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Medicare's new 23 and out for hip and knee replacement?
Is anyone else aware of this new Medicare change? And is it true? I went to a "joint camp" with my sister who is slated for a total knee replacement. The orthopedic surgeon informed us that as of Jan. 1, Medicare now has a rule that --unless there are extraordinary extenuating circumstances -- a TKR or THR patient is discharged 23 hours after they first go to their bed after surgery.
In addition, this doctor said that Medicare no longer allows a person to go to a nursing facility for rehabilitation of TKR/THP. You are supposed to take care of yourself apparently or call on family or friends. That may work for some people but I live an hour away from my sister and need a new hip. Our older sister lives in Florida. We have no other family left. She is single and in her 60s with chronic venous insufficiency for which she has to wear compression hosiery all the time. She is very upset and worried about what to do. Her neighbors are elderly or work. If what this surgeon is saying is true, how could our government come up with such a rule?
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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.
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1 ReactionHi everyone, ok i just spent some more time looking for the "23 hour rule". I do not think that this is something that anyone is going to fined called a 23 hour rule. I went to the Federal Register to find Medicare Changes regarding TKA & THA. https://www.federalregister.gov/d/R1-2017-23932
It is a very very very long document I looked under part IX #3 i think i did a find for length of stay or total knee replacement. This procedure was an IPO inpatient only procedure and Medicare has now changed their payment of it so it can also be done as an outpatient procedure. My take away was that outpatient procedures done as outpatient with Medicare as the guarantor are probably only allowed a 23 hour stay. Not sure and my knees hurt too bad to continue researching. So those under 75, BMI >40, etc. the physician could choose to do the operations as outpatient procedures. For those with diabetes, heart problems or other commorbidites they could perform the procedure as inpatient which is a longer stay. The deal with the rehab center i guess would fall under that rule about you have to be an inpatient for three days in order to qualify for Medicare to cover rehab. At least that is how it was when my mom went to rehab. She had been an outpt. so Medicare did not pay for her rehab. I think that her supplemental picked up most of it. Anyway, going to lie down and wait for pain meds to kick in, then do my five exercises. I think i walked too much yesterday.later
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
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