New Bill Requires Hospitals to Explain Admission Status

Health and Aging News, November 9, 2015

After a hiatus, Health and Aging News is back— with continuing stories about aging and health that don’t usually make the front pages or color screens of  mass media.

Today’s blog continues coverage  from last time of the dilemma faced by Medicare patients who are treated in hospitals and mistakenly consider themselves “admitted,” when they are actually  ”under observation.”  As such, they are liable  for treatments and medications  received. Until now, hospitals have not been required to inform patients of their status.

Legislation to resolve that problem was passed this summer. Yet, more challenges remain. Read on…

by Joan Aragone

The move to inform Medicare patients of their status as hospital patients— a topic covered by this blog in February— has moved one step closer to solution. But the job isn’t over yet.

As a result of strenuous lobbying by advocates for older Americans, Congress has passed and President Obama signed into law earlier this year a bill that requires hospitals to inform Medicare patients within 36 hours whether they are on “admittance” or “observation” status.  The “Notice Act” will go into effect in 2016.

But related problems for Medicare patients remain.

Under current regulations, Medicare pays major costs of hospital bills only for patients who are “admitted” to a medical facility following Medicare guidelines. But patients classified as “under observation,” even if they stay overnight or longer,  are responsible for hospital bills and tests received.  Until the new bill becomes law,  most patients will continue to learn their status only when the bill arrives.  For those who find themselves classified as “under observation” when they thought they had been admitted, the shock and the costs can be devastating.

Understandably, advocates for seniors want more.

“This is a just piece of the problem, not the end,” said Toby Edelman, senior policy attorney at the Center for Medicare Advocacy in Washington, DC.  “All this bill does is tell people what they didn’t know before. It doesn’t really change things.”

Rules for Medicare coverage need to be broadened and expanded, advocates say. Legislation on that topic is expected in the new year.  The situation is especially dire for Medicare patients who seek admittance to a long-term care facility following hospitalization.

For extensive background and details of the problem,  see the following two articles. The first, by Susan Jaffe of Kaiser Health News, explains the history of the hospital “admittance” versus “observation” dilemma, especially for Medicare patients who seek admittance to a long-term care facility.  The second, by Andy Marso of Kansas Health Institute, focuses on the problems faced by  Medicare patients who need extended care in another facility.

1. Congress Overwhelmingly Approves Bill Bolstering Medicare Patients’ Hospital Rights

By Susan Jaffe July 29, 2015, Kaiser Health News

The U.S. Senate unanimously approved legislation Monday night requiring hospitals across the nation to tell Medicare patients when they receive observation care but have not been admitted to the hospital. It’s a distinction that’s easy to miss until patients are hit with big medical bills after a short stay.

The vote follows overwhelming approval in the U. S. House of Representatives in March. The legislation is expected to be signed into law by President Barack Obama, said its House sponsor, Texas Democratic Rep. Lloyd Doggett.

To finish the story, go to http://khn.org/news/congress-overwhelmingly-approves-bill-bolstering-medicare-patients-hospital-rights/  Or Google: “Susan Jaffe and Observation versus Admittance” July 29, 2015.  Kaiser Health News is a nonprofit national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

2. More Debate On Medicare ‘Observation Stays’ Ahead

By Andy Marso, Kansas Health Institute, August 4, 2015

A bill headed to President Barack Obama’s desk will require hospitals to notify Medicare patients if they were admitted or only kept under observation.

But advocates for hospitals and nursing homes say there’s more work to be done on Medicare regulations that tie patients’ hospitalization status to reimbursements for skilled nursing care afterward.

The bill that unanimously passed both houses of Congress mandates that hospitals must inform Medicare patients within 36 hours whether they were admitted or kept under observation.

That’s important because patients who are frail may be transferred to a skilled nursing facility for further recovery before they can return home. Medicare currently will only reimburse that skilled nursing care if the transfer came after three consecutive days of inpatient hospital admission. Days spent in the hospital under observation do not count.

To continue the story, go to http://www.khi.org/news/article/more-debate-on-medicare-observation-stays-ahead Or Google: “More Debate on Medicare Observation Stays Ahead,” KHI (Kansas Health Institute)

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Next  time, a look at the state of geriatric medicine in the United States, why you may have difficulty finding a doctor who understands, let alone specializes in,  the healthcare of older patients and what some patients are doing about it.

 

 

 

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