Hip replacement recovery for many patients will take place in the home. Hip replacement patients will likely receive formal physical therapy from home health and/or outpatient physical therapy.
Medicare Reimbursement for Total Hip Replacement
For home health providers providing hip replacement surgery recovery, the average Medicare reimbursement will be $1900 and $3000 for the 1st 30-day billing episode and $1200 to $2800 for the 2nd 30-day episode. Given the scope of services for a patient with fundamental mobility limitations, its important that resources - nursing and/or therapy and/or home health aide - are allocated appropriately.
Recommended Utilization for Patients with Daytime Caregiver Who is Teachable
Identifying a teachable caregiver is one of the most important steps to successful discharge and a profitable episode.
Patients with a teachable daytime caregiver enable the HHA to be more conservative with the number of visits provided as the caregiver can be taught signs and symptoms requiring a call to the physician, and preventive care to promote healing and recovery. In this scenario the services of home health aide and/or nursing may be avoided enabling the full episode to be allocated to physical and/or occupational therapy.
If the patient requires nursing (for co-morbidities that can't or won't be addressed by the therapist), the preferred utilization is 6 therapy and 4 nursing visits (HIPPS = 1EA11) to 12 therapy and 4 nursing (2EC31). If no nursing is provided, 10 to 16 therapy visits.
Utilization for Patients with No Caregiver
Hip replacement patients without a teachable caregiver will likely require many more services - including home health aide.
Preferred utilization is 6 therapy and 12 home health aide (HIPPS = 1EA11) to 10 therapy and 13 HHA (2EC31).
Omission of Nursing
Under PDGM, home health agencies should assign therapists to perform monitoring of co-morbidities and - very importantly - provide comprehensive diagnosis-specific teaching resources so that nursing can be omitted.
Patient Teaching: The Do's of Hip Surgery Recovery
Instruct the patient to:
• Sit only in chairs with arms that can provide support when getting up.
• Wear anti embolism stockings (except when in bed at night).
• Keep the affected leg facing forward, whether sitting, lying down, or walking.
• Exercise regularly, as ordered. Stop exercising immediately if there is pain.
• Lie down and elevate feet and legs if they swell after walking.
• Rent or purchase a raised toilet seat for use at home, and use public toilets designated for the handicapped.
• Turn in bed only as directed by your doctor.
• Place a pillow between the legs when lying on the side and when going to bed at night. (This keeps the leg from twisting and dislodging the new hip.)
• Sit on a firm pillow when riding in a car, and keep the affected leg extended. (If the knee suddenly hits the dashboard the hip prosthesis could become dislodged.)
The Don'ts of Hip Surgery Recovery
Instruct the patient to avoid
• Leaning far forward to stand up.
• Sitting on low-chairs or couches.
• Bending way over when picking up objects or tying shoes.
• Crossing the legs or turn the hip or knee inward or outward. This can be avoided by placing a pillow between the knees.
• Scrubbing the surgical incision.
• Taking a tub bath.
• Lifting heavy items.
• Sexual intercourse until the doctor gives permission.
• Running, jogging, or other strenuous activities.
• Driving a car.
• Reaching to the end of the bed to pull the blankets up.
Call the Doctor if ...
• redness, swelling, or warmth around the incision
• drainage from the incision
• fever or chills
• severe hip pain uncontrolled by prescribed pain medicine
• sudden sharp pain and a clicking or popping sound in the joint
• leg shortening, with the foot turning outward
• loss of control over leg motion or complete loss of leg motion.
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