@predictable No, I am on Medicare and pay for a Supplement policy which picks up the extra that Medicare does not pay.

I am finding that a lot of Medicare news is not getting reported by mainstream media.
I Googled for info, for instance, and found an AARP article
https://www.aarp.org/politics-society/advocacy/info-2018/medicare-physical-therapy-caps-fd.html?intcmp=AE-ALRT-POL-MEDICARECAPSVIDEO
about how Congress usually repeals each year an automatic cap on speech, physical, and occupational therapy. But, as of Jan. 24, when the article was written, it had not. I was not aware of this at all. That mean therapies are limited to $2,010. And if Medicare does not pay, supplements also do not pay.

So I am still searching for more info but I can't imagine why the surgeon would make a point of saying it since my sister was just in the joint camp to get some answers and had not signed on with the doctor yet. In addition, I asked questions and I am not signed up with that surgeon for hip replacement.

I will continue searching as well and encourage all to do so. If anyone finds any rules and regs I could read, I would appreciate it.

Thanks, @mamie. Two things about that article. First, the therapies you mentioned are covered under "rehabilitation" rules, which are separate "outside" services ("outside" means not basic hospital or clinic services), and this helps to vastly confuse us in our efforts to understand the Medicare save-some-bucks practices. Second, the article explains that Medicare's automatic waiver of the cap on rehabilitation charges expired on December 31, 2017, and hasn't been renewed by Congress. I think this is mainly because Congress hasn't passed a regular appropriation bill for health programs in Fiscal 2018. That bill is the customary vehicle for making exceptions to program rules and charges.

We're still puzzling about the surgeon's "23 and out" rule. I'm inclined to agree that s/he probably wasn't conniving for a few bucks, but just mistaken (or confused about the "two midnights" rule). But something remains fishy about that, and I'll keep looking for answers.

Thanks, predictable. I now have more clarification. I called the office of the ortho surgeon who made the comments. I got a call back and was told that, as of Jan. 1, Medicare allows outpatient surgery for hip and knee replacements. So, apparently, even if you can go to a hospital and stay overnight, you are an outpatient, not an inpatient.

And, not of Jan. 1 but apparently as part of a gradual change over the last year, Medicare does not allow a patient to stay in the hospital unless "medically necessary." Since "most" people need what is deemed "custodial care" -- trying to walk, doing daily living tasks -- after that surgery, they can not stay in the hospital. But since Medicare requires a 3-night hospital stay for rehab in a nursing home, if you go to such a rehab center now, it is only private pay - YOU pay for it. And who the heck can afford that?

The person said that hospitals instead give you a "plan of care" where you arrange to have family or friends help you out and that you agree to stick to your exercise plan. That's great, I said, but what if you don't have family in the area, your friends have their own medical problems, and your neighbors either work or are elderly. Apparently that's unfortunate for the patient.

So the "23 and out" rule must have been just the doc's catchphrase for what is happening. Apparently our government -- in giving us more "choice" in the matter-- allows outpatient surgery which works to the detriment of those who don't have money for private care or friends or family who can provide any care they need in those first several days or weeks.

I can understand that the government needs to rein in costs but it needs to be reasonable with some common sense in the matter. It should be interesting to see what happens with this penny-wise, pound-foolish idea and people who have blood clots, infections, falls, etc., have to return to the hospital.

Great work, @mamie. A lot of clarification in your report on your inquiries -- and a lot of worry, from my point of view. It's still murky, given the fact that it involves differing rules based on Medicare Part A (hospitals); Medicare Part B (doctors and clinics); in-patient and out-patient surgery; aftercare in hospitals, nursing homes, and rehabilitation programs; all of which can be modified under Medicare Part C (Medicare Advantage) -- so many factors that it seems as though no general rules can apply and every case must be judged on its own set of facts!

What appears to be at work here is removal of Medicare services and support without benefit of Congressional involvement -- in short, unilateral actions by the Executive Branch alone, with virtual (artificial) approval by a Congressional leadership that has failed to even consider (let alone enact) appropriations legislation in which issues such as this are dealt with directly and transparently. Makes me think health care as a right for everybody is the only answer.
Martin

This also gives surgeons the ability to do do more surgeries in a day, maybe 7 surgeries instead of 5 a day. Then they can spend less time between patients cleaning that OR well enough to insure that no one goes home with a staph infection. Not. That's lovely, how many more corners can they cut?