I read with interest your cover story on the 45% rule (Sensitive trigger, April 30,
p. 6). Indeed, there is a rationing of healthcare across the board without the word being used. Because of the CMS 13 ruling (often referred to as the 75% rule), hospital administrators across the country are being forced to deny patients who do
not fit into 13 specific categories.
This affects more than just Medicare. The effect is also felt in Medicaid, commercial coverage and workers compensation. In the past year, there have been well over 88,000 patients denied access to rehabilitation hospitals across the country, and the public is just not aware of this silent epidemic in the political arena. Physicians have referred patients out of medical necessity but hospitals are forced to deny admission in order to maintain the 60% (and climbing) ratio of patients meeting the 13 criteria, which determines whether a rehabilitation hospital will receive reimbursement. There is legislation pending in the House and Senate to freeze the rationing at 60%. Many of the legislators have signed support for this bill but we need more visibility and support to ensure its passage this summer.
Chief executive officer
Wesley Rehabilitation Hospital