The hospital lobby strikes again with the '60% Rule'

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James M. Berklan, Editor
James M. Berklan, Editor
If you haven't noticed by now, the ballyhooed “75% Rule” has been laid to rest.

Long live the “60% Rule”!

Well, that could be the battle chant of acute-care providers at least.

The 75% Rule made for good theater during its short, fitful life. But in the end, it was kind of like a Sylvester Stallone movie. It didn't take many brains to figure out the brawny one was going to emerge victorious.

We're talking about the acute-care hospital lobby, and the American Hospital Association in particular. Let's be honest and admit that skilled-nursing's lobbying organizations – chiefly the American Health Care Association and the Alliance for Quality Nursing Home Care – can be pretty good at what they do.

But when it comes to wielding muscle on Capitol Hill, they and many others can bow down before the AHA. That group's lobbying resources absolutely dwarf skilled nursing's, and it knows how to use the carrot and stick better than most in Washington.

To refresh memories, the 75% Rule stood for the percentage of patients that have to have at least one of 13 diagnoses in order for an inpatient rehabilitation facility to receive higher government reimbursements. Many IRFs were a far cry from even the 50% mandate that started the upward gradation in 2005.

Hikes gradually went to 60% and then 65% last June, which culled even more prospective patients from IRFs. A result was fat times for nursing homes, which generally have no problem achieving the 75% level.

And the howling from hospital advocates hit tantrum level, notably with full-page newspaper advertisements touting their position while deriding skilled nursing facility care. But they also got organized and went to work on more discreet levels, getting bills passed in the House and Senate favoring their position.

A study from therapy giant RehabCare, which just about evenly splits its business between acute- and long-term care, also made a case for easing up on IRFs (and slimming the bonanza for SNFs). The RehabCare report was released in draft form in October, but that apparently was enough. Its sponsors wound up deciding no other version was needed, despite admitted shortcomings in methodology.

So now, it's actually back down to 60% from 65%, which isn't too bad from the SNF point of view, especially when you figure Goliath was at play. It's still a significant improvement compared with just a few years ago.

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