Friday, May 20, 2022

Re: U.S. Politics: SNF atrocities

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


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