Valley View has acute problem | PostIndependent.com
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Valley View has acute problem

by donna gray

People with arthritis or joint replacement in need of full-time rehabilitation might lose a crucial resource in the valley because of a change in Medicare rules.People with arthritis or joint replacement in need of full-time rehabilitation might lose a crucial resource in the valley because of a change in Medicare rules.Patients who have had hip replacement or spinal surgery are now being turned away because of the “75 Percent Rule,” said Judy Kelly, director of acute rehab at Valley View Hospital. The rule changes the criteria for classification as an acute in-patient rehab center. Although the rule comes out of Medicare regulations, it applies to all patients, whether they’re private-pay, or have insurance or Medicare coverage, Kelly said.The new rule limits access to those rehab services provided in the department by restricting the service to 13 conditions, which now exclude people with acute arthritis or joint replacement. According to the rule, as of July 2004, 50 percent of the patients coming into acute rehab must have one of the 13 conditions the new rule covers. In three years, that number must reach 75 percent.”It effectively eliminates the typical arthritic population,” which historically represents 65 to 75 percent of the patients treated at the unit, Kelly said. “People who are having a second joint done are being told they can’t come to rehab, and they’re very upset about it.” “We can’t make the 50 percent because almost 80 percent of the total number of patients (in the unit) are joint and spine patients,” who are now excluded, Kelly said. It also excludes other conditions, such as cancer, cardiac, and chronic pain.Lately, because it has not been able to meet the criteria, acute rehab has had to shut its doors – although only temporarily at this point. But as time goes by, Valley View will find it harder to comply with the new rule. The rule is onerous for rural hospitals with smaller populations. Urban centers will have no trouble meeting the restrictions of the newly prescribed conditions, Kelly said.”There are not enough people in the valley to meet these criteria,” she said. “As of today (Thursday), I’ve denied access to 10 people. Last week we were closed for five days. We’re closing tomorrow until a patient comes in who meets the criteria,” she said. Valley View offers the only acute rehab unit between Grand Junction and Denver, Kelly said. Without it, patients’ only options are to go to a nursing home after surgery, rely on one of the private home health care providers in the county, or go to outpatient physical therapists. None of them can provide the level of care that Valley View provides, Kelly said.Acute rehab “is mandated by the federal government to provide three hours of therapy a day, round-the-clock nursing care and close medical supervision,” Kelly said.Those things aren’t available at home or a nursing home, she said.So far, Valley View administration has been supportive in keeping the acute rehab unit open, Kelly said. “But the challenge is the next 15 patients have to fit the list or we are out of compliance. Then we’ll have to look at the viability (of the unit).”Kelly has urged her patients to write their legislators encouraging them to change the rule. Contact Donna Gray: 945-8515, ext. 510dgray@postindependent.com


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