Census Bedlock and What to Do About It

I had a friend call me today with an interesting dilema.  She knows an administrator who is in bedlock.  What this means is the administrator has a building that is dually certified – Medicare & Medicaid – and has so many long term Medicaid and private pay residents that she has no beds to admit a Medicare resident.  That’s great, right?  A full house; every bed is full.  Not so fast.  The Medicaid rate is much, much lower than your average Medicare rate.  Being bedlocked and  not able to admit any Medicare can be devastating to a facility and ruin it financially. 

What do you do?  Well, you can’t just discharge your Medicaid residents (and stay in compliance) unless you decertify some beds from Medicaid.  That isn’t a favorable option usually.  What I advise in this scenario is to focus on the clinical aspects of your facility, something you should be doing anyway.  Are there any residents who actually need a short term stay in another type of facility or hospital?  Specifically, I would look at mental health patients with behavioral issues that the facility has been unsuccessful in managing.  They may benefit from a short-term stay at a geripsyche facility.  Besides getting professional help with the mental health issues, medication adjustments, and suggestions for new behavioral interventions, you may be able to bring this patient back Medicare as long as all requirements are met.

What else can you do?  Take a look at any patients who have improved significantly to the point where they might not need nursing home care anymore.  The facility is still responsible for arranging a safe discharge to the appropriate setting, but this may be a viable option.  Most states have a type clinical evaluation or screening that must be submitted to the State which provides evidence the resident continues to meet nursing home criteria or continues to meet the medical necessity offered at the nursing home level. If they can move up to the Assisted Living level, you’ve opened up a bed that you can market for Medicare.

When you finally start moving out of bedlock, you have to determine how many beds to “save” for Medicare.  10 beds, 5 beds, whatever, you have to market specifically for short-term Medicare or managed care.  No long term care patients for these beds or you’ll be back in bedlock.  Skilled patients only.  You will most likely have to turn down a long term care referral.  That’s ok.  Just maintain quality relationships with your discharge planners and be truthful with them  Also, when you’re able to, help them out with a difficult-to-place patient every once in a while.

I hope this helps you push your facility forward.  Bedlock is just another problem that you have to guard your facility against.  Good luck!

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One Response to “Census Bedlock and What to Do About It”

  • #Taniaangel on

    Hello everyone, I’m Tania.
    Hope i’ll get along well with you guys.

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