Hospitals may cut discharges to agencies

Home care agencies could see a decrease in the number of patients discharged from hospitals to home care for certain diagnoses if proposed rules by the U.S. Department of Health and Human Services go through.

The changes would alter the way hospitals are paid for discharging patients with 10 specified DRGs to post-acute care facilities, including home care. The new rules, part of the 1997 Balanced Budget Act, change current payments from discharge rates to transfer payments.

Seven DRGs would move to a per diem charge. Those DRGs are:

· 14: specific cerebrovascular disorders except transient ischemic attack;

· 113: amputation for circulatory system disorders excluding upper limb and toe;

· 236: fractures of hip and pelvis;

· 263: skin graft and/or debridement for skin ulcer or cellulitis with CC;

· 264: skin graft and/or debridement for skin ulcer or cellulitis without CC;

· 429: organic disturbances and mental retardation;

· 483: tracheostomy except for face, mouth, and neck diagnoses.

Three other DRGs will be paid 50% of the full DRG amount on day one, and half of the per diem rate for each day thereafter. Those DRGs are:

· 209: major joint limb reattachment procedures of lower extremity;

· 210: hip and femur procedures except major joint ages greater than 17 with CC;

· 211: hip and femur procedures except major joint ages greater than 17 without CC.

There is fierce opposition to the proposal from the American Hospital Association in Washington, DC, and HR 2908, a bill which would rescind this part of the Balanced Budget Act, is currently in the House Ways and Means Committee.