Thursday, September 04, 2008
Medicare rules may need revision

By Dr. Anthony Policastro

Nothing is ever very simple. There are always rules and requirements governing everything. For example, Medicare provides payments for some stays at extended care facilities (nursing homes). However, it is only under certain circumstances. There is a clause in the Medicare requirements called the 3-day rule. This is the rule that provides guidance to paying for admissions to extended care facilities. What the rule basically says is that Medicare will only pay for an extended care facility visit if a patient has been admitted to a hospital for three days prior to the stay at the extended care facility. Thus you cannot go directly from home to an extended care facility and expect Medicare to help pay for it. You cannot be in the hospital one day and then expect Medicare to pay for a transfer to an extended care facility. You must have an illness serious enough to require at least three full days in a hospital before Medicare will consider paying for the extended care stay. Medicare also wants to make sure the admission is real. For that reason, they review three-day admissions to hospitals that lead to stays at an extended care facility. If they do a review and they find that the patient was really not sick enough to be in the hospital for a full three days, they will then charge the hospital with Medicare fraud. Therefore, hospitals cannot simply admit patients to keep them for three days before a transfer. The interesting thing about this particular rule was that it was written many years ago. Medicare had looked at patients going to extended care facilities from hospitals. They found that the average patient stayed three days before going to the extended care facility. So they wrote the rule based on that. Unfortunately, medical care has changed greatly since then. The first thing that has happened is that Medicare has gotten a lot stricter about what makes a patient sick enough to be in a hospital. For that reason less patients are admitted. In addition, it means patients are ready to go home sooner because they are no longer sick enough to stay in the hospital. The second change is that we do medical care much more efficiently now. If Medicare were to do a new study, they would find that the average stay is now less than the three days that it was when they originally looked at it. The logical thing would be to shorten the time period. However, it does not look like that will happen. Therefore, a rule written a long time ago when medical care was different has not changed. The result is that it is harder than it once was to get approval for an extended care facility stay. The rule requires someone to be sick enough to be in the hospital for three days. We need to follow the rules even though that is sometimes hard to do.

Nanticoke plans golf tournament The twenty-second annual Nanticoke Health Services Golf Tournament is Friday, Sept. 5 at the Seaford Golf and Country Club. The day will consist of practice, lunch, 18-holes of golf, dinner and door prizes. A full field of participants is expected with a 12pm shotgun start and scramble format. Teams of four players will compete for various prizes that have been donated. Contests for Longest Drive, Closest-To-The-Pin, Hit-The-Green and a Hole-In-One will be held. All participants will have the opportunity to putt through a three-step qualifying round. After dinner, three people will be putting for $2,500 each. Entry fees are $150 per player and $600 for a foursome. Sponsorships packages are available. Presenting sponsor is Wilmington Trust. Nanticoke Health Services hopes to raise over $35,000 from the tournament to help the hospital's charity endowment prescription fund, a special indigent fund for patients in need of assistance with the cost of their prescriptions. For reservations or sponsorship opportunities, contact the Nanticoke Health Services Development office at 302-629-6611, ext. 2404.

Low-cost mammograms Bayhealth Medical Center offers low-cost mammograms every month. The low-cost mammograms are offered on the third Wednesday from 1 to 3 p.m. Local screenings are held at Bayhealth Women's Center at Milford Memorial, 200 Kings Hwy., Suite 3, Milford. Pre-registration is required. For appointments and more information, contact Breast Care Coordinator Trisha Bentley at 302-744-6773.

Osteoporosis screenings offered Bayhealth Medical Center will offer free osteoporosis screenings from 9 to 11 a.m. on Wednesday, Sept. 17 at Milford Memorial Hospital Women's Wellness Center. Pre-registration is required. To register, call Bayhealth's Education Department at 302-744-7135 or toll-free at 1-877-453-7101.

Caregiver support group Join our monthly support group at the Cheer Community Center, the second Monday of each month at 11 a.m., 854-9500. This support group is for you, whether you are a new caregiver or have been taking care of a loved one for years. We are turning the "Fearless caregiver" book into a guide for our support group. Each month a chapter will be discussed, concerns shared and support given.

Depression support The Mental Health Association in Delaware will be sponsoring a Depression Support Group in Laurel on the second and fourth Thursdays of each month. The meetings begin at 7 p.m. The MHA encourages anyone dealing with a depressive disorder to attend. Register in advance by calling 1-800-287-6423. Peer support groups sponsored by Mental Health Association of Delaware are not intended to replace professional mental health treatment. MHA does not publish support group locations; locations are provided with registration.

Bayhealth offers aging clinics Bayhealth Medical Center will offer the Steps to Healthy Aging Clinics as an opportunity for you to meet one-on-one with a registered nurse from Bayhealth's Education Department to confidentially monitor your blood pressure, pulse and weight, and to discuss any health topic of concern to you. Clinics will be held in Milford every Thursday from 9 to 11 a.m. in Room 206 on the second floor of the Grier Building adjacent to Milford Memorial Hospital. For more information, call Bayhealth's Education Department at 302-744-7135 or toll-free at 1-877-453-7107.

Stroke support group Nanticoke Memorial Hospital will offer free monthly Stroke Support Group meetings designed for individuals who have survived a stroke as well as their families and caregivers. Meetings are held the third Thursday of each month at Nanticoke Cancer Care Center from 1:30 - 3:30 p.m. Sheila Brant and Joan Burditt, occupational therapists at Nanticoke Memorial Hospital, will facilitate the support group meetings. Pre-registration not required. For more information, call 629-6611, ext. 5121.