Finding the Right Post-Op Care for Medicare Beneficiaries

Many patients need post-op care after discharge from a hospital. After a stroke or major surgery, patients and their families need to make the big decision about where to go for continued post-op care, which they may need until they’re more recovered. Patients with private insurance may have more leeway, but Medicare beneficiaries need to be aware of rules and regulations which make their decision much more complicated.

What is post-op care?

As the name implies, post-op care is the care a patient receives after an operation or other major medical trauma. Hospitals are crowded places that are usually short on beds, and insurance companies pay a lot of money for each day a patient is hospitalized. For these reasons, hospital stay per patient are generally cut down to the minimum number of days that a patient needs acute care. Once that time has passed, he does not necessarily need hospital care, but that doesn’t mean he’s ready to go home. This is where inpatient and nursing facilities come into play for these patients – it’s the halfway house for medical care, post-treatment, when he needs more care than a home environment can provide.

What’s the best place for post-op patients?

There are many facilities available that cater to different types of patients with different needs. There are acute care facilities, subacute care facilities, long term care hospitals, and nursing facilities. Each facility may have its own specialties and service different populations. 

There are several problems with the model, beginning with the fact that hospitals don’t usually give a lot of time to make a decision – if the hospital stay is unplanned, which is typical, the family doesn’t have time to research post-op care options beforehand. The discharge notice generally only happens a day before the discharge, and during the hospital stay family members are advocating or taking care of the patient, so there’s no time then to think about the next step.

There are rules about what the hospital staff can recommend, because there’s the risk of their connections to facilities. And even more, there are no clear guidelines about what type of facility is best for each type of patient. So it is all a shot in the dark?

The long term care hospital myth

A long term care hospital is meant to be for the most acute cases, and Medicare pays much more for a stay there accordingly. However, a recent study showed that while Medicare pays triple the amount for a 25 day stay to a long term care hospital than it does to another type of post-op care facility, the outcomes and mortality rates are no different from those in a different facility. Patients also have a higher out of pocket expenses at the long term care hospital, without showing any benefit from it. Even more, a study found that half of Medicare beneficiaries in long term care hospitals had some sort of medical problem from their stay, a figure higher than in nursing care facilities.

Some hospitals may send Medicare patients to long term care hospitals because they get a lump sum from Medicare, and they can send the patient to the long term care hospital more quickly than to another facility.

The bottom line

It may be tricky to find the right facility. It’s important to listen to your doctor’s advice, but also to do your own research, which is so easily done today. If the hospital has a list of recommended facilities, don’t just take it at face value – ask what each facility needs to get onto that list – what are its criteria for excellence.

Another approach is to research options before you get sick, when you have the leisure to make appropriate inquiries.

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