Saturday, September 5, 2009
Draw the Rainbow
(When you dont know what is wrong with the patient, you draw every color blood tube you can find and send it to the lab for pan testing) I was supprised when on another blog a surgeon stated that he never had any problems with Medicare approving anything. I guess he either does not follow his patients in the hospital of that he has a very restricted practice because we run into it all the time. The usual situation is a patient who has sustained either a severe trauma or horrible infection that requires long term hospitalization. You get them through the acute phase but then there is the long recovery. Medicare will not cover the hospitalization after a certain peroid so then you try to get them to a "longer term rehab bed" but Medicare limits this. The patients only get so many days. So, you end up with the constant dilema. The patient is not well enough to be discharged but according to Medicare is not sick enough to be in the hospital. Before we could come up with some fuzzy diagnosis like "failure to thrive" or some such but that doesn't fly anymore. If you discharge them to a nursing home (Medicare wont pay for that either) and they come back to the hospital, Medicare counts that against you. So, what do you do? You have to come up with a diagnosis that Medicare will accept to keep the patient in the hospital that you can support with a lab or test. We use to just draw a UA or get a chest xray because we could always find an asymptomatic urinary tract infection in an elderly female patient or at least a questionable density on the chest xray to support a questionable pneumonia. But since these are now not reimbursed diagnosis by Medicare as "hospital acquired infections" they do not count. You see our goal is to keep the patients in the hospital until they are well without the patient and the hospital going broke. So, now we draw the rainbow and hope to come up with a documentable diagnosis to keep the patient in the hospital. If you draw enough blood for testing, the patient becomes anemic. Severe anemia is a Medicare approved reason for hospitalization!