Archive for Thursday, March 20, 1997

HOSPITAL UNIT MAY EXPAND

March 20, 1997

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More patients will be transferred to Lawrence Memorial Hospital's Skilled Nursing Facility.

Less than a year after failed inspections at Lawrence Memorial Hospital almost closed a nursing care facility there, LMH administrators hope to increase the number of beds in the unit.

LMH trustees on Wednesday agreed to the proposal, which will increase the beds at the Skilled Nursing Facility from 18 to 22. The Kansas Department of Health and Environment, which oversees inspections at the unit, will make the final decision.

The unit failed three state inspections last year but was given a clean bill of health in August. Past problems, which included patients with bed sores and inappropriate use of restraints, have not recurred. The unit's director resigned in the midst of the controversy surrounding the inspections.

Mindy Mitchell, vice president for nursing services, said more staff will be needed if more beds are approved, and that staff duty changes have been made since the failed inspections.

The unit is on the fourth floor of the hospital and is similar to a nursing home. Patients who are recovering but not able to stay at home, such as people who have undergone hip replacement surgery, stay in the unit, Mitchell said.

LMH trustees on Wednesday morning approved the increase in beds. The increase effectively will cut down the number of days Medicare patients spend in regular hospital rooms, hospital officials said.

The increase in beds could eventually reduce costs for LMH.

Dennis Strathmann, LMH chief financial officer, said Medicare reimbursements are figured differently for acute care in the hospital than for treatment in the unit. Medicare pays a fixed fee for treatment in the hospital, no matter what procedures are done or equipment is used. In the unit, however, the reimbursement is generally higher because it is based on total costs.

"In the hospital, a patient's stay is paid for on a fixed fee basis," Strathmann said. "It's just a number the government has attached to a particular kind of stay. In the Skilled Nursing Facility, it's sensitive to the resources being utilized."

The unit has an average daily population of 15.8. Patients admitted there must meet certain criteria. The extra beds are likely to be needed because admission policies have also changed, Mitchell said.

In the past, LMH generally used just two out of five criteria for admissions to the unit -- rehabilitation needs and nursing needs -- but that has now been expanded to include teaching needs and complex planning needs. Now, patients who need to be educated on how to use rehabilitative equipment or how to care for an injury after release from the hospital can be admitted.

"That doesn't mean that patients haven't qualified (for the unit) in the past, just that they've stayed in acute care at the hospital longer, at a higher cost than shifting over to the Skilled Nursing Facility," Strathmann said.

At the same time, Strathmann said, the hospital will have to be sensitive to the number of beds that are filled in the unit. The hospital can request cost-limit exceptions in some patient cases, allowing Medicare to reimburse more of the hospital's costs. Those exceptions, however, depend on occupancy rates. If occupancy rates drop below 75 percent, the reimbursements drop the same amount.

Strathmann said adding four beds in the unit is likely to bolster the hospital's budget.

"Depending on what kind of drop we have in the length of stays in the acute care on the hospital side, I think it will have a significant effect on the contractual allowances, which is basically the difference between what Medicare pays and what we charge," he said.

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