I have a resident who is on Medicare A
for P.T. and O.T. d/t weakness and debility secondary to a fall at home.
Her second qualifier is O2 use for C.O.P.D. exacerbation. Plan is for
short term stay. However, resident’s family wants her to have cataract
surgery before she goes home. They feel her eyesight is very poor and it
is the reason behind why she fails when she goes home. She’s diabetic
and takes numerous medications. In addition to her cataracts she has
diabetic retinopathy. My question is since she is on medicare A,
the facility would have to pay for the ophthalmology appt and surgery if it
took place while she was a resident at our facility correct???? My
D.O.N. and admissions nurse told me on admission of this patient that she
should not have this surgery while she is on Medicare A. So what should
I do. Any advise would be greatly appreciated.
Thank you,
Heidi
Heidi
Ebertowski,R.N.
MDS
Care Coordinator
Valley
Memorial Homes
Grand
Forks,
ND
(701)787-7937
fax (701)787-7901
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I think I
would explain that this was a condition that existed prior to her
hospitalization, and was not treated at the hospital for her cataracts, and
could not have arisen out of that treatment. Therefore, Medicare will
not cover it as a payable service. Further, I wo0uld assume that since
she is a diabetic, she was taken every 6 months to an opthalmologist for an
exam. I would try to get a copy of the last exam, to determine just how
bad her vision actually is. There are a number of approaches that allow
a patient with less than great vision to function safely. You probably
want to have your PT dept. make a home visit to assess and improve the home
for safe function after discharge. (Remove throw rugs, proper indirect
lighting, access to toilet, movement bars, etc. )
I once
didn't recommend a home visit, and then found out my patient had no
electricity and no running water, and was worried about where to store her
insulin because it couldn't be frozen or heated. (Life on the
Navajo reservation.)
Also, I'm
not certain that the retinopathy is too important unless she needs to have a
bleeder stopped, or a vessel cauterized in front of the retina.
(Retinopathy damage isn't helped by surgery once the vessels have pulled the
retina up) That actually is important and might not wait, but I dont
think that the facility should be responsible for the procedure, and she might
need to have it done outside the facility on her family's (or insurance's)
dime. Usually, that type of thing is progressive, and treated at the
time it's a problem, so it's unlikely she needs to have newly sprouted vessels
removed. The cataract can probably wait, especially since diabetics heal
much more slowly than others, and the treatment might actually hinder or
prevent her participation in therapy for a while.
Corey
