Hi, @nancylh You are in my thoughts. I hope your recovery goes smoothly.
@predictable - I hope you saw her note as well. So Nancy now has confirmation of what I had mentioned earlier. I had wondered whether it was just the message of one hospital/surgeon in my area but I guess not. People/voters have to be made aware of this!

I have seen nothing on the news and read nothing online. Seniors need to start speaking out to the organizations they belong to so that the erosion of Medicare stops. We need to bolster Medicare for all of the Baby Boomers entering -- not be giving tax breaks to the fabulously wealthy.

Wouldn\'t giving knee/hip replacement patients a better start -- either with an extra day at the hospital or at rehab -- make more sense than expecting people to fend for themselves less than a day after having such major surgery? These cost-saving \"formulas\" need to have more common sense and use fewer stats that allow for \"collateral damage.\" Two friends who had knee replacements a few years ago said the extra day helped get pain under control, got them established into what they had to do, and gave them confidence. And they had a spouse at home to help care for them.

Ok, I guess i\'m not looking under the correct search terms. I\'m not finding a good definition of the criteria. The entire issue is all about the bucks, bout the bucks not the patient.....whoops.....fits the all about the bass song. Sorry. Has to do with payments and inpatient vs. outpatient. This is the kind of stuff i found, i looked at articles by CMS, but they were very very long, did not give a concise definition of the criteria and so my knee will not allow me to sit here any longer. Sorry, i\'ve disappointed you and myself. All i have is what i was told. BMI >40, Diabetes, Taking Plavix etc. (implies heart disease), under 75 years old, can send home at 23 hours. But in the reading i just did, they talk about comorbidities (sp?) and the patient being switched over to inpatient if necessary. It seems to be a very tangled, complicated mess.

All i know is that 23 hours would be a very short time for any surgery, not just major surgery like TJA (total joint arthroplasty). My surgery this time was done by 10 a.m. Thursday. I was discharged by 11 a.m. Saturday. Before lunch. My BMI is 41, i have recently been diagnosed with diabetes 2, i have anxiety, hypertension, am being empirically treated for un-diagnosed congestive heart failure, morbid obesity, and so that is most likely why they kept me that long. The long lasting pain block ended on Friday at which point i did require IV pain meds just to move my leg. I guess that played a part also.

On a lighter note, my PT said i was doing much better than last time, good range of motion. So, keep doing the exercises, walking, keep up with the pain meds (this one is important) which means taking them regularly so the pain doesn\'t exceed what you can handle and also keeping up with the threat of constipation. I have my stock, sugar free candy with Stevia and sorbitol. Sorbitol has a laxative effect. Fiber one bars and Kashi cereal. And of course they have me on Senna - S and i also have Metamucil should i need it.

Being prepared is huge when you go home alone after surgery. One little thing out of place can stop you in your tracks. Like the 45 pound bag of cat litter that came from Chewy and got left next to the mini washer in the kitchen. So, then you have to reach out and try to find someone willing to come push that box out of the way. Oh my.

Anyway, OUCH have to go now. Hope i haven\'t tipped the apple cart.

n
Unlike traditional medical risk stratification for TJA, it is important to evaluate anxiety levels and social support for patients being considered for OTJA. Even patients without diagnosed anxiety disorder are often concerned about postoperative pain, being able to care for themselves, and mobility, especially if they live alone. A study of the effect of psychological support on patients indicated for primary TJA published by Tristano et al. demonstrated that patients who received psychological support had a lower incidence of anxiety and depression than those who did not [10]. Additionally, THA patients who received psychological support reached their physical therapy goals 1.2 days sooner than those who did not receive any psychological support [10]. Patients being considered for OTJA, who are required to manage their own pain control, physical therapy, and self-care, are even more likely to benefit from a strong psychological support. Identifying patients who already have strong social support vs. those who do not is thus extremely beneficial.

A detailed clinical and social assessment such as the General Anxiety Disorder-7 (GAD-7), which is a self-reported questionnaire for screening and measuring general anxiety disorder, is a useful tool and can be used in concert with other tools for screening overall health, such as the revised cardiac risk index (RCRI). For example, a patient may have three identified risk factors:

High body mass index (BMI)
Symptomatic chronic heart failure
Anxiety
These risk factors need to be properly managed and tracked until they are clinically capable of proceeding with surgery. Possible interventions for this patient may be setting up an appointment with a dietician, working with their primary care physician and cardiologist to manage congestive heart failure (CHF), and setting them up with psychotherapy prior to their visit. Risk calculations and historical data tell us the obese patients have higher risk for readmissions and complications [11]. If these issues are not managed, this patient could become one of the “bundle busters,” and experience complications and/or costly readmissions that may have been avoidable with more thorough preoperative optimization.

Got it @mamie, so that gives me some more research to do. @nancylh has had a troubling experience of her own, and I agree with both of you that it\'s crucial to get the \"23 and out\" policy/rule/whatever out in the open for all to consider. May I ask each of you: In what city did you have your surgery performed? Also, which health insurance company provides your supplemental coverage? Martin

I live in Cincinnati and have AARP united health care supplemental. I was lucky enough to stay 2 nights after tkr due to very difficult to manage pain, but was discharged on 1/2 percoset every 6 hours. My half block was ineffective. I have celiac and only recieved one meal without gluten. I am single. I only received 28 percoset. Told State law didnt allow anymore. Wrong!!. I was overwhelmed with pain and anger. Called surgeon practice and explained I was contacting medicare to report sloppy...substandard care. My surgeon met with me and appeared to listen respectfully. He prescribed pain management more appropriately. This recovery has been much more difficult than first replacement. This new standard is malpractice. Im am composing my letter to medicare and all the congressmen hiding under rocks. Also, not even allowed to discuss a coyple of days in rehab.

Hi, @predictable I have not yet had hip surgery. I had heard about the one-night stay/no rehab from a surgeon in the Green Bay area. My sister had met with him about TKR and invited me along to a presentation he puts on for upcoming surgery patients. In discussing the process/what to expect after, he brought up the information.

Hi Ann, 1/2 Percoset every six hours? And you survived? I cannot even imagine. I am a wimp when it comes to pain. I hope your letter makes a change. Hope you are feeling better also.

Hi Mamie, you might want to check my later post (two days ago from 2-19)

Hi, @nancylh Yes, thanks, I saw your info about Percoset and pain. I also read your note four days ago about how you are doing -- sounds like you are getting better ROM. Excellent. That's great. Keep up the good work! I also read your information about anxiety -- which my sister has tons of. Her surgery is this week. I'm just hoping she gets the time she needs in the hospital and rehab to get her successfully on the road to recovery.

Hi, @mamie just wanted to be sure you saw the part where i think i might have figured the 23 hour thing out. The way that i understand it, is that if your sister has certain commorbidities and the physician deems it necessary to do the procedure as in patient, and she was inpatient for the three days, then Medicare would cover part of a rehab. But don't quote me on that. That is just my understanding and is susceptible to error.

I think it is even more important that she has a good support system in place for when she goes home (alone you said?). Most people don't understand what you cannot do after surgery. Still others believe that somehow medical care people will help. Nope. It's like when you visit in a rest home and you aren't supposed to help anyone because if they got hurt you would get sued.

I was home alone after the first TKA also. I was depressed, scared and the line "do you know who your friends are" kept running through my head. Actually i received more help last time. Church group came for a few hours and helped get me organized and brought soup. There was no water main break. My sis came on the weekends and did a load of laundry and brought in the mail. But in the middle of it there seemed to be no help.

The worst is when people ask, well what about family, can they help? It's like, well i do think that i would be intelligent enough to ask them, so no, they can't/won't.

Another thing that is beneficial is receiving a get well card (if she can get to her mail), phone calls, just something that lets her know that she has not been stranded alone on planet earth.

I hope all goes well for her. If some little tidbit in all of my chatter proved helpful, that will make my homebound day.

God bless her and you also.

N