I had knee surgery 23 days ago, I am at a rehabilitation facility, progressing good. I was told I would be discharged 6 days after my dr. appt. which would make it 21 days. To my understanding I thought I would be able to be rehabilitated at least 75%, or at least be able to bend my knee, and have some time of mobility without a walker, and immobilizer. Knowing my discharge date, at my last appt with the Dr. I asked for a referral for an extension at the rehab. facility, expressing my worries of early discharge, due to not able to bend, walk without an immobilizer, and I feel I am not ready to be discharged. The Dr. replied, short and with no sympathy, that the decision was not up to a referral from him. It was my government insurance who was discharging me, and so in that he released me to be able to bare weight only using the immobilizer, see me in 2 weeks, and denied a referral of any kind. How do I acquire a Dr's referral for an appeal to extend my stay at the facility I am at? Reason being, I was told the day after my Dr's Appt. that I could appeal the early discharge which was Friday, now Sunday. Are my chances slim to none to even pursue an appeal with a discharge date 3 days from now? I feel I am being discharged without the proper rehabilitation 4 weeks too early!

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Why the immobilizer? Is the bend restriction suggested by PT? What was the expected movement range after the type of surgery you had? And has it gone as expected?
Helpful Answer (1)
Reply to Beatty

After 21 days your daily charges will go up to $165/day. It is not up to your doctor, it is Medicare rules. The rate increases slightly every calendar year. I believe if your stay is > 100 days, the rate goes up to $350/ day. Your other option is to go home and hire caregivers if you think you can save. You still can get a visiting nurse and PT for your rehab.
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Reply to MACinCT

You may or may not ever achieve your expectations of the knee surgery. It may take 4-6 months for you to achieve the total benefits that you will get. If you are not working through the pain, expecting zero pain, or fearful and that's preventing you from working with the rehab team, then you will never maximize the potential benefits from the surgery. I also don't understand why you are still in an immobilizer. By this point in rehab, most people are ready for discharge and continuing rehab exercises at home or at an outpatient PT office.
Helpful Answer (5)
Reply to NYDaughterInLaw

Aren’t you using a walker or a cane (why an immobilizer?). How old are you and do you have any chronic conditions like diabetes or high BP?

In my experience as a RN post op knee rehab averages about 10-14 days before someone goes home to continue out patient physical therapy because your rehab doesn’t end while you are in-center; you are expected to continue with visits 2-3 times a week at an out patient PT center. Thus the rehab specialist may ascertain by your progress at this point could be continued on an out patient basis.

Someone else will come along to inform you of out of pocket charges that you may need to pay if you stay in rehab > 21 days and on Medicare.

Why do you feel you are not progressing? Are you engaged in performing the exercises with the therapist? I am trying to assess why you are still in rehab @ 21 days post total knee replacement as that is a longer than usual. Everyone is different & there are always exceptions.
Helpful Answer (5)
Reply to Shane1124
AlvaDeer Sep 16, 2019
Great information right from the horse's mouth. Hope you stay around on the forum, Shane, because I always enjoy your answers.
When the doc goes to bat for you you have a few more chances, Kaimanu. The Government sets the rules, but the doctors can play around. The others best to go to bat for you are the PT folks themselves in the facility. If they chart that you are progressing well to the level expected, they will insure that you get the boot to outpatient care, not always easy to get to with the knee and transportation needed. Sometimes in-home can be arranged.
When my bro was in rehab after serious head injury the doc got him more time playing with added things such as "wound care" because the doc himself wanted him in care until a followup MRI could be done a month from original one.
The system isn't easy for them to play with. Once the marching orders are issued the Social Worker there will come with a paper telling you that you would be self pay after a certain day. Try to work with discharge planning to see if you can arrange in home visit.
Do you have any support at home, or a home you can go to briefly with family for a month or so?

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