SMOKINCHOICES (and other musings)

February 6, 2014

OK M/C – now tricky

Retirees not protected, just the “providers”

 The stories of shock and disbelief are happening all too often.  Fortunately, many retirees are able to roll with these punches – financially; but most of us simply cannot.  And if we can’t pay up when the bills start coming in, imagine how much less we can afford to hire an attorney and take them with us to tell us what is really going on when we go near some hospital. 

What good are rules and those thousands of pages of descriptions all about?  It would seem — just there to confuse everyone so that no one knows what is really going on.  Well, actions always have and probably always will speak louder than words.  As we live through the changes happening all around us, its a pretty good bet that few like what they are seeing.  Even all of us – “in-the-way” elders who have somehow been able to rely on Medicare and our Social Security to meet our scaled down needs are finding our ‘choices’ so impinged that many do not know which way to turn.  Frankly, all this ‘lip-service’ given to trying to help everyone receive medical care regardless of ability to pay has shown us that it is only that – – lip-service.  Those who can manipulate with high priced legalese will win every time.  

The story which follows is sickening, just sickening.  Jan

Health care

Hospital inpatient, or under observation? It matters


Barbara Hedrick thought she was admitted to Ohio-Health Grant Medical Center when she had a pain pump implanted in her back to make her scoliosis more tolerable.

She wore a hospital gown and a hospital-issued bracelet. She was hooked up to an IV. And after the procedure in December 2012, she even spent the night at the hospital.

Only weeks later, when the hospital bill arrived at her house in Columbus, did Hedrick learn that staying at the hospital has become more complicated and, in some cases, more costly. One reason is that hospitals are under pressure from insurers to reduce costly short-term inpatient stays. And when patients aren’t admitted, they don’t count as readmissions if they return within 30 days. Medicare reduces hospitals’ payments if their readmission rates are too high.

Hedrick’s hospital stay wasn’t considered an admission. Grant considered her an outpatient.

  • Hedrick, 72, had expected to pay the hospital about $250 under the terms of her Medicare Advantage plan. Instead, her portion of the bill approached $3,400.

She said she wanted the hospital to explain why this occurred, but she gave up after a collection agency started calling.

“When you get a letter from a collection agency, that upsets you,” said Hedrick, who is paying off the bill in monthly installments.

Columbus-based hospital systems now place more than 100,000 local patients on observation status — or consider them “outpatients in a bed” — each year without admitting them, The Dispatch has found.

Patients who show up in emergency departments with ailments such as chest pain are considered observation cases.

Patients such as Hedrick who show up for scheduled procedures are placed in beds to see whether complications arise. If there are no complications, they are considered outpatients.

Officials of OhioHealth and other hospital systems say they strive to keep patients informed about their status, even though they face no legal requirement to do so.

Dr. Amy Imm, Ohio-Health’s vice president of quality and patient safety, said many patients who are placed in hospital beds assume they have been admitted.

“Five years ago, that meant you were an inpatient,” she said. “That’s not the case today.”

*              *              *

In some cases, observation status keeps patients in limbo for far too long, advocates say.

  • Of the 1.5 million observation stays involving Medicare patients in 2012, 11 percent were for at least three nights, according to a Department of Health and Human Services report released in July.
  • Medicare, meanwhile, is concerned about overpaying for short hospital stays that it believes should have been classified as outpatient stays.
  • In 2012, the average short inpatient stay cost Medicare $5,142, versus $1,741 for an observation stay. On average, beneficiaries also pay less for observation stays: $401, compared with $725 for short inpatient stays.
  • But observation stays create pitfalls for some Medicare enrollees. Those who are not classified as an inpatient for at least three days during a hospital stay do not qualify under Medicare for help in paying for nursing-home care they receive after leaving the hospital.

In 2012, Medicare enrollees had 617,702 hospital stays that lasted at least three nights but did not qualify for paid nursing-home care.

In December, Michael Rasicci’s 88-year-old mother was taken to an Akron-area hospital in extreme pain from a fractured vertebra and spent seven days in a Summit County hospital.

Only as she was leaving did her family learn that she hadn’t been classified as an inpatient, disqualifying her from Medicare-covered nursing-home care.

Rasicci, who lives near Chicago with his wife, Linda, expects the cost of that nursing-home stay to be thousands of dollars.

“I felt frustrated, angry and frightened … because of the possibility of having some astronomical bill to pay,” he said.

The nonprofit Center for Medicare Advocacy wants a rule requiring hospitals to notify patients if they have been placed under observation status. And it wants patients to have a chance to appeal their status while they’re still in the hospital, said Toby Edelman, a senior policy attorney at the center.

*               *               *

To address concerns about Medicare beneficiaries having long outpatient stays in a hospital, the federal government has been planning the rollout of a so-called two-midnight rule.

Under the rule, if a physician expects that a Medicare patient’s surgical procedure, diagnostic test or treatment will require a stay in the hospital lasting through two midnights, hospitals generally will be allowed to consider it an inpatient stay.

But the new rule, whose most-punitive aspects have been put off until this fall, doesn’t address barriers to paid nursing-home care for some Medicare patients.

U.S. Sen. Sherrod Brown, D-Ohio, is sponsoring legislation that would allow time that a patient spends under observation to count toward the three-day minimum hospital stay needed to qualify Medicare beneficiaries for nursing-home care.

Local hospital officials say there is no difference between inpatient and observation care, despite the fact that hospitals receive far less money for observation cases.

  • The ways in which hospital stays are categorized keep evolving, said Dr. Andrew Thomas, chief medical officer at Ohio State University’s Wexner Medical Center.

“Medicare thought they were doing us a favor with a two-midnight benchmark,” he said. “But getting this to work in the real world can be hard.”

If you’re in the hospital for more than a few hours, officials urge you to ask your doctor or the hospital staff whether you are an inpatient or an outpatient.


Leave a Comment »

No comments yet.

RSS feed for comments on this post.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

%d bloggers like this: