[Repost] Feds Refuse To Shut Down Controversial ‘Two-Midnight’ Rule For Hospitals

English: Bryce Hospital, Admission Unit (Photo credit: Wikipedia)

 

From the 3 October 2013 article at Forbes with Evan Albright, Contributor

 

The federal agency in charge of Medicare announced that for the next three months it will relax enforcement of its controversial “two-midnight rule,” but will not eliminate it per the desires of healthcare providers and now members of Congress.

Earlier this year the Centers for Medicare and Medicaid Services (CMS) announced a new standard for determining whether a patient is admitted to a hospital or there for observation, the two-midnight rule. Medicare patients must spend at least two continuous midnights in a hospital to be classified as inpatient, a status which comes with the highest reimbursement rates. Patients who spend less than two midnights will be automatically considered outpatient or under observation status.

As with any rule there will be exceptions:…

…

For patients, the advice we offered a few weeks ago still stands: If you are admitted to a hospital, ask and ask often about your status. For more information about how to manage hospital visits, download this pamphlet from the United Hospital Fund, “Hospital Admission: How to Plan and What to Expect During the Stay.” The section pertaining to inpatient versus observation status begins on page 9.***

 

 

 

***From page 9 of Hospital Admission: How to Plan and What to Expect During the Stay

 

Hospital Admission or Observation Status?

Just because your family member is in a hospital bed, on a hospital unit, eating hospital food, and undergoing hospital tests does not automatically mean that he or she has been admitted to a hospital. Sometimes doctors want to watch a patient for a few hours or a day to see whether there is really a need to be admitted to the hospital. This is called “observation.” More patients are now in hospitals being observed rather than admitted. This is largely because of Medicare’s efforts to reduce expensive hospital admissions and possible readmissions.

Does it matter if your family member is admitted to the hospital or is just being observed? Yes, because Medicare pays for hospital admissions and observation differently. As a result, your family member’s part of the bill is likely to be higher if he or she is only being observed than if he or she were actually admitted.

Admission vs. Observation

Hospital admissions are covered under Medicare Part A. Under Medicare Part A, after a one-time deductible fee, all hospital costs are covered when a person is admitted as an inpatient.

Observation status and emergency room care (without admission) are considered outpatient care, and are covered only by Medicare Part B. Medicare Part B treats each lab test, X-ray, and other service as individual items, each with a copay. Prescription drugs are not covered and may be a separate charge.

There’s more. To be eligible for Medicare-covered skilled nursing facility services, your family member must have been a hospital inpatient for at least three days. The observation days do not

The result? After 72 hours of observation, your family member will have a higher hospital bill and will not be eligible for Medicare- paid rehabilitation services in a skilled nursing facility. Note that these rules apply to regular (that is, fee-for-service) Medicare; if your family member belongs to a Medicare Advantage (HMO) plan, check with the plan for its requirements.

What can you do?

 In addition to all your other questions, ask repeatedly, “Has my family member been officially admitted to the hospital, or is he or she under observation status?” Your family member’s primary care doctor will probably not be involved in this decision.

 Make a note of each staff person’s response, including the name and date.

 The hospital can retroactively (after the fact) change the patient’s status from inpatient to outpatient. This change is supposed to be made while the patient is still in the hospital, with a written notification to the patient.

 If you do not receive this notification, or if you want to appeal the decision, you can contact your state Quality Improvement Office at http://www.qualitynet.org/dcs/ContentServer?c=Page&page name=QnetPublic%2FPage%2FQnetTier2&cid=11447678747 93

 

 

 

 

 

 

 

Read the entire article here

 

Related articles

• Medicare rules leave patients in limbo (jsonline.com)
• New rule addresses hospital stays (nwitimes.com)
• The New Two-Midnight Rule – Scrutiny Delayed for 90 Days (bswhealthlawblog.com)
• Feds Refuse To Shut Down Controversial ‘Two-Midnight’ Rule For Hospitals (forbes.com)
• When Is an Inpatient Not an Inpatient? CMS Adopts a 2-Midnight Standard (patsoshealthlawblog.com)
• Observation Stay Lawsuit Dismissed in Court, Leaving Many with Out of Pocket Costs (cmscompliancegroup.com)
• CMS is Serious: Two Midnights for Inpatient Medical Necessity (3mhealthinformation.wordpress.com)
• CMS Clarifies Payments with “Two Midnight Rule” for Hospital Admissions (cmscompliancegroup.com)
• CMS Open Door Forum Clarifies Hospital “Two Midnight Rule” for Inpatient Stays (cmscompliancegroup.com)
• Two Midnight Rule: An Introduction (hmsabc.wordpress.com)

 

[Reblog] Hospitalization Tips That Make a Difference: For Aging Parents, Grandparents, Our Children, and Us

From the 28 September 2013 post at Help! Aging Parents – Ideas, Information, and Support for Boomers and Adult Children – To Help Parents and Grandparents Age Well

 

     I recently learned that a friend who worked in the health professionsneeded surgery.  He recently turned 65, is medicare eligible, but elected to remain with his managed care plan. The hospital he selected was one he knew and liked, was near his home, and was approved by his plan.

     Surgery was successful, but was followed by an infection, then other complications. His family insisted he be moved to a larger, more comprehensive hospital for additional treatment. This took a lot of doing–was not easily accomplished.

     After well over a month and several weeks in the larger hospital, he is in rehab for physical therapy, but health issues remain and he’s very week. There’s conversation about his returning to the comprehensive hospital.

This sobering chain of events calls attention to:

1. a slogan
2. advice, gained from Dr.Susan Love’s (surgeon and prominent breast cancer prevention advocate) hospital experience about the importance of family.
3. information from Jon La Pook, MD (NewYork-Presbyterian/Columbia U. Medical Center and Chief Medical Correspondent for CBS News) about how to get optimal hospital care.

1. WHERE YOU’RE TREATED FIRST MAKES ALL THE DIFFERENCE. Memorial Sloan-Kettering Cancer Center’s slogan (goes back to the 1990s if not earlier).

2. The IMPORTANCE OF FAMILY MEMBERS WHILE HOSPITALIZED.  NY Times 2/19/13 Science Section interview, Susan Love’s Illness Gives New Focus to Her Cause. Dr. Love discusses the 4-week ordeal following her bone marrow transplant and the fact that family members “offered round the clock support,” advocated for her during that time “when she wasn’t very articulate,” and the fact that one family member “slept in the hospital every night.”

While the article initially focuses on Dr. Love’s reasons for devoting her efforts to the cause of disease rather than the medicines to treat it, we learn about the importance of family, which translates into good advice for all of us.

Likewise, Marti Weston shares a personal experience as she blogs about the importance of family in her 2/9/13 post  Elder in Hospital. Does a Family Member Need to be There, Too? The bottom line is “yes.”  Marti gives specifics about why and about certain things/actions family members can do/take (which includes sleeping at the hospital) to avert problems.

3. OPTIMAL HOSPITAL CARE. Dr. Jon La Pook’s TV interview on CBS (following  NY-Presbyterian/Columbia U Medical Center’s earning #7 Best Hospital honors in the latest US News Best Hospital’s edition) gives the excellent advice about how to get optimal hospital care these days.

For example, Dr. La Pook stresses the importance of communication between the patient’s regular doctor and the hospital’s doctor or the hospitalist, emphasizing it needs to be “a good hand-off” and likening it to the passing of the baton in a relay. You don’t want the baton dropped.

He opens our eyes to to basic, but critical, things like hand-washing “it could save your life;” tells you what to be on the lookout for; and introduces new terms ie. “electronic healthcare buddy.” Link to this enlightening interview: http://www.cbsnews.com/8301-204_162-57594022/u.s-news-and-world-report-releases-2013-best-hospitals-list/.

This information can benefit all generations, as we try to help parents age well.

Note-New: Check out “Of Current Interest”(right sidebar). Links to timely information and research from top universities about cancer, dementia, Parkinson’s, plus some fun stuff–to help parents age well.

 

Read entire article here

What is observation care? Clearing up common misperceptions

From the 4 February 2013 article at KevinMD.com

o treat observation care as simply a loophole that allows hospitals to avoid the Medicare penalties from readmissions — as Brad Wright, an assistant professor of health management and policy at the University of Iowa did earlier this month — is to take a short-sighted approach to a complex health issue.

 

Observation care in fact aims to address several of healthcare’s thorniest challenges head on. In the process, a well-run observation unit can not only help reduce hospital readmission rates, but it can reduce crowding and speed throughput in the ER, save patients an extended first hospital admission (let alone a re-admission), and perhaps most importantly, improve patient outcomes.

To see how, and to clear any misconceptions some like Wright could have about observation care, it might be helpful to do some Q&A.

…

 

Read the entire article here

Related articles

• Can Patient-Centered Care Reduce Hospital Readmissions? (healthblawg.typepad.com)
• The Relationship Between Discharging Patients From the Hospital Too Early and the Likelihood of a 30 Day Readmission: Treat, Street and Repeat. (diseasemanagementcareblog.blogspot.com)
• D. Brad Wright: Penalizing Hospitals for Re-admissions: Will It Work? (huffingtonpost.com)
• Positive nursing environments reduce readmissions (medicalstaffingnetwork.wordpress.com)

 

Top 10 musts for your hospital visit

From an August 2011 posting by MITCHELL BROOKS, MD  in KevinMD.com

 Whether you are going to the hospital for an outpatient procedure or whether you will be admitted to the hospital for medical illness or surgical procedure, there are certain things you must know and certain things you must do in order to ensure that your reasonable expectations will be met….

 

Read the article (with the list of 10) here