Hospitalized but 'under observation'? Seniors, beware

[eridani]

From Medicare Watch: Observation Status an Increasing Problem

A recent Reuters article discusses an increasingly common problem that many Medicare beneficiaries are facing—observation status. Observation status occurs when someone goes to the hospital and is not formally admitted. There is no time limit that a person can be kept under observation and there is no federal requirement that the patient be notified. This can cause a number of complications for Medicare beneficiaries. One of the most commonly encountered complications is that Medicare beneficiaries’ costs are generally much higher when they are under observation than when they are admitted as an inpatient. Another common complication is that skilled nursing facility care is only covered by Original Medicare if the beneficiary has been an inpatient in the hospital for three days or more. Beneficiaries who were under observation status do not count as inpatients; therefore, Medicare will not cover their skilled nursing facility care.

Unfortunately, the number of Medicare patients under observation increased from 920,000 in 2006 to 1.4 million in 2011. More alarmingly, the number of observation stays lasting more than 48 hours has increased by more than 400% from 2006 to 2011. The increased use of observation stays started when a new Medicare rule was implemented, which denied reimbursements to hospitals for admissions that are considered “improper.” This well-meaning rule led hospitals to be much more cautious with their admissions and drastically increase the use of observation stays.

There has recently been increased focus on the issue of observation stays. Central to this momentum is a bill introduced both in the Senate and in the House to allow time spent under observation status to count towards coverage for skilled nursing facility stays. In April, Medicare is planning on applying a new rule that requires doctors to admit anyone they expect to stay more than two midnights as an inpatient. Those expected to stay less than two midnights would be put under observation. Many advocacy groups see this as a flawed and incomplete solution to the beneficiary challenges presented by observation status. . According to the Medicare Rights Center’s President Joe Baker, “The new rule doesn’t really fix the problem.”

Hospitalized but 'under observation'? Seniors, beware
http://www.reuters.com/article/2014/01/23/us-column-miller-medicare-idUSBREA0M1I520140123

[DURHAM D]

1. I have already had two Teaparty type seniors

tell me that this is a result of Obamacare. I have no idea how this widely distributed false claim has been circulated.

The other thing...a large number of seniors were enrolled in Medicare Advantage programs by their employees or former employees. They do not even know they are in an Advantage program and you can explain it until the cows come home but they are unable to take it in.

When you tell them that they have private insurance (usually United Health) and not regular Medicare they deny it. So naturally trying to explain that the rules about how much is covered if they are moved to a long term care facility is completely up to their private insurance provider's program they just resort to bitching about Obamacare.

Please consider posting this in the Seniors Group.

[frazzled]

10. Just read them this sentence from the article

The problem stems from a well-intentioned effort by Medicare to control costs through a program that audits hospitals for possible overpayments, which began during the George W. Bush administration.

[JDPriestly]

14. Imagine how difficult it can be for a doctor in a hospital to deal with an elderly patient tho

"cannot take it in"? And diagnosis is not an easy thing to do. Tests are needed. They take time. Doctors really care about their patients. The patients need to be proactive but that is difficult for very elderly people. Better safe than sorry.

I have a family member who works in a hospital. Hospitals try to be very thorough in their diagnoses because they can be sued if they are wrong. They have all kinds of meetings and procedure to make sure they are getting the right diagnosis as quickly as possible. But seniors often have complex and sometimes numerous conditions. Doctors do not want to make the wrong diagnosis and miss a small, treatable cancer that may become something very, very serious. The article is irresponsible.

[eridani]

20. So why the fuck can't they just be officially admitted in order for that to happen?

This "under observation" crap is a scam to take money out of the hides of our most vulnerable. It was published by Medicare Watch, a very mainstream advocate for Medicare patients.

[truedelphi]

15. However had there been a will and a way, then

This type of dastardly provision could have been outlawed or regulated back when we had a Democratic guy in the WH, and a majority of legislators with "D" after their name in Congress.

Instead, we have witnessed elected officials who could care less about provisions and oversight that would benefit the many,a s those provisions and oversight would come at the loss of profits to their lords and Masters in the Corporate Halls of Big Hospital and Big Pharma, etc.

[OnyxCollie]

2. This is an issue that is affecting my family

when my elderly mother was "under observation" recently.

[DURHAM D]

3. Was she moved to a care facility? nt

[OnyxCollie]

5. For 20 days.

But she was in the hospital for a few days.

The doctor had said not to worry, that she had been admitted and was not under observation.

As we are discovering now, that wasn't entirely the case.

[DURHAM D]

6. I am sorry to hear that.

Hope it works out okay.

[mantis49]

21. The only way you know for sure is to check with the business office.

N/T

[SheilaT]

4. There's another reason, as I understand it,

that the observation status is used. That's because Medicare will only pay for very specific diagnoses, and it's not always possible to come up with an appropriate diagnosis immediately. Not to mention, hospitals are dinged if they re-admit Medicare patients too quickly.

[Yo_Mama]

12. Right, so they are not formally admitting them in the first place

I think this is a problem.

[freshwest]

18. Yes, I thought the rule was to prevent sending home people too soon, not giving them time to heal.

There were people being sent home who had to return to the ER because they hospitals were shoving them out too fast. At one time, this was not an issue, but with the day surgery and even sending mothers home on the same day without watching for what might go wrong, there were tragic mistakes made. All about the profit margin.

[SheilaT]

19. I work the information desk at the only

hospital here in Santa Fe. Which means I observe a lot of stuff, but I'm not a medical person nor an expert on how or why people are charged. I can say this: that with recent changes in payments if people are re-admitted too soon, all of a sudden our "frequent flyers" have dropped precipitously. I am, of course, not at all privy to any medical details, so I don't know if it's a good thing or a bad thing that certain specific people I can think of who were coming into the hospital two or three times a month simply aren't showing up any more.

I'm sure it depends a lot on what, exactly, is going on with those people, but maybe going to the ER several times a month is not the appropriate way to be treating whatever ails them, and that they are getting better treatment now. Somewhere.

One hard truth about medical care in this country (and I'd love to know what comparable figures are in other places) is that some relatively small percentage of people consume a huge percentage of all the medical care. Sometimes, figuring out better ways to treat those people is a win-win situation: less money, better care. What we don't want to be doing is abandoning those who need care, which is what our traditional system here too often does.

[mopinko]

7. aca penalizes hospitals

if they have a high rate of re-admittance. these are old stats, so i don't know how it will shake out.
but on the face of it, it seems like a good thing. hospitals send too many elderly back home if they come in by ambulance, and are not sick enough to admit. keeping an eye on them for a while seems like the humane thing to do at the least. but readmissions are so expensive, i gotta think this saves money in the end.

hoping someone will appear with the letter of the aca on this.

eta- this is, of course, a smear job.

[EC]

8. So if seniors tell the hospital in the beginning

that they cannot pay for "observation" status, will the hospital that wants to be paid, then admit them as an inpatient?

[mantis49]

22. Medicare pays for the observation status.

What it affects is follow-up care and rehab if they need to go to Skilled Nursing Facility. If they haven't been actual in-patient status, then the patient is not able to access their Medicare Part A benefits for rehab.

[Paper Roses]

9. I heard about this from my brother-in-law. This really stinks.

None of us want to be 'under observation' with the 'no coverage' stipulation. Our doctors need to know that this is happening. If we are sick, we need care if we are sent to the hospital. Nothing that I can think of would allow a doctor send us to the hospital without a real reason.

Observation? I can do that at home. Visit to the doctor, OK is I feel it is necessary.? If my doc feels I have a problem that he cannot treat, he should have me admitted as a patient, not for a 'check up'. How many more of these 'avoidance of payment' situations do we have to accept?

This stinks.

[JDPriestly]

13. The article is nonsense. If your doctor keeps you in the hospital it's because you need to be there

If you go to the hospital and you are put under observation, it is most likely because the doctors are trying to make sure that you have been diagnosed correctly. Sometimes serious conditions like cancer are found only because a hospital doctor, a hospitalist, used all the hospitals resources to test for the real problem. Sometimes it is difficult to identify whether a person has a serious problem or not. You don't want to have a cancer that is missed. Sometimes a matter of months or weeks can make a difference in whether a cancer spreads.

And with older people, there is the problem in making sure the older person is mentally and physically fit enough to follow through on treatments. Doctors try to look for signs of things like dementia or the lack of the physical strength to take care of yourself.

[JDPriestly]

11. I seriously doubt that doctors are hospitalizing people for no good reason.

Sometimes they need extra tests and put them in for the testing.

Medicine in hospitals is sometimes like detective work. I know this because I have a family member who works in a hospital. People come in with symptoms that fit a number of possible diagnoses and then the doctor has to figure out which diagnosis is correct.

I have an elderly friend who went into the hospital for an unsteady heart beat. He drove there himself. The emergency staff was horrified when they saw how unsteady his heart beat was and how high his blood pressure had gone. They were very worried. One of the technicians was called on the phone and told the caller "We've got a crash here." That means the person may be dying and may need resuscitation. The hospital kept him overnight for observation.

I have another elderly friend who went in the hospital for a small complication after heart surgery. While in the hospital he had a stroke. He is still there waiting to find a place in assisted living or a nursing home. He cannot take care of himself now.

Old people just get sick. They handle this well in Europe. Why can't we handle it well here?

[truedelphi]

16. I don't think this article is stating that hospital staff is admitting the elderly for no reason.

Rather, what the article is stating is how the patient that is admitted is categorized. If you have been "admitted" with a full diagnosis, then you are going to see MediCare handle the costs. But the cost breakdown to the patient ends up being significantly more if their status is "under observation."

And totally agree with you that things regarding all matters related to health are handled much better in Europe. But fraud and various power plays are affecting health care there too.

[Generic Other]

17. It is a license to rob seniors and their families

Because the hospitals are receiving bonuses from Medicare for cost savings. Not admitting patients except under observation means that after the third day, they charge the patient out of pocket. And if the patient is there for more than three days, they lose their eligibility for a short term stay at a skilled care facility. This is many 1000s of dollars we are talking about. And the hospitals are not upfront about it including letting people know the costs involved in advance.

I just dealt with these health care vultures a few months back.