Opinion—Editor's desk: Be warned: The money says you're not worthy

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Nursing home operators, you've been fireballed. The temperamental healthcare giant called the American Hospital Association took off its gloves last month and made it clear it wanted to brawl.

I have to admit I had been expecting it.
For many months, opposing hospital and nursing home boosters had said all the gentlemanly things about the 75% Rule, which essentially is making it harder for inpatient rehabilitation facilities (IRFs) to retain some lucrative Medicare patients. Instead, these patients are going to nursing homes, which cost the federal government far less.
Dropping previous polite diplomatic language, in July the AHA unleashed a bare-knuckles ad campaign. The message? Nursing homes just aren't good enough. "For those Medicare patients who need medical rehabilitation – the choice between a rehabilitation hospital and a nursing home – isn't much of a choice at all," the ads say.
The AHA calls on Congress to "protect America's Inpatient Rehabilitation Hospitals" because "the case is as clear and simple" as indicated in a chart. And the chart is a doozy.
There are four categories: Better physician supervision, 24-hour rehab nursing, multidisciplinary approach and three hours of intensive therapy daily. There is printed a YES for each in the IRF column, and in the Nursing Homes column, a NOT REQUIRED is written each time.
Take that, you incapable, incompetent nursing homes. Or so the message seems to be.
While there is a reason for IRFs, with their more medically intense capabilities, the truth is most of the patients being redirected to nursing facilities are doing just fine, and in a less expensive setting.
It's been a rare win for long-term care providers, and the hospitals are going crazy. It's a higher-octane version of the way skilled nursing providers grit their teeth as Uncle Sam pushes nursing home residents out the door and into home- and community-based services. Again, the reasoning is it's less expensive.
So far, federal health officials have stood firm on the 75% Rule, noting that hospitals' claims of inadequate care for rehab patients are groundless.
But a word of warning to all involved: When the hospital lobby comes into play, the elephant has jumped into the swimming pool. In 2006, the three largest nursing home groups spent $4.3 million on lobbying, according to the Center for Responsive Politics. The AHA spent $17.4 million.
Get ready for even more fireworks.

James M. Berklan is the editor of, McKnight's Long-Term Care News. Contact him at jim.berklan@mltcn.com.