If choosing a representative of the nursing home industry to comment on rehabilitations 75% rule was meant to provoke, you have succeeded (75% rule ready to jump, June 18, p. 8).
You have apparently framed the entire discussion of medical necessity in rehabilitation facilities around Todd Mackenzies simplistic assertion that his nursing home performs the same functions at half the cost. This assertion assumes that all knee and hip replacement patients, for example, are equal, require less therapy and nursing care and access to less technology.
Sorry, but a few mat tables and a set of parallel bars do not make a rehabilitation center.
The issue is a bit more complicated. As an industry pressed by a growing senior population and the diagnoses associated with aging, we are faced with regulatory restrictions that are forcing hospitals to reduce available rehabilitation beds. We are concerned that our present and future are being controlled by an artificial system of diagnoses rather than by medical necessity. If such a constraint were placed on home health, acute-care facilities, or, God forbid, nursing homes, people would find it to be ridiculous.
Freezing the rule at 60% is not the best answer, but it is the only one available to us at this time. Over 30,000 people were denied access to rehabilitation facilities in the first year of the rule. They were denied because of the threshold rule, even after physicians had decided that they could be best treated in a rehabilitation facility. Thats bad medicine and even worse regulation.
Tom PughSenior vice presidentAllied ServicesScranton, Pa.