Inpatient Criteria Admission?

[DrQuinn]

Someone mentioned on a thread earlier about putting "Inability to perform ADLs" as a diagnosis (and therefore, possible admission). This was interesting to me, and I have been using it recently. Even admitted a patient to the Kaiser Hospitalist with the diagnosis. (Inability to perform ADLs, unable to walk). But, I wonder, if this truly would meet inpatient criteria, and if perhaps later insurance companies and Medicare would deny the payment for the admission. Anyone know?

To put everyone else on the same page, this is from wikipedia:
Health professionals, and especially occupational therapists[1] look at many Activities of Daily Living. These are the activities that are fundamental for self care. They are:

* Mobility
* Communication
* Breathing
* Bowel and bladder management
* Eating and drinking
* Personal cleansing and grooming
* Personal device care - Includes items like hearing aids, glasses, prosthetics, adaptive equipment, etc.
* Controlling body temperature
* Work and play
* Sexuality
* Sleeping


In certain circumstances (such as care of the elderly) Physicians, nurses, physical therapists, and occupational therapists are generally interested in the ability to: dress, eat, ambulate (walk), do toileting and take care of their own hygiene. These five tasks can be remembered with the mnemonic DEATH: dressing, eating, ambulating, toileting, hygiene.[2]

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[dchristismi]

I was also wondering this - I read the same thread, and have used it a couple of times for some softer somewhat social admits. While it's never been my primary plug to a admitting service, I must admit that it does work to bolster a case.

I've been looking at it much like I look at a trauma patient - if the patient can't ambulate, assuming they could prior to whatever event led them to me, can I really send them home?

I'm curious too, as I'm slowly trying to learn about billing, compensation, and the muddle that insurance is.

 

[Apollyon]

It's a buzzword, and that's what the insurance companies eat up. Likewise, does it change anything? No, but, when you are talking to the hospitalist, they have to be pretty deft to avoid the "can't do ADL's" label - I mean, what do you say to that?

From what I've seen/heard, it's even simpler to plug in for MediCare/insurance companies than the "failure to thrive" or "general weakness" or "unable to ambulate" - it is concrete benchmarks that the patients can't meet. Until they do, they are inpatient-quality.

 

[Jeff698]

Intractable weakness w/ inability to ambulate is one I use.

We had a list of admission criteria floating around at one point. Intractable seems to be a key word, as in weakness, vomiting, etc.

Take care,
Jeff

 

[Apollyon]

Intractable weakness w/ inability to ambulate is one I use.

We had a list of admission criteria floating around at one point. Intractable seems to be a key word, as in weakness, vomiting, etc.

Take care,
Jeff

Intractable vomiting is money, and a great catch-all is delirium.

 

[DrQuinn]

From what I've seen/heard, it's even simpler to plug in for MediCare/insurance companies than the "failure to thrive" or "general weakness" or "unable to ambulate" - it is concrete benchmarks that the patients can't meet. Until they do, they are inpatient-quality.

Glad to hear it. Anyone else have experience?

Also, I do like the intractable.

Where I'm at, the hospital gave us a list of "inpatient criteria." Believe it or not, there are a lot of things missing on there. Like, "subdural hematoma" but, whatever. It doesn't say anything remotely ike FTT or acute delrium or ambulation thingy, which is why I'm asking.

It makes sense that it should be justified, and our numbers are pretty good re: denied admission payments (I think 40 in the last fiscal year, with ~ 40k admissions).

I wonder if you can tie "intractable vomiting" along with "unable to tolerate po." I bet that is a good one, too.
Q

 

[Apollyon]

I wonder if you can tie "intractable vomiting" along with "unable to tolerate po." I bet that is a good one, too.
Q

Absolutely. In order to leave the ED, you have to be able to walk, talk, eat, and think (provided you can normally do those). Intractable vomiting (which goes with unable to tolerate PO), delirium/AMS, and the intractable weakness/unable to ambulate (which is where the "unable to perform ADLs" comes in) are all solid, and, well, speaking is likely a neuro (or another ENT/neurosurgical/trauma/surgical) thing, unless it is clinically an infectious thing, and, as such, is not so black and white as the others.

But, for eating, thinking, and walking, there's solid ground to go on.

 

[mikecwru]

Absolutely. In order to leave the ED, you have to be able to walk, talk, eat, and think (provided you can normally do those). Intractable vomiting (which goes with unable to tolerate PO), delirium/AMS, and the intractable weakness/unable to ambulate (which is where the "unable to perform ADLs" comes in) are all solid, and, well, speaking is likely a neuro (or another ENT/neurosurgical/trauma/surgical) thing, unless it is clinically an infectious thing, and, as such, is not so black and white as the others.

But, for eating, thinking, and walking, there's solid ground to go on.

I have looser criteria:

You need to be able to walk, drink, and wipe your own ass.

This became a good teachable moment for a 20 year old guy with bilateral forearm fractures: "Awww... man. Do I really have to stay in the hospital?" "How close are you with your friends?"

mike

 

[bulgethetwine]

In order to leave the ED, you have to be able to walk, talk, eat, and think.

You're talking about leaving the ED like as in finishing residency, right?

 

[BKN]

You're talking about leaving the ED like as in finishing residency, right?

good one. Unfortunately, sometimes it 3 out of 4. You teach those guys algorithms.

 

[bartleby]

There is a big difference between giving the hospitalist the hard sell ("you know what? You're right...it is a soft admission. Forget I even called...I'll just drop them off outside the adult daycare program. Sure, it's raining and 39 degrees, but they open for breakfast in 10 hours") and actually getting medicare to pay for the admission. I'd be interesting to see data regarding where the line is for the hospital getting successfully reimbursed for the hospital stay (and some bureaucrat in the billing office not then trying to stick the non-reimbursable admission with the patient).