This PPS/SNF has turned out to be a major disaster for not only O & P, but
also the OT’s and PT’s who are leaving the Nursing Homes in large numbers. I
had a situation arise just a few weeks ago where I recieved a call from a
case manager for a patient at a local hospital. She stated she has a patient
that needs a prosthesis ‘today’ and how soon can I be over to fit it. Being
a Social Worker with no knowledge of prosthetics she assumed it was that
simple, so I explained the process to her. The patient was one week post-op
and had her staples removed that day. The hospital felt she had stabilized
and was doing well enough to move on to the SNF and was ready to transfer
her. However the SNF administrator was refusing admission until this patient
had her prosthesis. I spent an hour on the phone with the administrator
explaining our options i.e. a monthly payment arrangement from the SNF to the
prosthetic provider (he refused this), having the patient discharged home for
a month to complete the prepatory fitting process and have her receiving
outpatient therapy at the SNF (this was not an option as she had no one to
care for her at home). I stated to him that it was against Medicare
regulations for him to refuse admission based on possible future financial
obligation to the SNF. He stated that he was aware of the regs but would
rather take his chances; “I’m going to be bankrupt if I accept these
patients, or I can refuse them and eventually lose my medicare certification
and again, go bankrupt, I’ll take my chances with the latter.” We eventually
got the hospital to keep this patient another week to get the prep fitting
complete before discharge but this created an absurd situation with the
practitioner caught in the middle. Many times the O & P provider is forced
to accomodate the SNF administrators wishes or risk losing the business of
that SNF. Leaving the outcomes of these patients in the hands of these
administrators is a very bad idea and I hope we can come up with some viable
solutions as it I’m sure it will be several years before this legislation is
overturned or changed.
Scott A. Boehlke
