheme developed by long-term care and traditional hospitals. Long-term care hospitals don’t treat any specific type of patients or offer services that you couldn’t get in a traditional hospital. They are cheap to set up and can be run profitably. Companies have rushed to open them up and have spent over $4 billion to build them. Many now are hospitals within hospitals.
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LONG TERM CARE HOSPITAL SCHEMES
Our general hospitals have always been equipped and staffed to provide short-term inpatient medical and surgical services. They handle any acute episodes, accidents which require intensive care. Over the past several years, hospitals have been forced to provide only short-term inpatient care which would be reimbursed by Medicare.
In the early 1980s, to respond to this crisis, more than 400 long-term care hospitals have opened nationally. Over half of these are hospitals within hospitals. They occupy a floor or two of an existing hospital, rather than having their own building. Few of them have doctors on staff, and most are for profit needs. They keep patients longer than hospitals are smaller, and average about 60 beds. Hospitals no longer are intended to treat patients for weeks or months. Their intensive care units help agents survive acute illnesses, heart attacks, and trauma.
Since Medicare no longer was paying for long periods of hospital stay, traditional hospitals have changed their goals. They now have a financial incentive] to discharge you to a long-term hospital. If you have a complex clinical medical problem or chronic condition, you may need hospital care for a long time. No longer are you admitted to a traditional hospital.
THE BIRTH OF LONG CARE HOSPITALS
In the early 1980s, to respond to this crisis, more than 400 long -term care hospitals were opened nationally. Over half of these are hospitals within existing traditional hospitals. They occupy a floor or two of an existing hospital, and don’t require their own building. Few of them have doctors on staff, and most are run for profit. They can keep patients longer, and average about 60 beds.
The traditional hospital will admit you to a long-term care hospital where the average Medicare length of stay must be greater than 25 days. If you are directly transferred from a traditional hospital to a long-term hospital you pay no additional deductions. However if you go home after your discharge from a traditional hospital, and then go to a long-term care hospital, you are responsible for deductions and copayments for the first 90 days.
WHO IS ADMITTED TO LONG-TERM CARE HOSPITALS?
Patients at long-term hospitals care for very sick patients usually in stable condition. These hospitals play an important role by treating patients who are too sick for nursing home care.
They may be on dialysis, need a ventilator, or have sores that will not heal. Since they have no emergency room, they can choose which patients they want to admit. Usually they pick the most profitable types of patients.
Long-term care hospitals don’t treat any specific type of patients or offer services that you couldn’t get in a traditional hospital. They are cheap to set up and can be run profitably. Companies have rushed to open them up and have spent over $4 billion to build them. Many now are hospitals within hospitals.
THE INTERRUPTED STATE
Hospitals get one payment for interrupted state patients. An interrupted state is when you are discharged from an acute care hospital, stays for a specific time, go home for less than nine days and then are readmitted to the same hospital.
If you are admitted to a long-term care hospital and then return less than 25 days to a regular hospital, Medicare will not pay the bill. Any long-term discharge admitted within three days is also considered an interrupted state. A long-term hospital only gets one payment for every interrupted state patient regardless of the time that is spent at that hospital. Long-term hospitals generally spend less on patients and have higher margins of profit than the traditional hospital.
MEDICARE PAYMENTS
Medicare pays a higher rate, for stays in a long-term hospital than a general hospital. The long-term care facility requires you to stay more than 25 days to receive their Medicare payment. If you stay less than 25 days, the hospital must repay their Medicare payments.
Today, Medicare pays a predetermined amount for discharge rates based on your diagnosis. Seven years ago, these hospitals were paid on the care they gave, if it did not exceed a predetermined limit. Medicare pays a different payment rate for different cases on the expected costs of treatment for that patient group. Once that estimated initial payment is reached, a hospital loses money the longer you stay. This encourages the hospital to transfer you to a long care treatment center once you reach the limit.
DOUBLE DIPPING
Since the long-term hospital has a different ownership than the traditional hospital, it is considered a separate entity for payment purposes. A second reimbursement will occur when you are simply transferred between floors to what now is now a long-term hospital.
When a regular hospital transfers you to a long-term hospital the long-term hospital gives a Medicare payment that averages about $40,000. Meanwhile, the regular hospital has an additional bed for a new patient and a new in reimbursement. The long care hospital is not required to provide quality data to Medicare and there is no penalty for failure to submit this data.
FRAUD SCHEMES
The long care hospital keeps you longer than medically necessary just to pad the number of days to 25 so it can get payment from Medicare. They delay creating discharge plans and tell you that your doctors want you to stay a few more days. A transfer to a nursing home or hospital facility is delayed if you have not reached the 25-day Medicare goal requirement.
They circumvent the interrupted state regulations that do not pay more funds if you return for readmission to the hospital in less than 10 days. The purpose of this rule was to prevent transferring you to another hospital just to bring you back.
If you are admitted to a hospital with an illness that Medicare will pay for a 30-day stay, the hospital will not get paid beyond that time. But if they send you away for 10 days and then you return, you can be readmitted to the hospital and Medicare will again pay your traditional hospital.
If you get better in eight days and go back to the long-term hospital and must return to your traditional hospital, the traditional hospital will block your admission by stalling and refusing to allow you to be transferred back until the 10 days are past, so they can again get Medicare money. Both hospitals benefit financially by this process.
COMMENTARY
Since these hospitals are understaffed and have a high staff turnover, complications are more numerous than in the traditional hospital. Statistics and state inspection reports all cite the long-term hospitals complication rate to be twice that of regular hospitals.
Medicare could force hospitals out of their program but this would force the hospital to close. The medical reimbursement rules have encouraged the growth of long-term care hospitals to receive a payment for a patient based on its diagnosis and not on its cost of care. If you recover quickly the hospitals are more profitable, if you become chronically ill, the hospital loses money.
When a regular hospital transfers you to a long-term care hospital, the long-term care hospital automatically gets an average of $40,000 from Medicare. The regular hospital also wins since it now has an extra bed for a new patient and new reimbursement.
Medicare has never taken steps to curb this financially perverse scheme developed by long-term care and traditional hospitals.
Source: NYTimes Feb 12, 2010
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