Sunday, May 24, 2009
The perfect administrative federal healthcare medicolegal storm seemed to hit this weekend. Medicare has a whole bunch of diagnosis that it will not pay for if a patient is discharged and then is readmitted within a certain peroid of time. Because of lawsuits and threats of lawsuits our nursing homes and extended care facilities are decreasing in number and want nothing to do with complicated patients. This leaves as the only option home care and home health for those patients that do no meet Medicare admission criteria anymore but cant get into an extended care faclility. So many go home and then need to be re-admitted. So what do you do. The answer that comes rapidly is to re-admit them but at another hospital. A so called lateral. A lot of folks went away for the holiday weekend, so what do you do with grandma? Just take her to the hospital! She was just there 2 weeks ago for her COPD exacerbation, they will admit her for a few days while we go to the beach!" Since she was just there and was dumped at the ER you have no choice to admit her, but then the shell game starts. Doesn't her internist also have privaledges at the other hospital? And so goes the lateral.
The long and short of it. Medicare wont let you keep them in the hospital. The nursing homes and ECFS wont take them because of liability and lack of pay, so you discharge them and readmit them to another hospital. Welcome to the world of federally managed healthcare.