Medicare regulations: New rules reduce hospital stays: The days when patients were admitted to the hospital for length tests and week-long stays are slowly ending as a result of a new payment system used by government programs and insurance carriers which now pay a set fee for designated illnesses and care. Primarily because of the shorter, or in some instances, eliminated hospital stays created by the set-fee review process, the patient occupancy at Graham Hospital is below 50 percent and hospital officials are in the process of converting a 44-bed area of the hospital to a skilled nursing care facility. “It was a major reason behind the conversion of some of our space to skilled nursing care,” explained Ray Slaubaugh, senior vice president of Graham Hospital. “There’s a switch to out-patient care nationwide and it’s a trend we feel will increase.” Although the federal government’s Medicare program had began notifying physicians and hospitals last year as to what reimbursement would be received for treatment of various illnesses and began reviewing patient charts, the program stopped paying for “unnecessary” care in February. He added that approximately 45 to 50 percent of the hospital’s patients are generally elderly and on Medicare. “Up until early February they paid,” Slaubaugh said. “But since then they’ve decided the hospital won’t be paid for services they feel shouldn’t have been used or extended.” He said patients charts are now reviewed prior to admission to the hospital to decide if the care requires hospitalization or treatment can be given on an outpatient basis. He said if it is determined the physician���s health care orders for the patient meet Medicare of other guidelines at admission, the patient is admitted as usual. However, if it is determined the physician’s recommended treatment does not require hospitalization the patient is still admitted but the physician is given 24 hours to document the need for the recommended health care. If the care is documented, the patient remains. If the need for hospitalization cannot be documented, the patient is notified that Medicare will not cover the costs and then has another 24 hours to decide if he or she wish to remain in the hospital at their own expense or leave. If the patient elects to leave within the 48 hours, Medicare will cover health care expenses as if the patient had been an outpatient at the outset. “The patient is admitted just as always and they never know any difference at that time,” Slaubaugh said. He added that if a hospital admits a patient who Medicare determines should not have been hospitalized, Medicare will not reimburse the costs of care to the hospital and hospital cannot charge the costs to the patient. To prevent that from occurring, Slaubaugh said Graham Hospital, as well as many other hospitals, has an in-house screening committee to review admissions and recommended care. As a result of the new Medicare payment system Slaubaugh said the average patient stay in the hospital has been cut from seven or more days to about five or six days and the normal occupancy rate of about 60 percent or more has dropped to about 50 percent or less. Empty beds: One of every two beds at Graham Hospital is empty, such as in Byron Carley’s room, and hospital officials feel the trend toward less hospitalization will continue. Officials are not intending to spend an approximate $850,000 to convert some of the area to a skilled care nursing facility.
