OPINION: Clarifications on health careHealth care is a very complex and often confusing journey which includes clinical experiences we often fear or don’t understand.
By: Tom Clark, Guest columnist
Health care is a very complex and often confusing journey which includes clinical experiences we often fear or don’t understand. It is made exceedingly more complicated when we factor in the multiple levels of federal and state laws and regulations. This complication factor compounds again when we add in Medicare, Medicaid and insurance mandates, requirements and restrictions.
Even those of us who work in health care and deal with these issues every day struggle to understand the constantly growing and sometimes contradictory rules and regulations. I’ve been in this business for close to 30 years and it is still hard for me to follow and attempt to understand. To borrow a phrase from one of our more recent presidents, “I feel your pain.”
There was a letter to the editor printed in The Daily Republic recently regarding the complexity of Medicare. In the letter the writer stated that “a three day inpatient hospital stay is necessary for Medicare to cover a nursing home stay.” While this statement is somewhat true, there is more to this Medicare requirement, and in true regulatory fashion, that makes it more difficult to understand. Although I am not an expert when it comes to Medicare, let me offer the following clarification on this regulation; it might help provide more complete information for Medicare recipients and their families.
Medicare Part A covers inpatient care in a skilled nursing facility under the following circumstances:
* A patient’s stay must begin within 30 days of an inpatient hospital stay of at least three days and meet Medicare’s acute criteria.
* The patient must need, and have a physician’s prescription for, daily skilled nursing care or physical rehabilitation.
* Care must be given in a Medicare-certified skilled nursing or rehabilitation facility.
* Coverage lasts only while the patient’s condition is improving. Once the patient’s condition has stabilized, Medicare Part A will no longer cover inpatient care.
This community is blessed to have, in my humble opinion, the best staff in the country working at Avera Queen of Peace. Their efforts have resulted in national recognition as being a top performing hospital in the country in many areas. We work every day to keep current and understand these rules and regulations. As your local health care resource, we are available to help you navigate these waters as best we can.
There is also a multitude of material available online and I am including the links for your convenience. This information can be found at:
http://www.caring.com/medicare_information/medicare-coverage-of-nursing-facility-care, or http://www.medicare.gov/publications.
We hope you find this information helpful. It is a pleasure and honor for all of us at Avera Queen of Peace Hospital to care for you and your families, and we take the obligation that goes with that very seriously.